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Ophthalmology > Sudden Loss of Vision > Flashcards

Sudden Loss of Vision Flashcards

1
Q

Things to refer on the same day

A
  • CRAO (less than 4 hrs history)
  • ischaemic optic neuropathy
  • retinal detachment less than 1 week Hx
  • optic neuritis
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2
Q

Things to refer within days

A
  • vein occlusion
  • artery occlusion of duration longer than 6 hrs
  • sudden deterioration of ARMD
  • retinal detachment longer than 1 week
  • vitreous haemorrhage
  • tumours
  • choroiditis, ritinitis
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3
Q

Things to refer to physician, neurologist or stroke unit

A
  • homonymous hemianopia
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4
Q

Characteristics of central retinal artery occlusion

A
  • pale infarcted retina
  • non-perfused arteries partly obscured by retinal oedema
  • cherry red spot at the macula
  • VA is CF or worse
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5
Q

Central retinal artery occlusion may be:

A
  • embolic
  • thrombotic
  • arteritic (GCA)
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6
Q

Characteristics of central retinal vein occlusion

A
  • dilated tortuous veins
  • cotton wool spots
  • haemorrhages
  • VA 6/18-CF
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7
Q

Causes of vein occlusion

A
  • poorly controlled BP
  • diabetes
  • hypercoagulable states (incl malignancy)
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8
Q

Complications of vascular occlusion in the eye

A
  • neovasculatisation of the disc, retina and iris
  • vitreous haemorrhage
  • neovascular glaucoma
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9
Q

Non-schaemic causes of vitreous haemorrhage

A
  • bleeding disorders
  • tumours
  • retinal detachment
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10
Q

Important cause of ischaemiic optic neuropathy

A

Giant cell arteritis

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11
Q

Other symptoms of giant cell arteritis

A
  • malaise
  • myalgia
  • jaw claudication
  • weight loss
  • scalp tenderness
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12
Q

Treatment of GCA

A
  • prednisone (1mg/kg)

- needs temporal artery biopsy within 10 days

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13
Q

What is an altitudinal field defect?

A
  • either the upper or lower half of visual field is selectively affected
  • often creates vertical line across visual field
  • often associated with ischamic optic neuropathy
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14
Q

Symptoms of ARMD

A
  • slow loss of vision from scarring round drusen
  • sudden loss of vision from bleeding
  • metamorphopsia
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15
Q

Symptoms of retinal detachment

A
  • flashing lights
  • floaters
  • grey curtain from periphery
  • loss of vision
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16
Q

Different types of floaters

A
  • muscae volitantes: in posterior vitreous detachment

- showers of dots in vitreous haemorrhage

17
Q

DD of flashing lights

A
  • scintillating scotomata

- fortification spectrum of migraine

18
Q

DD of curtain coming down

A

Amaurosis fugax

19
Q

Characteristics of choroidal metastasis

A
  • vision usually normal or distorted until a secondary exudative retinal detachment suddenly detaches the macula
20
Q

Characteristics of choroidal malignant melanoma

A
  • flashing lights or visual loss
  • sudden visual loss when fluid exudate or solid tumour detach the fovea
  • appears solid elevated lesion with greyish pigmentation
21
Q

Characteristics of active toxoplasmosis

A
  • old scar surrounded by sheathed vessels and vitreous haze
  • poor red reflex
  • refer for bactrim, oral steroids and eye monitoring
22
Q

Signs and symptoms of CRAO

A
  • VA is CF or worse
  • afferent puil defect
  • pale, infarcted retina
  • non-perfused, thread-like arteries, partly obscured by retinal oedema
  • cherry red spot at macula
23
Q

Management of CRAO

A
  • if appropriate, need age-appropriate stroke work-up
  • within 4 hrs:
  • digital massage of the globe and oral acetazolomide
  • get patient to breathe into a paper bag (vasodilation)
24
Q

Pathogenesis of ischaemic optic neuropathy

A
  • occlusion of the short posterior ciliary artery
25
Q

Flashing lights

A

Photopsia

26
Q

Pathogenesis of optic neuritis

A
  • demyelination
  • infective
  • immune
  • infiltrative
27
Q

Causes of optic neuritis

A
  • multiple sclerosis
  • syphilis
  • idiopathic
  • HIV
  • sarcoidosis
28
Q

Signs and symptoms of optic neuritis

A
  • loss of vision
  • central scotoma
  • afferent pupil defect
  • loss of colour vision
  • optic disc may be swollen
29
Q

Causes of retinitis and choroiditis

A
  • TB
  • syphilis
  • CMV
  • toxoplasmosis

Ophthalmology (10 decks)

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