Vision Loss Flashcards
What is TVML?
Transient monocular visual loss
Sudden loss of vision lasting less than 24 hours
What are most common causes of sudden painless vision loss?
Vascular
Vitreous haemorrhage
Retinal detachment
Retinal migraine
What do we call vascular related vision loss?
Amaurosis fugax
What is vascular issues can cause vision loss?
Large artery disease - atherothrombosis, embolus, dissection
Small artery disease - Vasculitis, temporal arteritis
Venous disease
Hypo-perfusion
What are features of posterior vitreous detachment?
Flashes of light (photopsia) - in the peripheral field of vision
Floaters, often on the temporal side of the central vision
What are features of retinal detachment?
Dense shadow that starts peripherally progresses towards the central vision
A veil or curtain over the field of vision
Straight lines appear curved
Central visual loss
What are features of vitreous haemorrhage?
Large bleeds cause sudden visual loss
Moderate bleeds may be described as numerous dark spots
Small bleeds may cause floaters
What are some causes of red eye?
Glaucoma
Anterior uveitis
Scleritis
Conjunctivitis
Subconjunctival haemorrhage
What effects whether a visual defect is ipsilateral or homonymous?
Location relative to the optic chiasm
Pre-chiasmial lesions - ipsilateral monocular defect
Post-chiasmal lesions - contralateral homonymous
What visual defects would the following lesions cause?
What visual defect would a pituitary adenoma cause?
Bitemporal Hemianopia
Where would a lesion cause ipsilateral monocular blindess? What might cause this?
Optic Nerve
Ipsilateral monocular blindness
Optic neuritis
Amaurosis fugax
Optic atrophy
Retrobulbar optic neuropathy
Trauma
What visual field defect would a middle cerebral artery stroke cause?
Contralateral homonymous hemianopia
What visual defect would a posterior cerebral artery stroke cause?
Contralateral homonymous hemianopia with macular sparing
Define uveitis
inflammation of one or all parts of the uvea (the vascular area between the retina and sclera of the eye)
Risk of painless visual loss
What are presenting features of uveitis?
Dull pain in orbital region if anterior otherwise painless (intermediate or posterior)
Decreased vision
Synchiae (iris adhereance to cornea or lens)
Flare (inflamation and leukocytes in aqueous humor)
Keratic precipitates
What are the symtoms of uveitis?
Tearing
Photophobia
Floaters
Red eye no discharge
Constricted/non-reactive pupil
How is Uveitis diagnosed?
Clinically
What is the management for uveitis?
Corticosteroid eye drops
Oral corticosteroids
What are the presenting features of scleritis?
red eye
classically painful but sometimes only mild pain/discomfort is present
watering and photophobia are common
gradual decrease in vision
Define optic neuritis
inflammation of the optic nerve
commonly idipathic as a part of MS
What are the presenting feature of optic neuritis?
unilateral decrease in visual acuity over hours or days
poor discrimination of colours, ‘red desaturation’
pain worse on eye movement
relative afferent pupillary defect
Whst test is used to diagnose optic neuritis?
Swining torch test for relative affernt pupillary defect
What investigation should be done for optic neuritis?
MRI of optic nerves (swelling, white matter MS lesions)
What is the management for optic neuritis?
high-dose steroids
recovery usually takes 4-6 weeks
What causes thyroid eye disease?
Graves disease - 25-50% of patients
Autoimmune response against autoantigen causing retro-orbital inflammation
Inflammation results in glycosaminoglycan and collagen deposition in the muscles
What is the most important modifiable RF in thyroid eye disease?
Smkoing
What are the features of thyroid eye disease?
exophthalmos
conjunctival oedema
optic disc swelling
ophthalmoplegia
inability to close the eyelids may lead to sore, dry eyes
What is the managment of thyroid eye disease?
topical lubricants may be needed to help prevent corneal inflammation caused by exposure
steroids
radiotherapy
surgery
In thyroid eye disease, what would warrant an urgent expert review?
Unexplained deterioration of vision
Change in intensity/quality of colour vision
Eye suddenly popping out
Corneal opacity
Cornea visible when eyes are close
Disc swelling
