Sudden loss of vision

Question 1

What usually causes central retinal artery occlusion?

Answer 1

thrombo embolus - clot, tumour, infective

Question 2

How does the retina appear in CRAO?

Answer 2

white w a cherry red spot at the macula

Question 3

What is important to exclude in CRAO?

Answer 3

Temporal arteritis

Question 4

What are the features of CRAO?

Answer 4

sudden PAINLESS loss of vision in one eye

RAPD

Question 5

What is the rx of CRAO?

Answer 5

Increase retinal blood flow by reducing IOP by:

• ocular massage
• surgical removal of aqueous from anterior chamber
• antihypertensives

Question 6

What is central retinal vein occlusion associated w?

Answer 6

Increased age 
arteriosclerosis
HTN
DM
Polycythaemia
Glaucoma

Question 7

what is seen on fundoscopy in CRVO?

Answer 7

widespread haemorrhages

swollen disc

Question 8

How does CRVO present?

Answer 8

sudden painless vision loss

Question 9

What is anterior ischaemic optic neuropathy? (AION)

Answer 9

when the optic nerve is damaged due to blockage of posterior ciliary arteries by inflammation or atheroma

Question 10

What is seen on fundoscopy in AION?

Answer 10

pale swollen optic disc

Question 11

What is arteritic AION known as?
how does it present?
what tests would u do?
What is the rx?

Answer 11

1. GCA
2. malaise, jaw claudication +/- tender scalp and thickened temporal arteries w absent pulses
3. ESR >47 + CRP >2.45
4. Prednisolone 80mg/24hr PO promptly, give before result of temporal artery biopsy

Question 12

What is vitreous haemorrhage?

Answer 12

bleeding into the vitreous humour of the eye

Question 13

How does vitreous haemorrhage present>?

Answer 13

sudden onset of floaters or dark spots followed by diffuse vision loss
undergoes spontaneous resorption

Question 14

What are causes of VH?

Answer 14

proliferative diabetic retinopathy
posterior vitreous detachment t
ocular trauma

Question 15

What are the signs of VH

Answer 15

Decreased visual acuity

Visual field defect if severe

Question 16

What is seen on fundoscopy in VH?

Answer 16

haemorrhage in the vitreous cavity

Question 17

What investigations would u do for VH?

Answer 17

US - rules out retinal tear/detachment and useful if haemorrhage obscures the retina
FA - identifies neovascularisation

Question 18

What are the causes of optic neuritis?

Answer 18

MS
DM
Syphilis

Question 19

How does optic neuritis present?

Answer 19

• Unilateral decrease in visual acuity over hrs/days
• Poor discrimination of colours (red desaturation)
• Painful eye movements
• RAPD
• Central scotoma

Question 20

What is the management of optic neuritis

Answer 20

high dose IV methylprednisolone (250mg/6hr) for 72hr then

prednisolone 1mg/kg/d for 11 days

Question 21

What is seen on fundoscopy in optic neuritis?

Answer 21

normal optic disc

disc swelling - papillitis

Question 22

What are the five questions to ask regarding sudden loss of vision? what does each question point to?

Answer 22

1. Headache? -> GCA (do ESR urgently in all 50+yrs)
2. Eye movements hurt? - optic neuritis
3. Lights/flashes preceding visual loss? -> detached retina
4. Like a curtain descending?
5. Poorly controlled DM

Question 23

How does retinal detachment present?

Answer 23

4 F's:
Floaters
Flashes
Field loss
Fall in acuity 
PAINLESS 
May be curtain falling over the vision

Question 24

What is seen on ophthalmoscopy in retinal detachment?

Answer 24

grey opalescent retina ballooning forward

Question 25

What happens if the macular detaches in retinal detachment?

Answer 25

central vision is lost

Question 26

What is rx of retinal detachment?

Answer 26

SURGERY - vitrectomy

Question 27

what is amaurosis fugax

Answer 27

transient and painless loss of vision in one eye

Question 28

What are causes of amaurosis fugax?

Answer 28

transient retinal ischaemia
occlusive arterial disease (atherosclerosis of internal carotid)
reduced perfusion pressure
increased resistance to retinal perfusion - malignant HTN, migraine, increase blood viscosity