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Cognition, movement and senses > Sudden loss of vision > Flashcards

Sudden loss of vision Flashcards

1
Q

What is non-arteritic ischaemic optic neuropathy?

A

Ischaemia and infarction of the optic nerve head not caused by arterial inflammation
e.g. by occlusion of the short posterior ciliary arteries

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2
Q

Symptoms of non-AION:

A

Painless monocular sudden loss of vision

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3
Q

Signs of non-AION:

A

Moderate-severe decrease in VA (6/12 to 6/60)
Swollen optic nerve with splinter/flame haemorrhages
RAPD
VFD corresponding to area of disc swelling (most commonly inferior altitudinal defects)

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4
Q

Pale disc indicates…

A

Loss of neural tissue

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5
Q

What happens in GCA?

A

Vasculitis of medium and large arteries causes AION

Treat with high dose systemic steroids

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6
Q

Main differential for GCA?

A

Pain and raised ESR and CRP
Non-pulsatile tender temporal arteries
Scalp tenderness

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7
Q

Symptoms of GCA?

A

Sudden painful severe monocular vision loss (transient episodes before) can spread to other eye in hours
Headaches and scalp tenderness
Loss of appetite and weight loss

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8
Q

Signs of GCA:

A

Non-pulsatile tender temporal arteries
Swollen optic disc and RAPD
Flame haemorrhages and cotton wool spots indicating retinal nerve fibre layer infarction

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9
Q

What do flame haemorrhages and cotton wool spots indicate?

A

Retinal nerve fibre layer infarction

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10
Q

What is retinal migraine?

A

Vasospasm of the retinal artery causing occlusion

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11
Q

Central retinal artery occlusion causes?

A

Loss of central and peripheral vision
Cherry red spot at macula
RAPD

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12
Q

Branch retinal artery occlusion causes:

A

Result ranges from small asymptomatic peripheral scotoma to loss of VA if involves area supplying fovea
Can cause RAPD if large enough occlusion

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13
Q

Symptoms of retinal artery occlusion:

A

Sudden painless unilateral profound loss of vision

May be preceded by amaurosis fugax

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14
Q

What is amaurosis fugax?

A

Painless transient loss of vision

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15
Q

What do cotton wool spots indicate?

A

Infarcts of the nerve fibre layer

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16
Q

Result of retinal vein occlusion?

A

Retinal/macula oedema
Reduction in VA
CRVO = haemorrhage throughout the fundus
Retinal haemorrhage and cotton wool spots

17
Q

Later features of retinal vein occlusion

A 
Optic disc collateral vessels
Pathological vessels grow from the optic disc into the vitreous cavity causing vitreous haemorrhage
Rubeotic glaucoma (new vessels on iris block outflow)
18
Q

Which test reveals macula oedema?

A

Optical coherence tomography

19
Q

What use is a fluorescein angiogram in retinal vein occlusion?

A

View retinal/optic disc neovascularisation and macular oedema
Can classify disease as ischaemic or non-ischaemic

20
Q

How to manage retinal vein occlusion:

A

Intravitreal steroid injections for macular oedema
Anti-VEGF drugs e.g. ranbizumab and aflibercept
Macular laser to leaking areas from BRVO
PRP laser ablates peripheral retina to reduce O2 demand and reduce VEGF (treats robotic glaucoma)

21
Q

Risk factors for AACG:

A 
Hypermetropia
Narrow anterior chamber angle
Age > 30
Asian/Inuit
Women
22
Q

Symptoms of AACG:

A

Unilateral red painful eye with vision loss. (6/36 or worse)
Halos around lights
N+V and headache
Can be asymp with previous intermittent symptoms

23
Q

Signs of AACG:

A 
Decreased VA
Corneal oedema
Raised IOP
Oval, unreactive pupil
Hypermetropia
24
Q

Treatment of AACG to lower IOP:

A

Systemic: acetazolamib 500 mg IV stat
Eye drops: timolol 0.5%, apraclonidine 1%
Laser: YAG peripheral iridotomy (bypass pupil block)

25
Q

Pathology of AACG:

A

Failure of aqueous humour to drain out through pupil and trab meshwork
e.g. due to pupil-block or iris being pushed forward onto trab meshwork

26
Q

What are the two layers of the retina?

A

Neurosensory

Retinal pigment epithelium

27
Q

What is a rhegma?

A

Retinal tear (caused by posterior vitreous detachment)

28
Q

What is a rhegmatogenous retinal detachment?

A

Vitreous fluid passes through the tear, separating the two layers

29
Q

Symptoms of retinal detachment?

A

Mainly loss in VF, if macula is lost then also a loss in VA
Floaters
Peripheral photophobia (flashing lights)

30
Q

Exams with retinal detachment:

A

Dilate with phenylephrine 2.5% and tropiccamide 1% drops (avoid if previous AACG)
Measure VA and check for RAPD (present if big enough)
Check peripheries and other eye

31
Q

Surgery for retinal detachment:

A

Cryobuckle surgery
Pars plana vitrectomy
(treat. before macula detaches

Cognition, movement and senses (20 decks)

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