Sudden Vision Loss Flashcards

1
Q

pneumonic for causes of sudden loss of vision

A

VARICOSE

Vascular occlusion / vitreous haemorrhage

Age related macular degeneration

Retinal detachment

Ischaemic optic neuropathy

Closed angle glaucoma

Optic neuritis

Stroke

Emergency refferal

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2
Q

types of vascular occlusion

A

central retinal artery occlusion

central retinal vein occlusion

amaurosis fugax

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3
Q

causes of central retinal artery occlusion

A

atherosclerosis

giant cell arteritis

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4
Q

presentation of central retinal artery occlusion

A

painless vision loss

RAPD

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5
Q

what is a RAPD

A

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
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6
Q

appearance of central retinal artery occlusion on fundoscopy

A

pale retina with cherry red spot

thread like vessels

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7
Q

management of central retinal artery occlusion presenting within 24 hours

A

occular massage

  • trying to move occlusion from central artery to a branch artery
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8
Q

investigations for cause of central retinal artery occlusion

A

carotid doppler – atherosclerosis

ESR + temporal biopsy – giant cell arteritis

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9
Q

what causes a central retinal vein occlusion?

what are the risk factors

A

thrombus formation in the retinal vein

HTN

high cholesterol

diabetes

smoking

glaucoma

SLE

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10
Q

appearance of central retinal vein occlusion on fundoscopy

A

retinal haemorrhages

optic disc + macula oedema

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11
Q

treatment options for central retinal vein occlusion

A

aim to prevent macula oedema and neovascularisation

  • laser photocoagulation
  • intravitreal steroids
  • anti-VEGF
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12
Q

what is amaurosis fugax

A

transient central retinal artery occlusion

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

may indicate TIA- prescribe 300mg aspirin

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13
Q

what is wet age related macula degeneration

A

development of new vessels in choroid layer of retina

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

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14
Q

symptoms of wet ARMD

A

loss / blurring of central vision

distorted vision - straight lines look wavy

floaters

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15
Q

treatment of wet ARMD

A

anti-VEGF

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16
Q

what is a retinal detachment

A

retina separates from choroid underneath

  • allows vitreous fluid to get under retina and fill space underneath
17
Q

risk factors for retinal detachment

A

trauma

previous detachment

myopia

marfans syndrome

18
Q

symptoms of retinal detachment

A

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

flashes + floaters

19
Q

treatment of retinal detachment

A

surgical repair

20
Q

what is ischaemic optic neuropathy

A

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

21
Q

causes of ischaemic optic neuropathy

A

arteritic - Giant cell arteritis

non-arteritic - atherosclerosis

22
Q

what causes acute closed angle glaucoma

A

raised intra-ocular pressure secondary to impaired aqueous outflow

23
Q

normal pressure range in the eye

A

10-21 mmHg

24
Q

risk factors for acute closed angle glaucoma

A

increasing age

hypermetropia (long sighted)

female

asian ethnicity

25
symptoms of acute closed angle glaucoma
severely painful red eye haloes around lights nausea + vomiting - symptoms worse watching tv in a dark room
26
appearance of the pupil in acute closed angle glaucoma
fixed mid dilated pupil
27
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
28
treatment of acute closedangle glaucoma
topical pilocarpine -- constricts pupil to open the angle oral acetezolamide - decreases aqeuous humour production
29
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
30
what is optic neuritis
inflammation of the optic nerve
31
what conditions can cause optic neuritis
**MS** Diabetes Sarcoidosis Syphilis
32
symptoms of optic neuritis
**pain worse on eye movement** impaired colour vision unilateral decrease in visual acuity
33
treatment of optic neuritis
methylprednisolone - recovery takes 4-6 weeks
34
who is vitreous haemorrhage most common in
diabetics
35
symptoms of vitreous haemorrhage
sudden painless vision loss red hue in vision floaters