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Opthalmology > Painless Visual Loss > Flashcards

Painless Visual Loss Flashcards

1
Q

What are causes of painless loss of vision?

A
  • Cataract
  • Open angle glaucoma
  • Retinal detachment
  • Central retinal vein/artery occlusion
  • Diabetic reitnopathy
  • Vitreous haemorrhage
  • Posterior uveitis
  • Age-related macular degeneration
  • Optic nerve compression
  • Cerebral vascular disease
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2
Q

What are causes of painful loss of vision?

A
  • Acute closure glaucoma
  • GCA
  • Uveitis
  • Scleritis
  • Keratitis
  • Shingles
  • Orbital cellulitis
  • Trauma
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3
Q

What are acute causes of painless loss of vision?

A
  • Stroke/TIA
  • Retinal vessel occlusion (vein/artery)
  • Retinal/Vitreous haemorrhage
  • Retinal detachment
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4
Q

What are neurological causes of chronic painless loss of vision?

A

Compression from tumour

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5
Q

What are opthalmic causes of chronic/gradual painless loss of vision?

A
  • Corneal dystrophies
  • Cataracts
  • Glaucoma
  • Diabetic retin/maculopathy
  • Age related macular degeneration
  • Uveitis
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6
Q

What are sympotms of a central retinal artery occlusion?

A

Sudden loss of vision - within seconds –Finger counting or worse

Often described as a “curtain” descending over the vision, in one or both eyes.

Can be temporary - amaurosis fugax

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7
Q

What are signs of a central retinal artery occlusion?

A
  • May be decreased visual acuity - depends on whether the macula or its fibres are affected. Extent depends on area of retina affected.
  • RAPD
  • Oedematous and pale retina
  • Cherry red spots
  • Pale swollen optic nerve head - postrerior ciliary artery occlusion
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8
Q

What layers of the retina are supplied by retinal vessels

A

Inner two thirds of the neuroretina

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9
Q

What layers of the retina are supplied by the choroid?

A

Outer third of the retina

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10
Q

What are the two main arterial systems which can become occluded in central retinal artery occlusion?

A
  • Central or branch retinal arteries—occlusion leads to retinal infarction
  • Posterior ciliary arteries—occlusion leads to optic nerve head infarction (arteritic and non-arteritic anterior ischaemic optic neuropathy
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11
Q

What are risk factors for the development of Central Retinal Artery Occlusion?

A
  • Embolic disease - Increased BP, carotid disease, DM, Cholesterol, smoking
  • GCA
  • Severe retinal vasculitis
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12
Q

If someone presented with acute painless loss of vision, what questions might you specifically want to ask about?

A
  • Headache - GCA?
  • Eye movements painful - Optic neuritis?
  • Lights/flashes preceding loss - retinal detachement?
  • Poorly controlled DM - vitreous haemorrhage?
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13
Q

What investigations might you consider doing in someone presenting with central retinal artery occlusion?

A

ALWAYS EXCLUDE GCA

  • Bloods - FBC, ESR, CRP
  • Temporal artery biopsy
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14
Q

What are symptoms of central retinal vein occlusion?

A
  • Vague visual disturbance or of field loss
  • Decreased visual acuity - only if the occlusion affects the temporal vascular arcades and damages the macula.
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15
Q

What is the most common cause of Central retinal vein occlusion

A

Hypertension

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16
Q

What are signs of central retinal vein occlusion?

A
  • Decreased visual acuity - only if macula is damaged
  • Peripheral field loss - if a branch occlusion has occurred.
  • Flame haemorrhages in the affected areas
  • Swollen optic disc - if there is occlusion of the central vein
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17
Q

How would you manage a central retinal vein occluson?

A
  • Treat causes - Hypertension, DM, hyperviscosity syndromes, and chronic glaucoma
  • Consider Antiplatelet therapy
  • Anti-VEGF Therapy
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18
Q

What is posterior vitreous detachement?

A

A condition of the eye in which the vitreous membrane separates from the retina. It refers to the separation of the posterior hyaloid membrane from the retina anywhere posterior to the vitreous base (a 3–4 mm wide attachment to the ora serrata).

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19
Q

What are symptoms of posterior vitreous detachement?

A
  • Acute “floaters”
  • Flashing lights
20
Q

Why might somoene with posterior vitreous detachement experience flashing lights?

A

Suggests that there may be traction on the retina, which may result in a retinal hole and a subsequent retinal detachment.

21
Q

What signs might you see in someone with psoterior vitreous detachement?

A
  • Normal visual acuity
  • No loss of visual field.
22
Q

How would you manage posterior vitreous haemorrhage?

