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opthalmology - vision loss > vision loss > Flashcards

vision loss Flashcards

1
Q

causes of sudden vision loss

A

retinal detachment, vascular causes, WET ARMD, closed angle glucoma, optic neuritis, stroke

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2
Q

vision loss can happen due to occlusion of which 2 things?

A

retinal circulation

optic nerve circulation

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3
Q

vision loss can occur from haemorrhage from

A

abnormal formed vessels - diabetes, wet ARMD

retinal tear

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4
Q

symptoms of central retinal artery occlusion

A

sudden vision loss
Profound (Counting Fingers or less- remember CRA is ‘end artery’)
Painless

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5
Q

signs of central retinal artery occlusion

A

RAPD (relative afferent pupil defect)
Pale oedematous retina, thread-like retinal vessels
red dot on fovea

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6
Q

what are the causes of central retinal artery occlusion ?

A

Carotid artery disease

Emboli from the heart (unusual)

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7
Q

management of central retinal artery occlusion

A

in first 24 hours - ocular massage - increasing pressure of eye to try dislodge emboli to branch and increase retinal perfusion
Vascular management
Establish source of embolus – carotid doppler
Assess and manage risk factors

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8
Q

2 other types of retinal artery occlusion apart from CRAO

A

retinal artery branch occlusion

TRANSIENT CRAO–amaurosis fugax

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9
Q

signs and symptoms of amaurosis fugax

A

transient painless visual loss
curtain like blindness
vision restored fully around 5 minutes
nothing noramlly seen on examination

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10
Q

treatment of amaurosis fugax

A

Immediate referral TIA clinic

Aspirin

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11
Q

other cause of transient visual loss

A

migrane

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12
Q

causes of central retinal vein occlusion

A

Systemic causes
Atherosclerosis }
Hypertension } Virchow’s triad
Hyperviscosity }

Ocular causes	
raised IOP (venous stasis)
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13
Q

symptoms and signs of central retinal vein occlusion

A

Symptoms:
Sudden visual loss
Moderate to severe visual loss (6/9 – P of L)

Signs:
Retinal haemorrhages
Dilated tortuous veins
Disc swelling and macular swelling

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14
Q

treatment of central retinal vein occlusion

A

Based on treatment of systemic or ocular causes (eg hypertension, diabetes, glaucoma)

Monitor : may develop complications due to development of new vessels

  • laser treatment may be required to avoid complications from these vessels eg vitreous haemorrhage)
  • anti- VEGFs used (VEGF = vascular endothelial growth factor)
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15
Q

what colours do a central retinal vein and artery occlusion look like on fundoscopy?

A

artery occlusion - pale

vein occlusion - dark

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16
Q

what 2 types of ischemic optic neuropathy are there?

A

arteritic - GCA

non-arteritic - artherosclerosis

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17
Q

what do both types of ischemic optic neuropathy cause?

A

sudden, profund loss of vision with a swollen disc

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18
Q

how does giant cell arteritis cause ischemic optic neuropathy?

A

Lumen of artery becomes occluded (posterior ciliary arteries)

Visual loss from ischaemia of optic nerve head

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19
Q

symptoms of arteritic ischemic optic neuropathy

A 
Visual symptoms
Sudden visual loss
Profound (CF – NPoL)
Irreversible blindness
swollen disc
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20
Q

why is arteritic ischemic optic neuropathy important to diagnose?

A

immediate treatment may prevent bilateral visual loss

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21
Q

what are the symptoms of giant cell arteritis?

A 
Headache (usually temporal)
Jaw claudication
Scalp tenderness (painful to comb hair)
Tender/enlarged scalp arteries
Amaurosis fugax
Malaise
Very High ESR , PV and CRP
Temporal artery biopsy may help diagnosis
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22
Q

what treatment must be started quickly to prevent visual loss in other eye for giant cell arteritis?

A

corticosteroids, starting at 40-60mg prednisolone and gradually reducing. Steroid sparing agents such as methotrexate and azathioprine may be added.

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23
Q

what can cause vitrous hamorrhage?

A

retinal tear

bleeding from abnormal vessels

24
Q

signs and symptoms of vitrous haemorrhages

A 
Symptoms
     Sudden Loss of vision
      ‘Floaters’ 
Signs 
       Loss of red reflex
       May see haemorrhage on fundoscopy
25
Q

treatment for vitrous haemorrhages

A

Management
Identify cause
Vitrectomy for non-resolving cases

26
Q

cause for retinal detachment

A

Vitrous gel – when you get older the gel becomes more liquid based and then the vitrous can collapse and pull the retina with it – this causes the flashing
The floaters are due to epithelial cells getting pulled off by the retina and then you see these

27
Q

symptoms and signs of retinal detachment

A

Symptoms
Painless loss of vision
Sudden onset of flashes/floaters (mechanical separation of sensory retina from retinal pigment epithelium)

Signs
May have RAPD - relative afferent pupillary defect
May see tear on ophthalmoscopy

28
Q

management of retainal detachment

A

surgical

29
Q

symptoms and signs of wet age related macular degeneration

A

Symptoms
Rapid central visual loss
Distortion (metamorphopsia)

Signs
haemorrhage/exudate

30
Q

wet ARMD treatment

A

Previously:
Laser
Photodynamic therapy

Now:
Anti-VEGF treatment – injected into vitreous cavity. Stops new blood vessels growing by binding to VEGF (vascular endothelial growth factor)

31
Q

cause of wet ARMD

A

new vessels begin to grow in choroid body and these vessels leak which cause scarring and retina to be displaced from choroid

32
Q

causes of gradual visual loss

A 
CARDIGAN 
Cataract
Age related macular degeneration (dry type)
Refractive error 
Diabetic retinopathy
Inherited diseases e.g. retinitis pigmentosa 
Glaucoma 
Access (to eye clinic) Non-urgent
33
Q

what is cataracts?

