Sudden Vision Loss

Question 1

DDx for painful unilateral vision loss

Answer 1

Corneal abrasia
Acute angle closure glaucoma
Optic neuritis
Temporal arteritis
Retroorbital haematoma
Trauma

Question 2

DDx for painless unilateral vision loss

Answer 2

Retinal detachment
Vitreous detachment
Vitreous haemorrhage
Lens dislocation

Question 3

DDx for painful bilateral vision loss

Answer 3

Keratitis
Optic chiasm impingment
Toxic exposure to eye
Trauma

Question 4

DDx for painless bilateral vision loss

Answer 4

Stroke
Central retinal vein occlusion
Central retinal artery occlusion
Keratitis

Question 5

Which condition typically presents with “curtains falling down” in eyes

Answer 5

Amaurosis fugax

Question 6

How does amaurosis fugax present + treatment

Answer 6

Temporary loss of vision in one eyes - curtains coming down
Complete recovery after few seconds/minutes
- due to thrombotic embolus

REFER URGENTLY TO OPHTHALMOLOGY TEAM - thrombus may break off and cause stroke!!

Question 7

Presentation and clinical signs of central retinal artery occlusion

Answer 7

Sudden painless decrease in visual acuity
May be associated to history of amourosis fugax

Clinical signs - on fundoscopy - pale retina, cherry red macular spot

Question 8

Central retinal artery occlusion treatment

Answer 8

digitally massage globe for 5-15 secs, release an drepeat to dislodge embolus
Urgent referral to ophthomology

Give GTN and IV acetazolamide whilst waiting for optho

Question 9

Predisposing factors for central retinal vein occlusion

Answer 9

Old age
Chronic glaucoma
Arteriosclerosis
Hypertension
Polycythaemia

Question 10

Clinical findings for central vein occlusion

Answer 10

Decreased visual acuity

Fundoscopy shows ‘STORMY SUNSET’ appearance - hyperaemia with engorged veins and flame shaped haemorrhages
Disc may be obscured and cotton wool spots may be seen

Question 11

Central retinal vein occlusion treatment

Answer 11

Cannot treat but refer to optho urgently to protect other eye

Question 12

Temporal (giant cell) arteritis presentation

Answer 12

Aged over 50
Associated with polymyalgia rheumatica
Rapid visual loss preceded by headaches, jaw pain and temporal arteries are tender to palpation

Question 13

Treatment for temporal giant cell arteritis

Answer 13

IV hydrocortisone immediately

Question 14

When does retinal detachment happen

Answer 14

Pts with myopias, diabetes elderly or after trauma

Question 15

Symptoms of retinal detachment and treatment

Answer 15

Flashing lights before developing cloudy vision
Visual field defect - decreased visual acuity
Retina is dark and opalescent, may see brain folds

Refer urgently for surgery and re-attachment