Vision Loss Flashcards
Name 6 important parts of a patients history regarding vision loss?
Speed of onset Painfulness Extent of loss Associated symptoms Padt ocular history Past medical history
Name 4 causes of gradual vision loss
Cataract
Age related macular degeneration
Chronic open angle glaucoma
Diabtetic retinopathy
What are common causes of cataracts?
Age Congenital Trauma Metablolic Drugs Intra-uterine infections
Name 4 subtypes of cataract?
Nuclear sclerotic
Cortical (snowflake)
Posterior Subcapsular
Mature (white)
What were previous treatments for cataracts?
Intra-capsular cataract extraction (ICCE)
Extra-capsular cataract extraction (ECCE)
What is the routine treatment for cataracts nowadays?
Phaco-emulsification with intra-ocular lens implantation
What type of vision loss occurs with macular degeneration?
Central vision
Describe dry age related macular degeneration?
Wear and tear of retinal pigment epithelium (RPE)
Deposition of druse and RPE hypo/hyperpigmentation
Slow, progressive drop in central VA
What can help with dry age related macular degeneration?
Low visual aids
Dietary/smoking advice
Amsler grid
Blind registration
Describe wet age related macular degeneration?
Eye grows new blood vessels within macula to try and repair dry macular degeneration.
Vessels leak fluid into retinal tissue
Sudden drop in central VA
Assoc. metamorphopsia
What investigations can be done for wet age related macular degeneration?
Ocular Coherance Tomography (OCT)
Fundus Flourescene Angiography (FFA)
How do you treat wet age related macular degeneration?
Anti-VEGf e.g. Ranibizumb (lucentis)
Monoclonal antibodies
Inhibiting the growth of new vessels
Argon lasers and photo-dynamic therapy
What are painless causes of sudden visual loss?
Central retinal artery occlusion Central retinal vein occlusion Ischaemic optic neuropathy Amaurosis fugax Retinal detachment Vitreous haemorrhage
What are painful causes of sudden visual loss?
Acute angle closure glaucoma
Optic neuritis
Giant cell arthritis
Describe central retinal artery occlusion
Sudden, profound loss <6/60
RAPD
Pale, swollen retina with cherry red spot at macula
What are causes of central retinal artery occlusion?
GCA
Embolic - calcific heart valves, vegetations
thrombus
What is the treatment for CRAO?
Only effective within 12-24hrs Occular massage Paper bag breathing IV Diamox Anterior chamber paracentesis
What are the features of central retinal vein occlusion?
Moderate to severe visual loss RAPD Retinal flame haemorrhages (stormy sunset) Tortuous vessels Swollen disc Cotton wool spots Neovascularisation (if longstanding)
How do you treat CRVO?
no ischaemia - observe every 3 months
Ischaemia but no neovascularisation - observe every 4-6 weeks
Neovascularisation and ischeamia - Urgent argon laser pan-retinal photocoagulation
What should be ruled out with Anterior Ischaemic Optic Neuropathy (AION)?
GCA
How does no artertic AION present?
45-65 years
Hypermetropes with small crowded optic discs
smokers
What symptoms occur with a retinal detachment?
Persisting flashing lights
Burst of new floaters
Dark shadow in peripheral vision, increasing in size
In who is a retinal detachment more common in?
Myopes
What surgical procedures can help a detached retina?
Scleral buckle
Internal approach with vitrectomy/laser or cryotherapy/ bubble of gas to act as internal tamponade - posture needs to be correct for 10 days to position bubble correctly.
Symptoms of optic / retrobulbar neuritis?
Loss of vision over few days
Washed out colours
Dull ache on eye movements
Signs optic / retrobulbar neuritis?
Decreased VA RAPD Decreased colour vision Enlarged blind spot Optic disc swelling (not in retrobulbar)
How do you treat optic / retrobulbar neuritis?
Interferon B Not steroids (may worsen)
Describe Horner’s syndrome?
Paralysis of sympathetic supply to eye
Mild ptosis
Constricted pupil which does not dilate
Reduced ipsilateral sweating
What are causes of Horner’s syndrome?
Pancoast tumours Carotid /Aortic aneurysms Lesions of neck Congenital Idiopathic
