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Ophthalmology > Transient monocular vision loss > Flashcards

Transient monocular vision loss Flashcards

1
Q

What are the causes of central retinal vein occlusion (CRVO)?

A
  • Atherosclerosis
  • Hypertension
  • Diabetes mellitus
  • Glaucoma
  • Polycythaemia
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2
Q

What are the clinical features of non-ischaemic CRVO?

A
  • Subacute, mild to moderate loss of vision in affected eye

- Absent RAPD

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3
Q

What are the ophthalmoscopic findings in non-ischaemic CRVO?

A
  • Few flame-shaped haemorrhages in all 4 retinal quadrants
  • Mild/no macular oedema
  • Mild/no papilloedema
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4
Q

What are the clinical features of ischaemic CRVO?

A
  • Sudden, severe loss of vision

- RAPD present

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5
Q

What are the ophthalmoscopic findings in ischaemic CRVO?

A
  • Severe haemorrhages in all 4 retinal quadrants and venous thickening
  • Cotton wool spots (yellow-white deposits on the retina)
  • Severe macular oedema
  • Severe papilloedema
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6
Q

How are non-ischaemic and ischaemic CRVO differentiated from one another?

A

Fluorescein angiography

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7
Q

What are the causes of central retinal artery occlusion (CRAO)?

A
  • Thromboembolism (from atherosclerosis)

- Arteritis (e.g. temporal arteritis)

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8
Q

What are the clinical features of CRAO?

A
  • Sudden , painless loss of vision in affected eye
  • Vision loss often described as a descending curtain
  • RAPD present
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9
Q

What investigations should be performed when a diagnosis of CRAO is suspected?

A
  • Carotid doppler
  • Echo
  • Inflammatory markers (ESR/CRP)
  • Temporal artery biopsy
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10
Q

What are the ophthalmoscopic findings in CRAO?

A
  • Grey-ish white (cloudy) discolouration of the entire retina
  • Cherry-red spot at the fovea centralis
  • Retinal plaques/emboli
  • Narrowing of all retinal vessels
  • Box-carring: segmented appearance of retinal vessels
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11
Q

What is the management for CRAO?

A
  • CRAO is an ophthalmologic emergency*
  • Eyeball massage
  • Carbogen therapy: inhaling a mixture of 5% CO2 and 95% O2
  • Decrease IOP: surgical therapy
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12
Q

What is amaurosis fugax?

A

Sudden, painless loss of vision that lasts for seconds to minutes and is followed by spontaneous recovery

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13
Q

What is the cause of amaurosis fugax?

A

Retinal ischaemia following transient occlusion of the central retinal artery by microemboli

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14
Q

What is a potential complication of amaurosis fugax?

A

TIA

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15
Q

What are the causes of vitreous haemorrhage?

A
  • Proliferative diabetic retinopathy
  • Posterior vitreous detachment
  • Ocular trauma (particularly in children and young adults)
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16
Q

What are the clinical features of vitreous haemorrhage?

A
  • Sudden, painless visual loss
  • Red hue
  • New onset of floaters and ‘cobwebs’
  • Symptoms which may be worse in the morning if blood settles on the macula
  • Hx of diabetes, hypertension, sickle cell, ocular surgery or trauma
  • moderate bleed may be described as numerous dark spots

**No photopsia - how to differentiate from PVD and RD

17
Q

What is the management of vitreous haemorrhage?

A

Usually observation

  • Laser photocoagulation
  • Anterior retinal cryotherapy
  • Vitrectomy
  • Intravitreal anti-VEGF agents
18
Q

What is posterior vitreous detachment?

A

Separation of the posterior hyaloid face of the vitreous body from the neurosensory retina

*Most common cause of floaters and flashes

19
Q

What are the clinical features of posterior vitreous detachment?

A
  • Asymptomatic
  • Painless
  • Single or multiple floaters; often described as circular, ovoid, or a curvilinear ; often on temporal side of vision
  • Photopsia (ocular flash), usually in visual peripheries
  • Shower of black specks
20
Q

What is retinal detachment?

A

Involves the neurosensory layer of the retina separating off from the underlying retinal pigment epithelium (RPE)

21
Q

How can retinal detachment be classified?

A

Rhegmatogenous and non-rhegmatogenous

*Rhegmatogenous is the more common form

22
Q

What are potential risk factors for retinal detachment?

A

Myopia
FHx of retinal break or detachment
Previous history of retinal break or detachment

23
Q

What are the clinical features of retinal detachment?

A
  • New onset of floaters and flashes
  • Sudden, painless, usually progressive visual field loss
  • Vision loss may be described as a dark curtain/shadow, which usually starts in the periphery and then progresses towards the centre
  • RAPD will be present if the macula is detached (or if 2+ quadrants of the non-macular retina have detached)

Ophthalmology (11 decks)

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