Vascular eye things

Question 1

What is central retinal artery occlusion?

Answer 1

Sudden cause of unilateral visual loss due to thromboembolism or arteritis (temporal arteritis)

Question 2

What are the features of central retinal artery occlusion?

Answer 2

Sudden, painful unilateral visual loss.
Relative afferent pupillary defect (RAPD).
‘Cherry red spot’ on pale retina.

Question 3

What is the management of central retinal artery occlusion?

Answer 3

Difficult and prognosis is poor.
Treat any underlying conditions.
Intraarterial thrombolysis may be attempted

Question 4

What are the risk factors for central retinal vein occlusion?

Answer 4

Increasing age,
HTN,
CV disease,
Glaucoma
Polycythaemia

Question 5

What are the features of central retinal vein occlusion?

Answer 5

Sudden, painless reduction or loss of visual acuity.
Fundoscopy shows hyperaemia and several retinal haemorrhages.

Question 6

Differential diagnosis for central retinal vein occlusion?

Answer 6

Branch retinal vein occlusion - more limited area of the fundus will be affected.

Question 7

Management of central retinal vein occlusion?

Answer 7

Most managed conservatively.
Indications for treatment include: Macular oedema (give intravitreal anti VEGF) and retinal neovascularisation (give laser photocoagulation)

Question 8

Causes of vitrous haemorrhage?

Answer 8

Proliferative diabetic retinopathy,
Posterior viterous detachment,
Occular trauma

Question 9

Presentation of viterous haemorrhage?

Answer 9

Painless visual loss/haze,
Red hue in vision,
Floaters or shadows/dark spots in vision.
Decreased VA,
Visual field defect.

Question 10

Investigations for viterous haemorrhage?

Answer 10

Dilated fundoscopy - haemorrhage in cavity.
Slit lamp examination - rbcs in anterior vitreous.
Ultrasound - rule out retinal tear/detachment
Fluorescein angiography

Question 11

What are the different types of diabetic retinopathy?

Answer 11

Non-proliferative diabetic retinopathy - picked up in screening which is offered over age 12 if T1DM or after 5 years of diagnosis if T2DM.
Proliferative diabetic retinopathy - sight threatening (vitreous haemorrhage, retinal detachment and neovascular glaucoma).
Maculopathy

Question 12

Presentation of non-proliferative diabetic retinopathy?

Answer 12

Mild - Microaneurysms,

Moderate - Microaneurysms, blot haemorrhages, hard exudates, cotton wool spots (represents areas of retinal infarction).

Severe - blot haemorrhages and microaneurysms in 4 quads, venous bleeding in 2 quads and intraretinal microvascular abnormalities.

Question 13

Features of proliferative diabetic retinopathy

Answer 13

Presentatation: Retinal neovascularisation may lead to vitrous haemorrhage and fibrous tissue forms anterior to retinal disc.

Management: Panretinal laser photocoagulation - turns off ischaemic drive to save central retina/macula (may reduce visual fields and worsen night vision) or Intravetrial VEGF inhibitors. Often a combination is used.

Question 14

Presentation and management of maculopathy

Answer 14

Presentation - impaired central vision. Hard exudates form on macula.
Management - If change in visual acuity then use VEGF inhibitors

Question 15

Management of non-proliferative retinopathy

Answer 15

Regular observation and if severe then consider panretinal laser photocoagulation.

Question 16

Two types of Anterior ischaemic optic neuropathy?

Answer 16

Arteritic AION - often giant cell arteritis)

Non arteritic AION - other CV risk factors

Question 17

Presentation of AION?

Answer 17

Sudden, painless visual loss.
Reduced VA
RAPD
Disc swelling with haemorrhages and cotton wool spots.
If arteritic AION then may also have symptoms of headache, jaw claudication, sclap tenderness, along with thickened pulsatile temporal artery).

Question 18

Investigations and management of AION?

Answer 18

Ix - bloods (FBC, UEs, LFTs, lipids, glucose, CRP, ESR).
Management -
If arteritic then give pulsed methylpred with PPI cover and consider temporal artery biopsy.
If non-arteritic then consider secondary prevention, smoking cessation advice and BP check.

Question 19

Staging of hypertensive retinopathy?

Answer 19

Keith Wagener classification
1. Arteriolar narrowing and increased light reflex.
2. AV nipping.
3. Cotton woll excudates, flame and blot haemorrhages
4. Papilloedema