Sudden loss of vision

Question 1

What supplies the inner 2/3rd of the retina

Answer 1

central retinal artery

Question 2

What supplies the outer 1/3rd of the retina

Answer 2

choroid

Question 3

If there is CRAO, what will the patient present with

Answer 3

sudden profound vision loss

painless

Question 4

What will be seen when investigating CRAO

Answer 4

relative afferent pupillary defect test +ve (swing test)
pale oedematous retina
thread like vessels

Question 5

What are the causes of CRAO

Answer 5

carotid artery disease

emboli

Question 6

what is the treatment for CRAO

Answer 6

if presents within 24hrs - ocular massage

Question 7

What is the further management of a patient with CRAO

Answer 7

identify cause - carotid doppler

angio

Question 8

What is another name for transient CRAO

Answer 8

amaurosis fugax

Question 9

What will transient CRAO present with

Answer 9

transient sudden loss of vision
like a curtain
resolves within 5min

Question 10

What is the management for a patient with transient CRAO

Answer 10

urgent referral to stroke clinic

Question 11

CRVO will present as

Answer 11

sudden vision loss

mod-severe vision loss (6/9)

Question 12

What are the causes of CRVO

Answer 12

atherosclerosis
hypertension 
hyperviscosity 
(VIRCHOW'S TRIAD) 
IOP

Question 13

What would be seen on fundoscopy of someone with CRVO

Answer 13

haemorrhages
dilated tortuous veins
disc and macular swelling

Question 14

what is the treatment for CRVO

Answer 14

Anti-VEGF

address underlying factors

Question 15

What happens in ischaemic optic neuropathy

Answer 15

the posterior ciliary artery becomes occluded causing ischaemia and vision loss

Question 16

What are the 2 causes of ischaemic optic neuropathy

Answer 16

GCA (50%)

non-arteritic

Question 17

what is the investigation for GCA

Answer 17

temporal artery biopsy

Question 18

What is the treatment for GCA

Answer 18

immediate high dose steroids to prevent loss of vision in other eye

Question 19

Vitreous hameorrhage is caused by

Answer 19

retinal ischaemia that causes new abnormal blood vessel growth

Question 20

What is vitreous haemorrhage often seen in

Answer 20

CRVO

diabetic retinopathy

Question 21

What will a patient present with in vitreous haemorrhage

Answer 21

sudden loss of vision
floaters
painless

Question 22

What might be seen on ophthalmascopy of VH

Answer 22

loss of red reflex

haemorrhage

Question 23

What is the most likely diagnosis of someone with no new abnormal vessel growth and haemorrhage

Answer 23

retinal tear

Question 24

What is the treatment for vitreous haemorrhage

Answer 24

identify underlying cause

vitrectomy for those that don’t resolve

Question 25

What will someone with retinal detachment present with

Answer 25

painless sudden loss of vision | flashes and floaters

Question 26

Why do flashes and floaters occur in retinal detachment

Answer 26

due to the mechanical separation of the retinal from the sensory pigmented epithelium

Question 27

What will be seen on investigation of a patient with a retinal detachment

Answer 27

may have RAPD | detachment seen on fundoscopy

Question 28

What is the treatment for retinal detachment

Answer 28

surgical repair

Question 29

wet age related macular degeneration will present with

Answer 29

sudden loss of vision central vision loss distortion of vision (metamorphopsia)

Question 30

what is the most common cause of blindess in patients >65yrs

Answer 30

wet ARMD

Question 31

What is the cause of wet ARMD

Answer 31

unknown

Question 32

what causes an increased risk of getting wet ARMD

Answer 32

``` age smoking diabetes poor nutrition +ve FHx ```

Question 33

what is wet ARMD

Answer 33

new blood vessels grow from the choroid and leak causing a build up of fluid/blood and eventual scarring

Question 34

What will be seen on investigation of wet ARMD

Answer 34

haemorrhage | hard exudates

Question 35

What is the treatment for wet ARMD

Answer 35

Anti-VEGF

Question 36

How does closed angle glaucoma occur

Answer 36

increased pressure gradient causes the iris to bow forward causing obstruction of the canal of Schlemm and the trabecular meshwork - causes the aqueous humour to encounter increased resistance which leads to IOP

Question 37

what will someone with closed angle glaucoma present with

Answer 37

``` pain red eye sudden vision loss N&V headache ```

Question 38

What will be seen on investigation of the eye in closed angle glaucoma

Answer 38

corneal clouding (ischaemia) mild pupil dilatation circumcorneal injection

Question 39

what is the treatment for acute closed angle glaucoma

Answer 39

CA inhibitors/B blockers/ alpha 2 agrenergic agonists/ Parasympathomimetics/prostanoids - to decrease ocular pressure THEN - laser peripheral iridotomy