Sudden painless loss of vision

Question 1

What are the most common causes of sudden painless loss of vision?

Answer 1

• Ischaemic optic neuropathy (e.g. temporal arteritis or atherosclerosis)
• Occlusion of central retinal vein
• Occlusion of central retinal artery
• Vitreous haemorrhage
• Retinal detachment

Question 2

Give a brief description of Ischaemic optic neuropathy and who gets it.

Answer 2

May be due to arteritis (e.g. temporal arteritis) or atherosclerosis (e.g. hypertensive, diabetic older patient)

Due to occlusion of the short posterior ciliary arteries, causing damage to the optic nerve

Altitudinal field defects are seen

Question 3

Give a brief description of central retinal vein occlusion and who gets it.

Answer 3

Incidence increases with age, more common than arterial occlusion

Causes: glaucoma, polycythaemia, hypertension

Cheese pizza (severe retinal haemorrhoages) on fundoscopy.

Question 4

Give a brief description of central retinal vein occlusion and who gets it.

Answer 4

Due to thromboembolism (from atherosclerosis) or arteritis (e.g. temporal arteritis)

Examination: Afferent pupillary defect,

Fundoscopy -‘cherry red’ spot on a pale retina

Question 5

Give a brief description of the features vitreous haemorrhage and who gets it.

Answer 5

• Causes: diabetes, bleeding disorders
• Features may include:
  
  • Large bleeds lead to sudden visual loss.
  • Dark spots due to moderate bleeds
  • Floaters from small bleeds.

Question 6

Give a brief description of the features posterior vitreous detachment and who gets it.

Answer 6

Flashes of light (peripheral vision)

Floaters (temporal side of the central vision)

Then retinal attachment can occur.

Question 7

Give a brief description of the features retinal detachment and who gets it.

Answer 7

Dense shadow that starts peripherally progresses towards the central vision

A veil or curtain over the field of vision

Straight lines appear curved

Central visual loss