Sudden Vision Loss Flashcards
What are some important history taking points for an acute loss of vision
pain sudden/gradual intermitternt/constatn? flashes/floaters unilateral/bilateral total loss? blurred? (can you see light) central/side vision colour/loss PMH - ocular specifically FHx of eye diseae cardiovascular health
what should always be examined in patients that come in with acute loss of vision
acuity visual fields pupil reactions fundoscopy bloods - CV risk factors, inflammatory markers
What are causes of acute loss of vision
acute corneal disease Giant cell arteritis anterior chamber haemorrhage vitreous haemorrhage optic neuritis/ischaemic optic neuropathy branch retinal vein occlusion central retinal vein occlusion central retinal artery occlusion branch retinal artery occlusion retinal detachment macular haemorrhgae bitemporal hemianopia optic nerve compression via papilloedeme migraine CVA acute angle closure glaucoma anterior uveitis
What are causes of painful loss of vision
Giant cell arteritis Migraine optic neuritis acute angle closure glaucoma anterior uveitis
what does acute corneal disease make the cornea look like
cloudy
when is acute corneal disease not painful
when infected by HSV
what age group is most affected by giant cell arteritis
> 50
what blood test is most indicative of giant cell arteritis, and what values are you looking for
ESR, >50
what are some symptoms of giant cell arteritis
scalp tenderness - particulary over pterygoid visual obscurations jaw claudication (pain on chewing) weight loss decreased appetite proximal myopathy )dif
How should you investigate suspected giant cell arteritis
urgent ESR + CRP
refer to opthal
how do you treat giant cell arteritis
IV steroids 80mg/day
followed by discharge + oral pred 12-18 months (following histology)
if untreated what is the prognosis of giant cell arteritis
can go blind in a few hours
What must be done before giving someone long term steroids for giant cell arteritis
histology sample must be taken from the superficial temporal artery to confirm diagnosis
what can you see histologically that would confirm giant cell arteritis
tunica media thickening
smaller lumen size
commonly giant cells found (hence the name)
what are some features of Temporal Arteritis
> 60, acute visual loss (usually central), pain on chewing/combing hair nad when moving eyes red eye, raised ESR
what should always be done if optic neuritis is suspected
baseline MRI (rule out MS)
what is optic neuritis associated with and what percentage risk is there
MS - 50% lifetime risk, in 15-25% of MS patients optic neuritis is the first presentation
how do you treat optic neuritis
if MRI normal - symptomatic relief with IV steroids (methylprednisolone) if required - speeds recovery but doesnt recover any more vision than it would usually
If 2+ demylelinated lesions seen on MRI then MS is high risk and neurology referral is required for assessment for inteferon-1a or 1b
whats the pathology of optic neuritis
inflammatory demyelination of the optic nerve
optic neuritis prognosis
most regain normal vision in 6 months
if it returns, risk of MS is higher
what is more common, venous occlusion or retinal artery occlusion, and which is worse
venous, aterial is usually worse
what are features of a branch retinal vein occlusion
ventral visual loss - usually on waking
fundoscopy: cotton wool spots + haemorrhages in 1 quadrant of the eye
commonly raised BP and irregularity in routine bloods
what is the treatment for branch retinal vein occlusion
if mild - watch and wait (50% get better with no treatment)
otherwise: if neovascularisation is present, panretinal photocoagulation may be offered
macular laser therapy is offered if the macula is ‘waterlogged’
Anti-VEGF drugs or a dexamethasone implant may be injected into the eye
what are examples of some anti-VEGF drugs
Ranibizumab( Lucentis)
Aflibercept ( Eylea)
Bevacizumab (Avastin)
