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Ophthalmology > Sudden loss of vision > Flashcards

Sudden loss of vision Flashcards

1
Q

causes of sudden loss of vision

A

optic neuritis, retinal artery occlusion, anterior ischaemic optic neuropathy (GCA), vitreous haemorrhage, transient visual loss, retinal detachment, acute closed angle glaucoma, migraine

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2
Q

what is anterior ischaemic optic neuropathy

A

optic nerve is damaged. post ciliary arteries blocked by inflammation or atheroma

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3
Q

what is seen on fundoscopy AION

A

pale swollen optic disc

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4
Q

what is the cause of arteritic AION

A

GCA: other eye at risk until steroids given. malaise, jaw claudification, tender scalp, temporal arteries and neck pain

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5
Q

tests in GCA

A

high ESR, high CRP

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6
Q

treatment GCA

A

prednisolone 80mg /24h

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7
Q

associations non arteritic AION

A

incr bp, incr lipids, DM, smoking.

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8
Q

what is vitreous haemorrhage due to

A

retinal new vessels, retinal tears, retinal detachment, trauma

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9
Q

what are vitreous floaters

A

small extravasations of blood- small black dots or ring like forms

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10
Q

treatment vitreous haemorrhage

A

spontaneous- absorption. dense VH- vitrectomy

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11
Q

what happens in optic neuritis

A

unilateral loss of acuity over hours-days. colour vision affected- red desaturation. eye movements hurt.

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12
Q

what does the pupil show in optic neuritis

A

afferent defect- absent direct response but consensual response is present

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13
Q

disc appearance in optic neuritis

A

normal in 60%; swollen, blurred, hyperaemic, temporal pallor

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14
Q

what does temporal pallor suggest in optic neuritis

A

past attack of optic neuritis in the same eye

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15
Q

how long does recovery take optic neuritis

A

2-6 weeks. 45-80% develop MS.

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16
Q

causes optic neuritis

A

MS, syphilis, Lebers optic atrophy, diabetes, vitamin deficiency,

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17
Q

treatment optic neuritis

A

high dose methylprednisolone, then prednisolone

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18
Q

what should you think if the vision loss is transient

A

vascular cause

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19
Q

typical causes transient vision loss

A

vascular, TIA, migraine, MS, subacute glaucoma, papilloedema

20
Q

how soon is the visual loss in central retinal artery occlusion

A

within seconds of occlusion. afferent pupil defect within seconds

21
Q

appearance of retina in central retinal artery occlusion

A

white with cherry red spot at the macula

22
Q

what happens to acuity in central retinal artery occlusion

A

decreases

23
Q

what is the occlusion due to in central retinal artery occlusion

A

usually thromboembolic- signs of atherosclerosis, bruits, incr BP, heart disease, diabetes

24
Q

treatment central retinal artery occlusion

A

if seen within 6h aim is to increase retinal blood flow by reducing IOP- ocular massage, surgical removal aqueous from ant chamber or use of antihypertensives

25
Q

what happens if a single branch of the retinal artery is occluded

A

retinal and visual changes relate only to the part of retina supplied

26
Q

which is commoner- central retinal vein or artery occlusion

A

retinal vein

27
Q

associations central retinal vein occlusion

A

arteriosclerosis, incr BP, diabetes and polycythaemia, glaucoma (all types)

28
Q

which visual loss is more sudden retinal vein or artery

A

artery

29
Q

what is visual loss due to in central retinal vein occlusion

A

ischaemia and macular oedema

30
Q

what is central retinal vein occlusion divided into

A

non ischaemic- better acuity and prognosis, less dramatic signs; and ischaemic

31
Q

what is used to see degree of ischaemia central retinal vein occlusion

A

fundus fluorescin angiogram

32
Q

signs on fundoscopy central retinal vein occlusion ischaemic

A

cotton wool spots, swollen optic nerve, macular oedema, risk of neovascularisation)

33
Q

treatment central retinal vein occlusion

A

bevacizumab, lasers, dexamethasone intravitreal implants

34
Q

branch retinal vein occlusion signs

A

unilateral visual loss, fundal appearances in the corresponding area

35
Q

what does retinal ischaemia lead to

A

release VEGF (vascular endothelial growth factor) and retinal new vessel formation

36
Q

how to treat neovascularisation

A

laser photocoagulation

37
Q

how does the retinal vein occlusion look under fundoscopy

A

hyperaemia, haemorrhages- stormy sunset

38
Q

other causes sudden visual loss

A

retinal detachment, acute glaucoma, migraine

39
Q

is sudden bilat visual loss usual

A

no- suspect CMV retinitis in HIV patient

40
Q

what type of eyes are more prone to retinal detachment

A

myopic

41
Q

what happens in retinal detachment

A

holes/tears in retina allow fluid to separate sensory retina from retinal pigment epithelium

42
Q

what does retinal detachment present with

A

4 F’s- floaters, flashes, field loss, fall in acuity

43
Q

what can retinal detachment be due to

A

rhegmatogenous, 2ary to intraocular problem- melanoma, diabetes; after cataract surgery, trauma

44
Q

if there is a superior detachment where is the field loss

A

inferior

45
Q

treatment retinal detachment

A

vitrectomy and gas tamponade, scleral silicone implants

Ophthalmology (6 decks)

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