Sudden Vision Loss

Question 1

pneumonic for causes of sudden loss of vision

Answer 1

VARICOSE

Vascular occlusion / vitreous haemorrhage

Age related macular degeneration

Retinal detachment

Ischaemic optic neuropathy

Closed angle glaucoma

Optic neuritis

Stroke

Emergency refferal

Question 2

types of vascular occlusion

Answer 2

central retinal artery occlusion

central retinal vein occlusion

amaurosis fugax

Question 3

causes of central retinal artery occlusion

Answer 3

atherosclerosis

giant cell arteritis

Question 4

presentation of central retinal artery occlusion

Answer 4

painless vision loss

RAPD

Question 5

what is a RAPD

Answer 5

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

Question 6

appearance of central retinal artery occlusion on fundoscopy

Answer 6

pale retina with cherry red spot

thread like vessels

Question 7

management of central retinal artery occlusion presenting within 24 hours

Answer 7

occular massage

• trying to move occlusion from central artery to a branch artery

Question 8

investigations for cause of central retinal artery occlusion

Answer 8

carotid doppler – atherosclerosis

ESR + temporal biopsy – giant cell arteritis

Question 9

what causes a central retinal vein occlusion?

what are the risk factors

Answer 9

thrombus formation in the retinal vein

HTN

high cholesterol

diabetes

smoking

glaucoma

SLE

Question 10

appearance of central retinal vein occlusion on fundoscopy

Answer 10

retinal haemorrhages

optic disc + macula oedema

Question 11

treatment options for central retinal vein occlusion

Answer 11

aim to prevent macula oedema and neovascularisation

• laser photocoagulation
• intravitreal steroids
• anti-VEGF

Question 12

what is amaurosis fugax

Answer 12

transient central retinal artery occlusion

temporary painless loss of vision - ‘like a curtain coming down’

may indicate TIA- prescribe 300mg aspirin

Question 13

what is wet age related macula degeneration

Answer 13

development of new vessels in choroid layer of retina

vessels leak causing fluid build up, vision loss and eventual scarring

Question 14

symptoms of wet ARMD

Answer 14

loss / blurring of central vision

distorted vision - straight lines look wavy

floaters

Question 15

treatment of wet ARMD

Answer 15

anti-VEGF

Question 16

what is a retinal detachment

Answer 16

retina separates from choroid underneath

• allows vitreous fluid to get under retina and fill space underneath

Question 17

risk factors for retinal detachment

Answer 17

trauma

previous detachment

myopia

marfans syndrome

Question 18

symptoms of retinal detachment

Answer 18

painless sudden peripheral vision loss - like a shadow coming across vision

flashes + floaters

Question 19

treatment of retinal detachment

Answer 19

surgical repair

Question 20

what is ischaemic optic neuropathy

Answer 20

infarction of optic nerve head due to obstruction of posterior ciliary arteries

Question 21

causes of ischaemic optic neuropathy

Answer 21

arteritic - Giant cell arteritis

non-arteritic - atherosclerosis

Question 22

what causes acute closed angle glaucoma

Answer 22

raised intra-ocular pressure secondary to impaired aqueous outflow

Question 23

normal pressure range in the eye

Answer 23

10-21 mmHg

Question 24

risk factors for acute closed angle glaucoma

Answer 24

increasing age

hypermetropia (long sighted)

female

asian ethnicity

Question 25

symptoms of acute closed angle glaucoma

Answer 25

severely painful red eye haloes around lights nausea + vomiting - symptoms worse watching tv in a dark room

Question 26

appearance of the pupil in acute closed angle glaucoma

Answer 26

fixed mid dilated pupil

Question 27

signs of acute closed angle glaucoma on examination

Answer 27

fixed mid dilated pupil no pupillary light response decreased visual acuity red hard eye clouding of cornea

Question 28

treatment of acute closedangle glaucoma

Answer 28

topical pilocarpine -- constricts pupil to open the angle oral acetezolamide - decreases aqeuous humour production

Question 29

what may be required as a definitive treatment of closed angle glaucoma

Answer 29

laser iridotomy - makes hole in iris to allow aqueous humour to flow from posterior chamber into anterior chamber

Question 30

what is optic neuritis

Answer 30

inflammation of the optic nerve

Question 31

what conditions can cause optic neuritis

Answer 31

**MS** Diabetes Sarcoidosis Syphilis

Question 32

symptoms of optic neuritis

Answer 32

**pain worse on eye movement** impaired colour vision unilateral decrease in visual acuity

Question 33

treatment of optic neuritis

Answer 33

methylprednisolone - recovery takes 4-6 weeks

Question 34

who is vitreous haemorrhage most common in

Answer 34

diabetics

Question 35

symptoms of vitreous haemorrhage

Answer 35

sudden painless vision loss red hue in vision floaters