Sudden Painless Vision Loss: Amaurosis Fugax, Central Retinal Vein Occlusion, Central Retinal Artery Occlusion, Vitreous Hemorrhage, Retinal Detachment ☺️

Question 1

Amaurosis fugax

• causes
• presentation
• management

Answer 1

Many causes - thromboembolic disease, vasculitis, TIA

Curtain coming down
Transient visual loss

Aspirin 300mg

Question 2

Central retinal vein occlusion vs central retinal artery occlusion

• causes
• fundoscopy findings
• management

Answer 2

Both are painless, sudden loss, unilateral

Vein - more common
-glaucoma, polycythemia, HTN, diabetes => macula edema
Fundoscopy - retinal hemorrhage

Artery
-thromboembolism, temporal arteritis
Fundoscopy - cherry red spot

No cure for either

• optimise risk factors
• CVO - antiVEGF may help

Question 3

Vitreous hemorrhage

• causes
• presentation
• management

Answer 3

Diabetes, bleeding disorders/AC
-bleeds from abnormal blood vessels in diabetic retinopathy/vitreous detachment/trauma

Small bleed => floaters
Moderate bleed => dark spots
Large bleeds => visual loss

Slit lamp

Management depends on cause

• waiting is most common
• laser treatment - stop bleed, repair retinal tears
• antiVEGF - shrink abnormal vessels

Question 4

Posterior vitreous detachment and retinal detachment

• describe the relationship between them
• presentation of both
• management of RD

Answer 4

Posterior vitreous detachment may precede retinal detachment

PVD

• flashes - vitreous pulling on retina stimulates cells
• floaters

RD
4 Fs
-floaters, flashes => field loss, fall in acuity

Surgical management

• vitrectomy - replace vitreous
• scleral buckle/pneumatic retinopexy - push retina and wall close
• cryotherapy - seal retinal hole

Question 5

AION

• types and pathophysiology
• presentation
• investigations
• management

Answer 5

Ischemia of optic nerve => vision loss
Arteritic AION - inflammation of arteries
Non arteritis AION - non inflammatory disease of small vessels

AAION - temporal arteritis symptoms precede visual loss
-temple, scalp pain
-pain eating
-fatigue, systemically unwell
Lead to
-painless visual loss => permanent within hours
MUST BIOPSY TEMPORAL ARTERY TO CONFIRM => CS

NAION - CV risk factors
-sudden vision loss from waking up
Manage risk factors to prevent further loss