A

Urgent (same day) ophthalmic assessment, so that any retinal breaks or detachment can be identified and treated at an early stage.

23
Q

What are risk factors for central retinal vein occlusion?

A
  • Age
  • HTN
  • Glaucoma
  • DM
24
Q

What imaging modality could you use to visualise the layers of the retina?

A

Optical Coherence Tomography

25
Q

What is viterous haemorrhage?

A

Extravasation, or leakage, of blood into the areas in and around the vitreoushumor of the eye

26
Q

What are causes of vitreous haemorrhage?

A
  • New retinal vessels - e.g. in diabetic retinopathy
  • Retinal tears
  • Retinal detachement
  • Trauma
27
Q

What are symptoms of vitreous haemorrhage?

A
  • Sudden onset of floaters, or “blobs,” in the vision
  • Reduced visual acuity - if large haemorrhage
  • Flashing lights - retinal traction
28
Q

What are signs of viterous haemorrhage?

A
  • Decreased visual acuity - if large
  • Reduced red reflex
  • Clots of blood that move with the vitreous.
29
Q

How would you manage vitreous haemorrhage?

A

Refer to opthalmology to exclude retinal detachment

  • Spontaneous reabsorbtion - small haemorrhages
  • Vitrectomy - dense haemorrhage
  • Photocoagulation Laser therapy - occludes neovascular membranes
30
Q

What is optic neuritis?

A

A demyelinating inflammation of the optic nerve. It is also known as optic papillitis (when the head of the optic nerve is involved) and retrobulbar neuritis (when the posterior part of the nerve is involved)

31
Q

What are causes of optic neuritis?

A
  • Idiopathic
  • MS
  • SLE
  • Sarcoidosis
  • Sjogren’s syndrome
  • Behcets disease
  • Syphillis
  • Vitamin deficiency
  • Diabetes
32
Q

What are the symptoms of optic neuritis?

A

Usually a woman, aged 20-40

  • Disturbance of vision of one eye - scotoma, floaters
  • Pain that worsens on eye movement
33
Q

What are signs of optic neuritis?

A
  • Altered visual acuity - may range from 6/6 to PL
  • RAPD
  • Lack of red reflex/retina obsured - large haemorrhage
  • Red desaturation
  • Central scotoma
  • Swollen optic disc - if inflamamtion anterior
34
Q

How would you manage optic neuritis?

A

Most recover spontaenously

  • Systemic steroids - hastens recovery, but does not improve acuity
    • ​Methylprednisolone
    • Prednisolone
35
Q

What is retinal detachment?

A

An acute or progressive condition in which the neuroretina separates from the retinal pigment epithelium with accumulation of sub-retinal fluid and loss of retinal function.

36
Q

What are signs of a branch retinal vein occlusion?

A
  • Unlilateral visual loss
  • Retinal haemorrhage following occluded vein path
37
Q

What are common risk factors for development of retinal detachment?

A
  • Myopia
  • Trauma
  • Family history
  • Cataract surgery
  • Intraocular tumours/inflammation
  • Viteral degeneration
38
Q

What type of eye problem can increase the risk of retinal detachment during cataract surgery?

A

Myopia

39
Q

What are symptoms of retinal detachment?

A
  • Sudden onset floaters - pigment or blood in the vitreous
  • Flashing lights - traction on retina
40
Q

What are the 4 f’s of the presentation of retinal detachement in a patient?

A
  • Flaoters
  • Flashes
  • Field loss
  • Fall in acuity
41
Q

What are signs of retinal detachement?

A
  • Reduced Visual acuity - reduced to CF or HM if macula is detached
  • Field loss - dependent on the size and location of the detachment
  • Grey, opalescent detached retinal folds - larger detachments
42
Q

How would you manage someone with retinal detachement?

A

Urgent referral to opthalmology

  • Cryotherapy
  • Vitrectomy and Gas Tamponade
  • Laser therapy
  • Surgery
43
Q

What are typical causes of amaurosis fugax?

A
  • Vascular - emboli from plaques or carotid arteries
  • TIA
  • Migraine
  • MS
  • Subacute glaucoma
  • Papilloedema
44
Q

How would you distinguish a central retinal artery occlusion from a branched retinal artery occlusion on history/examination?

A

Visual loss

  • CRAO - total visual loss in one eye
  • BRAO - Scotoma

RAPD

  • CRAO - Present
  • BRAO - Absent
45
Q

What might you find on general examination of someone with branched retinal vein occlusion?

A

Largely normal, except on fundoscopy and visual acuity testing

Opthalmology (12 decks)

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