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Opthalmology > Sudden visual loss > Flashcards

Sudden visual loss Flashcards

1
Q

What is retinal detachment

A
  • the retina separates from the choroid underneath

- Sight threatening condition

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2
Q

Why do retinal detachments usually occur

A

This is usually due to a retinal tear that allows vitreous fluid to get under the retina and fill the space between the retina and the choroid. The outer retina relies on the blood vessels of the choroid for its blood supply

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3
Q

What are the risk factors for retinal detachment

A 
Posterior vitreous detachment
Diabetic retinopathy
Trauma to the eye
Retinal malignancy
Older age
Family history
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4
Q

What is the presentation of retinal detachment

A
  • Peripheral vision loss. This is often sudden and like a shadow coming across the vision.
  • Blurred or distorted vision
  • Flashes and floaters
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5
Q

What is the management of retinal detachment

A
  • Urgent opthalmology review
  • Treat retinal tears
  • reattach the retina and reduce any traction or pressure that may cause it to detach again
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6
Q

What is the management of retinal tears

A

Laser therapy

Cryotherapy

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7
Q

How can you reattach the retina

A
  • Vitrectomy
  • Scleral buckling
  • Pneumatic retinopexy
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8
Q

What is pneumatic retinopexy

A

involves injecting a gas bubble into the vitreous body and positioning the patient so the gas bubble creates pressure that flattens the retina against the choroid and close the detachment.

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9
Q

What is a vitrectomy

A

involves removing the relevant parts of the vitreous body and replacing it with oil or gas.

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10
Q

What is a Central retinal vein occlusion

A

occurs when a blood clot (thrombus) forms in the retinal veins and blocks the drainage of blood from the retina. There are four branched veins that come together to form the central retinal vein. Blockage of one of the branch veins causes problems in the area drained by that branch whereas blockage in the central vein causes problems with the whole retina.

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11
Q

What is the pathophysiolgoy behind a retinal vein occlusion

A
  • Blockage of a retinal vein causes pooling of blood in the retina.
  • This results in leakage of fluid and blood causing macular oedema and retinal haemorrhages.
  • This results in damage to the tissue in the retina and loss of vision.
  • It also leads to the release of VEGF, which stimulates the development of new blood vessels (neovascularisation).
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12
Q

What are the risk factors for central vein occlusion

A 
Hypertension
High cholesterol
Diabetes
Smoking
Glaucoma
Systemic inflammatory conditions such as systemic lupus erythematosus
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13
Q

What is the presentation of central retinal vein occlusion

A

Blockage of one of these retinal veins causes sudden painless loss of vision.

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14
Q

what will you see on fundoscopy of a central retinal vein occlusion

A

Flame and blot haemorrhages
Optic disc oedema
Macula oedema

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15
Q

What are the risk factors for central vein occlusion

A 
Hypertension
High cholesterol
Diabetes
Smoking
Glaucoma
Systemic inflammatory conditions such as systemic lupus erythematosus
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16
Q

What is the presentation of central retinal vein occlusion

A

Blockage of one of these retinal veins causes sudden painless loss of vision.

17
Q

what will you see on fundoscopy of a central retinal vein occlusion

A

Flame and blot haemorrhages
Optic disc oedema
Macula oedema

18
Q

Other investigations that should be compelted for a patient with ? retinal vein occlusion

A 
Full medical history
FBC for leukaemia
ESR for inflammatory disorders
Blood pressure for hypertension
Serum glucose for diabetes
19
Q

Management of central retinal vein occlusion

A
  • referred immediately to an ophthalmologist
  • Management in secondary care aims to treat macular oedema
  • prevent complications
    • Laser photocoagulation
    • Intravitreal steroids (e.g. a dexamethasone intravitreal
      implant)
    • Anti-VEGF therapies (e.g. ranibizumab, aflibercept or
      bevacizumab)
20
Q

What are the complications of central retinal vein occlusion

A
  • neovascularisation of retina and iris

- glaucoma

21
Q

What is central retinal artery occlusion

A
  • something blocks the flow of blood through the central retinal artery.
  • The central retinal artery supplies the blood to the retina. - It is a branch of the ophthalmic artery, which is a branch of the internal carotid artery.
22
Q

What are the causes of central retinal artery occlusion

A
  1. Atherosclerosis

2. giant cell arteritis

23
Q

What are the risk factors for central retinal artery occlusion

A 
Older age
Family history
Smoking
Alcohol consumption
Hypertension
Diabetes
Poor diet
Inactivity
Obesity
giant cell arteritis 
polymyalgia rheumatica.
24
Q

Presentation of a patient with central retinal artery occlusion

A
  • sudden painless loss of vision

- relative afferent pupillary defect.

25
Q

What is a relative afferent pupillary defect.

A

the pupil in the affected eye constricts more when light is shone in the other eye compared when it is shone in the affected eye. This occurs because the input is not being sensed by the ischaemic retina when testing the direct light reflex but is being sensed by the normal retina during the consensual light reflex.

26
Q

What will be seen on fundoscopy in a patient with a central retinal artery occlusion

A
  • pale retina: lack of perfusion with blood
  • cherry red spot: the macula, which has a thinner surface that shows the red coloured choroid below and contrasts with the pale retina.
27
Q

What is the immediate management of central retinal arterty occlusion

A
  • Ocular massage
  • Removing fluid from the anterior chamber to reduce intraocular pressure.
  • Inhaling carbogen (a mixture of 5% carbon dioxide and 95% oxygen) to dilate the artery
  • Sublingual isosorbide dinitrate to dilate the artery
28
Q

What is the long term management of central retinal artery occlusion

A

treating reversible risk factors and secondary prevention of cardiovascular disease.

Opthalmology (4 decks)

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