Vision Loss Flashcards
Using the “vision, pupils, pressure” framework, distinguish cataracts, macular degeneration and glaucoma
- Cataracts
- Poor vision improved with pinhole
- Pupils, pressure normal
- (also diminished red reflex)
- Macular degeneration
- Poor vision not corrected with pinhole
- Pupils, pressure normal
- Glaucoma
- Normal vision
- RAPD if acute, raised IOP
A patient presents with sudden, painless loss of vision. Provide a differential
- Unilateral
- Central retinal artery occlusion
- Central retinal vein occlusion
- ARMD (wet) - macular haemorrhage
- Retinal detachment/vitreous haemorrhage
- Temporal arteritis
What might you find on eye examination in someone with a central retinal artery occlusion?
How would you treat them?
- Total visual field defect
- Cherry red spot on fovea
- Whitened oedematous retina
- Rule out GCA (FBE, ESR, CRP)
- Lie patient flat
- CO2 rebreathing (dilate vessels)
- Ocular massage
- Acetazolamide (decrease IOP)
What might the retina look like in someone with a central retinal vein occlusion?
A dry macular degeneration?
- Haemorrhagic
- Drusen (photoreceptor crud) over macula
In arteritic anterior ischaemic optic neuropathy (GCA), what is the retina likely to look like? How is it treated?
- Swollen optic disc
- High dose prednisolone
How is someone with acute angle-closure glaucoma likely to present? How would you treat them?
- Painful, onset over hours, red eye, vision loss
- Cloudy, oedematous cornea, part-dilated pupil, RAPD
- Rule out GCA (ESR, CRP)
- IOP reduction
- Acetazolamide (decrease vitreous production)
- Topical beta-blocker and steroid
- Peripheral iridotomy when IOP down
What are the fundoscopic features of non-proliferative diabetic retinopathy?
How might you know that it’s progressed to proliferative diabetic retinopathy?
- Hard exudates (lipid)
- Oedema
- Small haemorrhages, microaneurysms
- Cotton wool spots (ischaemia)
- Neovascularisation adjacent to the optic nerve
- Vitreous haemorrhage/retinal haemorrhage
- Macular oedema
