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Ophthalmology > Sudden vision loss > Flashcards

Sudden vision loss Flashcards

1
Q

What are some causes of sudden vision loss?

A

Retinal artery/vein occlusion
Wet ARMD
Vitreous haemorrhage
Retinal detachment
Closed-angle glaucoma
*Sympathetic ophthalmia

Think ABC:

A - Age-related macular degeneration

B - Bleed or Blockage

C - Closed-angle glaucoma

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2
Q

What is the main artery that supplies the eye?

A

Ophthalmic artery

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3
Q

What branch of the ophthalmic artery supplies the inner 2/3rds of the retina?

A

Central retinal artery

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4
Q

What branch of the ophthalmic artery supplies the outer 1/3rd of the retina?

A

Posterior ciliary arteries

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5
Q

What are the 3 main forms of retinal artery occlusion?

A
  • Central retinal artery occlusions (CRAO)
  • Branch retinal artery occlusion
  • Amaurosis fugax
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6
Q

What is a central retinal artery occlusion?

A

Occlusion of the central retinal artery, with resultant infarction of the inner 2/3 of the retina (outer 1/3 is supplied by choroid) and vision loss

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7
Q

What usually causes central retinal artery occlusion?

A

Arteriosclerosis-related thrombosis
Giant cel arteritis

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8
Q

What are some risk factors for developing central retinal artery occlusion?

A
  • Older age
  • Hypertension
  • Diabetes
  • Smoking
  • Obesity
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9
Q

What are some symptoms of central retinal artery occlusion?

A
  • Sudden, profound vision loss
  • Painless
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10
Q

What is a sign of central retinal artery occlusion?

A

RAPD (Relative afferent pupil defect)

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11
Q

What will fundoscopy show in central retinal artery occlusion?

A
  • Pale oedematous retina
  • Thread-like retinal vessels
  • Cherry red spot
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12
Q

What causes the cherry red spot on fundoscopy in central retinal artery occlusion?

A

Nerve fibre layer becomes opaque due to oedema, however, no nerve fibre layer at the fovea means that its normal reddish colour is seen against the retinal pallor

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13
Q

What is shown?

A

Central retinal artery occlusion

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14
Q

How should central retinal artery occlusion be managed?

A

Immediate referral to stroke clinic

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15
Q

What is a branch retinal artery occlusion?

A

Occlusion of one of the branches of the central retinal artery

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16
Q

How will branch retinal artery occlusion present?

A
  • Acute onset of painless, monocular visual impairment
  • The severity of visual loss depends upon the area of retinal tissue affected by the vascular occlusion
17
Q

What will fundoscopy show in branch retinal artery occlusion?

A

Absence of perfusion in the affected artery

18
Q

What is shown?

A

Branch retinal artery occlusion

19
Q

How is branch retinal artery occlusion managed?

A

Refer to stroke clinic

20
Q

What is amaurosis fugax?

A

Transient central retinal artery occlusion

21
Q

What are some symptoms of amaurosis fugax?

A
  • Transient painless visual loss
  • Like a curtain coming down
  • Lasts around 5 minutes and then recovers
22
Q

How will amaurosis fugax show on fundoscopy?

A

Usually no signs of abnormality

23
Q

How is amaurosis fugax managed?

A

Refer to stroke clinic

24
Q

What are the 2 main types of retinal vein occlusion?

A

Central
Branch

25
Q

How does central retinal vein occlusion occur?

A

Occurs when a thrombus forms in the retinal veins and blocks the drainage of blood from the retina

26
Q

How does branch retinal vein occlusion occur?

A

Venous occlusion at any branch of the central retinal vein resulting in visual problems in the area drained by that branch

27
Q

How does occlusion of a retinal vein cause problems?

A
  • Blockage of a retinal vein causes pooling of blood in the retina, resulting in leakage of fluid and blood causing macular oedema and retinal haemorrhages
  • This results in damage to the tissue in the retina and loss of vision
  • It also leads to the release of VEGF, which stimulates the development of new blood vessels (neovascularisation)
28
Q

How does retinal vein occlusion present?

A
  • Sudden painless loss of vision
  • Branch retinal vein occlusion may result in visual field defects corresponding to affected branch
29
Q

What will be shown on fundoscopy in retinal vein occlusion?

A
  • Flame and blot haemorrhages
  • Optic disc oedema
  • Macula oedema
  • Dilated tortuous veins
30
Q

What is shown?

A

Central retinal vein occlusion

31
Q

How is central retinal vein occlusion managed in secondary care?

A

Treat macular oedema and prevent complications such as neovascularisation - laser photocoagulation, intravitreal steroids, anti-VEGF

32
Q

What is sympathetic ophthalmia?

A

A condition in which injury to 1 eye causes vision loss in both eyes (Louis Braille had this)

33
Q

How does sympathetic ophthalmia occur?

A
  • Injury causes immune blood cells moving into the eye and recognise this as a foreign body as they are usually not in the eye (Due to blood-ocular barrier)
  • This causes release of antibodies against both eyes
34
Q
A

Ophthalmology (9 decks)

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