A

cloudiness of lens

34
Q

causes of cataracts

A 
Many different causes
Age related
Congenital – intrauterine infection (importance of checking red reflex in neonates)
Traumatic
Metabolic – diabetes
Drug-induced (steroids)
35
Q

cataracts management

A

Management is surgical removal with intra-ocular lens implant if patient is symptomatic

36
Q

symptoms and signs of dry ARMD

A

Symptoms
Gradual decline in vision
Central vision ‘missing’ (scotoma)

Signs
Drusen – build up of waste
products below RPE - retinal pigment epithelium
Atrophic patches of retina

37
Q

treatment of dry ARMD

A

No cure – treatment is supportive with low vision aids eg magnifiers

38
Q

what is a refractive error?

A

the eye cannot focus clearly

39
Q

what is myopia?

A

short sighted

cannot see far away as lens is too powerful and brings things to focus before the retina

40
Q

what is hypermetropia?

A

long sighted

lens isnt powerful enough to focus close objects on the retina

41
Q

What causes unilateral, sudden vision loss?

A 
retinal artery embolisim
    retinal vein thrombosis
    vitreous haemorrhage (wet ARMD, retinal tear)
    temporal arteritis
    retinal detachment
    optic neuritis
    migraine
    acute glaucoma
42
Q

what causes bilateral, sudden vision loss?

A

bilateral occipital lobe ischaemia or infarction
bilateral occipital lobe trauma
severe bilateral papilloedema
rapidly progressive chiasmal compression
bilater optic nerve damage 3.g methyl alcohol poisoning
hysteria

43
Q

what causes unilateral, gradual vision loss?

A

asymmetic cateract development
choiroiditis
inferior retinal detachment
malignant melanoma of the choroid

44
Q

what causes bilateral, gragual visual loss?

A 
diabetic maculopathy
hypertensive retinopathy
cateracts
chronic glaucoma
Chiasmal or bilateral optic nerve compression
bilateral optic nerve damage
45
Q

What causes diabetic retinopathy?

A
  1. retinal capillary microaneurysms and excessive vascular permeability
  2. vascular occlusion and proliferation of new blood vessels and accompanying fibrous tissue
  3. contraction of fibrovascular proliferations and vitreous
46
Q

What are cotton wool spots?

A

cotton wool spots occur secondary to microvascular occlusion and represent retinal microinfarcts of the nerve fibre layer

47
Q

Some pathology that occurs in diabetic retinopathy

A

retinal thickening, oedema and hard exudates occur as a result of leakage from capillaries; hard exudates are composed of lipoprotein and lipid filled macrophages

Flame-shaped haemorrhages occur when the rupture of microaneurysms occurs at nerve level

blot haemorrhages occur if rupture of microaneurysms occur deep in the retina
48
Q

how could proliferative diabetic retinopathy cause sudden visual loss?

A

In PDR, the fibrovascular proliferation extends beyond the internal limiting membrane. The new vessels are leaky, fragile, and often misdirected. They may grow off the retina and into the vitreous. As the vitreous shrinks with age, it pulls on these fragile vessels and can cause them to tear, resulting in a vitreous haemorrhage and sudden vision loss.

These vessels may also scar down, forming strong anchors between the retina and vitreous causing traction on the retina. If enough force is created, a tractional retinal detachment may occur. This is another mechanism by which PDR can cause sudden vision loss. If the retina is not re-attached soon, especially if the macula is involved, vision may be permanently compromised.

49
Q

what is the most common cause of sudden vision loss in diabetic retinopathy?

A

macular oedema.
Macular oedema can occur in NPDR, but it is more common in more severe cases of DR due to the leakiness of the new blood vessels

50
Q

What is astigmatism?

A

usually irregular corneal curvature

51
Q

What is presbyopia?

A

weakening of the eye with age

52
Q

What is glucoma?

A

progressive optic neuropathy
Fluid builds up behind the iris and pushes the iris forward – sometimes so much that it shuts off the angle – this is acute glaucoma

53
Q

symptoms of acute glucoma

A

VERY painful, red eye/visual loss/headache/nausea/vomiting

54
Q

treatment of acute glucoma

A

need to lower IOP with drops/oral medications to stop blindness

55
Q

Symptoms and signs of open angle glucoma

A 
symptoms
   Often NONE  
    Optician may discover it
Signs
  Cupped disc
   Visual field defect
   May/may not have high IOP
56
Q

Treatment of open angle glucoma

A

eye drops, lasers, surgery to reduce IOP

opthalmology - vision loss (1 decks)

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