Painless loss of vision

Question 1

What things can cause acute loss of vision?

Answer 1

Vascular events

• Systemic - stroke/TIA
• Eye - retinal vessel occlusion, ischaemic optic neuropathy

Retinal + vitreous

• Haemorrhage
• Retinal detachment

Question 2

What things can cause chronic loss of vision?

Answer 2

Neurological

• Tumours compressing along optic n pathway

Ophthalmic

• Corneal dystrophies
• Cataract
• Glaucoma
• Diabetic retinopathy/maculopathy
• ARMD
• Uveitis

Question 3

How does amaurosis fugax/TIA present?

Answer 3

Transient loss of vision, usually recovers within 1h

Question 4

How should you assess someone with amaurosis fugax?

Answer 4

Assess CV risk factors, BP

Fundoscopy - check for retinal emboli

Asculutate for carotid bruits/heart murmurs

Question 5

What tends to cause central retinal artery occlusion?

Answer 5

Usually embolic from carotids/heart

Rarely inflammatory, e.g. GCA, severe retinal vasculitis

Question 6

What are the two types of anterior ischaemic optic neuropathy?

Answer 6

Arteritic and non-arteritic cause

Question 7

What are the symptoms of AION?

Answer 7

Rapid onset blurred vision
Classically altitudinal

Question 8

What are RFs for AION?

Answer 8

CV risk factors

Question 9

What must you exclude as a cause of AION?

Answer 9

GCA (unilateral headache, jaw claudication, ESR, CRP, FBC)

Use temporal artery biopsy

Question 10

What are risk factors for central retinal vein occlusion?

Answer 10

Age, HTN, glaucoma, DM

Question 11

What are common causes of vitreous haemorrhage?

Answer 11

Proliferative DR

Retinal tears

Disciform macular degeneration

Question 12

What are common risk factors for retinal detachment?

Answer 12

Myopia

Trauma

Family history
Cataract surgery

Question 13

What are rarer causes for retinal detachment?

Answer 13

Intraocular tumours

Intraocular inflammation

Vitreal degeneration

Question 14

What are common causes of cataracts?

Answer 14

Advanced age

Smoking

Ocular trauma

Prev. intraocular surgery
Congenital

Assoc with systemic dontions

Question 15

What are symptoms of cataracts?

Answer 15

Reduced visual acuity - hazy, foggy, cloudy

Glare

Myopic shift (becoming more short sighted)

Monocular diplopia

Question 16

How are cataracts managed?

Answer 16

Phacoemulsification + intraocular lens implantation

Question 17

What generally causes this pattern of visual loss?

Answer 17

Open angle glaucoma

Question 18

What is the visual loss like in ARMD?

Answer 18

Painless progressive loss of central vision

Metamorphopsia (distortion) + scotoma

Question 19

What are risk factors for ARMD?

Answer 19

Age

Smoking
Poor diet and lack of greens

Question 20

What does dry ARMD look like on fundoscopy?

Answer 20

Drunsen deposits

Areas of atrophy

Question 21

Answer 21

Drusen

Question 22

What occurs in wet ARMD?

Answer 22

Choroidal neovascular membrane leaks fluid/blood in or under retina detaching photoreceptors

Question 23

How is dry ARMD managed?

Answer 23

Specific multivitamins

Supportive measures

Question 24

How is wet ARMD managed?

Answer 24

Intra-vitreal anti-VEGF

Question 25

What are risk factors for diabetic retinopathy?

Answer 25

Duration of diabetes Poor metabolic control Pregnancy

Question 26

What are signs of diabetic retinopathy?

Answer 26

Microaneurysms, retinal haemorrhages, exudates, macular oedema, cotton wool spots, intraretinal microvascular abnormality, abnormal new vessel growth

Question 27

Answer 27

Cotton wool spots

Question 28

What is the classification of diabetic retinopathy/

Answer 28

Background diabetic retinopathy - dot and blot haemorrhages Pre-proliferative - cotton wool spots, IRMA Proliferative - new vessels, tractional RD Diabetic macular oedema - exudates, haemorrhage, retinal thickening

Question 29

Answer 29

Non-proliferative diabetic retinopathy

Question 30

How do you manage diabetic retinopathy?

Answer 30

Control blood sugar, BP, cholesterol Laser Surgery in severe cases Intravitreal anti-VEGF, steroid

Question 31

Answer 31

Diabetic maculopathy Top left: early Bottom left: focal Top right: diffuse Bottom right: macular grid

Question 32

Answer 32

Hypertensive retinopathy Far right is malignant hypertension

Question 33

What signs do you see in thyroid eye disease?

Answer 33

Lid retraction, proptosis, corneal exposure, reduced ocular movement, diplopia, optic nerve compression

Question 34

What are the types of uveitis?

Answer 34

Anterior Intermediate - vitreous and ciliary body Posterior - retina: retinitis; choroid: choroiditis; BVs: vasculitis Panuveitis

Question 35

What are causes of uveitis?

Answer 35

Idiopathic Systemic dx - sarcoidosis, Wegner's, AS, Behcets, SLE Infection - TB, syphillis, toxoplasmosis, HSV, Lyme, CMV Masquerade - intraocular lymphoma, leukaemia

Question 36

How is uveitis treated?

Answer 36

If infective - find agent, treat accordingly Idiopathic/assoc. w. systemic dx - anti-inflammatories + immunosupression

Question 37

What are some anterior segment sequelae of anterior uveitis?

Answer 37