Sudden Vision Loss Flashcards
pneumonic for causes of sudden loss of vision
VARICOSE
Vascular occlusion / vitreous haemorrhage
Age related macular degeneration
Retinal detachment
Ischaemic optic neuropathy
Closed angle glaucoma
Optic neuritis
Stroke
Emergency refferal
types of vascular occlusion
central retinal artery occlusion
central retinal vein occlusion
amaurosis fugax
causes of central retinal artery occlusion
atherosclerosis
giant cell arteritis
presentation of central retinal artery occlusion
painless vision loss
RAPD
what is a RAPD
relative afferent pupillary defect
- pupil in the affected eye constricts more when light is shone in the other eye compared to when it is shone in the affected eye itself
appearance of central retinal artery occlusion on fundoscopy
pale retina with cherry red spot
thread like vessels
management of central retinal artery occlusion presenting within 24 hours
occular massage
- trying to move occlusion from central artery to a branch artery
investigations for cause of central retinal artery occlusion
carotid doppler – atherosclerosis
ESR + temporal biopsy – giant cell arteritis
what causes a central retinal vein occlusion?
what are the risk factors
thrombus formation in the retinal vein
HTN
high cholesterol
diabetes
smoking
glaucoma
SLE
appearance of central retinal vein occlusion on fundoscopy
retinal haemorrhages
optic disc + macula oedema
treatment options for central retinal vein occlusion
aim to prevent macula oedema and neovascularisation
- laser photocoagulation
- intravitreal steroids
- anti-VEGF
what is amaurosis fugax
transient central retinal artery occlusion
temporary painless loss of vision - ‘like a curtain coming down’
may indicate TIA- prescribe 300mg aspirin
what is wet age related macula degeneration
development of new vessels in choroid layer of retina
vessels leak causing fluid build up, vision loss and eventual scarring
symptoms of wet ARMD
loss / blurring of central vision
distorted vision - straight lines look wavy
floaters
treatment of wet ARMD
anti-VEGF
what is a retinal detachment
retina separates from choroid underneath
- allows vitreous fluid to get under retina and fill space underneath
risk factors for retinal detachment
trauma
previous detachment
myopia
marfans syndrome
symptoms of retinal detachment
painless sudden peripheral vision loss - like a shadow coming across vision
flashes + floaters
treatment of retinal detachment
surgical repair
what is ischaemic optic neuropathy
infarction of optic nerve head due to obstruction of posterior ciliary arteries
causes of ischaemic optic neuropathy
arteritic - Giant cell arteritis
non-arteritic - atherosclerosis
what causes acute closed angle glaucoma
raised intra-ocular pressure secondary to impaired aqueous outflow
normal pressure range in the eye
10-21 mmHg
risk factors for acute closed angle glaucoma
increasing age
hypermetropia (long sighted)
female
asian ethnicity
symptoms of acute closed angle glaucoma
severely painful red eye
haloes around lights
nausea + vomiting
- symptoms worse watching tv in a dark room
appearance of the pupil in acute closed angle glaucoma
fixed mid dilated pupil
signs of acute closed angle glaucoma on examination
fixed mid dilated pupil
no pupillary light response
decreased visual acuity
red hard eye
clouding of cornea
treatment of acute closedangle glaucoma
topical pilocarpine – constricts pupil to open the angle
oral acetezolamide - decreases aqeuous humour production
what may be required as a definitive treatment of closed angle glaucoma
laser iridotomy
- makes hole in iris to allow aqueous humour to flow from posterior chamber into anterior chamber
what is optic neuritis
inflammation of the optic nerve
what conditions can cause optic neuritis
MS
Diabetes
Sarcoidosis
Syphilis
symptoms of optic neuritis
pain worse on eye movement
impaired colour vision
unilateral decrease in visual acuity
treatment of optic neuritis
methylprednisolone
- recovery takes 4-6 weeks
who is vitreous haemorrhage most common in
diabetics
symptoms of vitreous haemorrhage
sudden painless vision loss
red hue in vision
floaters
