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Year 3 Emergency > Vision Loss > Flashcards

Vision Loss Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What is TVML?

A

Transient monocular visual loss
Sudden loss of vision lasting less than 24 hours

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2
Q

What are most common causes of sudden painless vision loss?

A

Vascular

Vitreous haemorrhage

Retinal detachment

Retinal migraine

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3
Q

What do we call vascular related vision loss?

A

Amaurosis fugax

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4
Q

What is vascular issues can cause vision loss?

A

Large artery disease - atherothrombosis, embolus, dissection

Small artery disease - Vasculitis, temporal arteritis

Venous disease

Hypo-perfusion

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5
Q

What are features of posterior vitreous detachment?

A

Flashes of light (photopsia) - in the peripheral field of vision

Floaters, often on the temporal side of the central vision

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6
Q

What are features of retinal detachment?

A

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

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7
Q

What are features of vitreous haemorrhage?

A

Large bleeds cause sudden visual loss

Moderate bleeds may be described as numerous dark spots

Small bleeds may cause floaters

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8
Q

What are some causes of red eye?

A

Glaucoma
Anterior uveitis
Scleritis
Conjunctivitis
Subconjunctival haemorrhage

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9
Q

What effects whether a visual defect is ipsilateral or homonymous?

A

Location relative to the optic chiasm

Pre-chiasmial lesions - ipsilateral monocular defect

Post-chiasmal lesions - contralateral homonymous

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10
Q

What visual defects would the following lesions cause?

A
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11
Q

What visual defect would a pituitary adenoma cause?

A

Bitemporal Hemianopia

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12
Q

Where would a lesion cause ipsilateral monocular blindess? What might cause this?

A

Optic Nerve

Ipsilateral monocular blindness

Optic neuritis

Amaurosis fugax

Optic atrophy

Retrobulbar optic neuropathy

Trauma

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13
Q

What visual field defect would a middle cerebral artery stroke cause?

A

Contralateral homonymous hemianopia

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14
Q

What visual defect would a posterior cerebral artery stroke cause?

A

Contralateral homonymous hemianopia with macular sparing

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15
Q

Define uveitis

A

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

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16
Q

What are presenting features of uveitis?

A

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

17
Q

What are the symtoms of uveitis?

A

Tearing

Photophobia

Floaters

Red eye no discharge

Constricted/non-reactive pupil

18
Q

How is Uveitis diagnosed?

A

Clinically

19
Q

What is the management for uveitis?

A

Corticosteroid eye drops

Oral corticosteroids

20
Q

What are the presenting features of scleritis?

A

red eye

classically painful but sometimes only mild pain/discomfort is present

watering and photophobia are common

gradual decrease in vision

21
Q

Define optic neuritis

A

inflammation of the optic nerve

commonly idipathic as a part of MS

22
Q

What are the presenting feature of optic neuritis?

A

unilateral decrease in visual acuity over hours or days

poor discrimination of colours, ‘red desaturation’

pain worse on eye movement

relative afferent pupillary defect

23
Q

Whst test is used to diagnose optic neuritis?

A

Swining torch test for relative affernt pupillary defect

24
Q
A
25
Q
A
26
Q

What investigation should be done for optic neuritis?

A

MRI of optic nerves (swelling, white matter MS lesions)

27
Q

What is the management for optic neuritis?

A

high-dose steroids

recovery usually takes 4-6 weeks

28
Q
A
29
Q

What causes thyroid eye disease?

A

Graves disease - 25-50% of patients

Autoimmune response against autoantigen causing retro-orbital inflammation

Inflammation results in glycosaminoglycan and collagen deposition in the muscles

30
Q

What is the most important modifiable RF in thyroid eye disease?

A

Smkoing

31
Q

What are the features of thyroid eye disease?

A

exophthalmos

conjunctival oedema

optic disc swelling

ophthalmoplegia

inability to close the eyelids may lead to sore, dry eyes

32
Q

What is the managment of thyroid eye disease?

A

topical lubricants may be needed to help prevent corneal inflammation caused by exposure

steroids

radiotherapy

surgery

33
Q

In thyroid eye disease, what would warrant an urgent expert review?

A

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

Year 3 Emergency (11 decks)

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