Sudden loss of vision Flashcards
What usually causes central retinal artery occlusion?
thrombo embolus - clot, tumour, infective
How does the retina appear in CRAO?
white w a cherry red spot at the macula
What is important to exclude in CRAO?
Temporal arteritis
What are the features of CRAO?
sudden PAINLESS loss of vision in one eye
RAPD
What is the rx of CRAO?
Increase retinal blood flow by reducing IOP by:
- ocular massage
- surgical removal of aqueous from anterior chamber
- antihypertensives
What is central retinal vein occlusion associated w?
Increased age arteriosclerosis HTN DM Polycythaemia Glaucoma
what is seen on fundoscopy in CRVO?
widespread haemorrhages
swollen disc
How does CRVO present?
sudden painless vision loss
What is anterior ischaemic optic neuropathy? (AION)
when the optic nerve is damaged due to blockage of posterior ciliary arteries by inflammation or atheroma
What is seen on fundoscopy in AION?
pale swollen optic disc
What is arteritic AION known as?
how does it present?
what tests would u do?
What is the rx?
- GCA
- malaise, jaw claudication +/- tender scalp and thickened temporal arteries w absent pulses
- ESR >47 + CRP >2.45
- Prednisolone 80mg/24hr PO promptly, give before result of temporal artery biopsy
What is vitreous haemorrhage?
bleeding into the vitreous humour of the eye
How does vitreous haemorrhage present>?
sudden onset of floaters or dark spots followed by diffuse vision loss
undergoes spontaneous resorption
What are causes of VH?
proliferative diabetic retinopathy
posterior vitreous detachment t
ocular trauma
What are the signs of VH
Decreased visual acuity
Visual field defect if severe
What is seen on fundoscopy in VH?
haemorrhage in the vitreous cavity
What investigations would u do for VH?
US - rules out retinal tear/detachment and useful if haemorrhage obscures the retina
FA - identifies neovascularisation
What are the causes of optic neuritis?
MS
DM
Syphilis
How does optic neuritis present?
- Unilateral decrease in visual acuity over hrs/days
- Poor discrimination of colours (red desaturation)
- Painful eye movements
- RAPD
- Central scotoma
What is the management of optic neuritis
high dose IV methylprednisolone (250mg/6hr) for 72hr then
prednisolone 1mg/kg/d for 11 days
What is seen on fundoscopy in optic neuritis?
normal optic disc
disc swelling - papillitis
What are the five questions to ask regarding sudden loss of vision? what does each question point to?
- Headache? -> GCA (do ESR urgently in all 50+yrs)
- Eye movements hurt? - optic neuritis
- Lights/flashes preceding visual loss? -> detached retina
- Like a curtain descending?
- Poorly controlled DM
How does retinal detachment present?
4 F's: Floaters Flashes Field loss Fall in acuity PAINLESS May be curtain falling over the vision
What is seen on ophthalmoscopy in retinal detachment?
grey opalescent retina ballooning forward
