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Opthamology > Vision Loss and Blindness > Flashcards

Vision Loss and Blindness Flashcards

1
Q

List all causes of sudden vision loss.

A 
Vascular aetiology
Retinal detachment
Age related macular degeneration (ARMD) -wet type
Closed angle glaucoma	
Optic neuritis
Stroke
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2
Q

What provides the major blood supply to the eye?

A

various branches of OPHTHALMIC ARTERY

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3
Q

What vascular causes can lead to acute vision loss?

A

Occlusion of: - retinal circulation
- optic nerve head circulation

Haemorrhage from: - abnormal blood vessels (eg diabetes, wet ARMD)
- retinal tear

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4
Q

What are the signs of central retinal artery occlusion?

A

RAPD (relative afferent pupil defect)

Pale oedematous retina, thread-like retinal vessels

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5
Q

What are causes of central retinal artery occlusion?

A

Carotid artery disease

Emboli from the heart (unusual)

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6
Q

What is central retinal artery occlusion a type of?

A

stroke

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7
Q

How should you manage central retinal artery occlusion?

A

Ophthalmic management:
If presents within 24 hours,
Ocular massage (try to convert CRAO to BRAO)

Vascular management:
Establish source of embolus – carotid doppler

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8
Q

What are the 2 further variants of central retinal artery occlusion?

A

Branch retinal artery occlusion

Amaurosis fugax

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9
Q

What are the symptoms of Amaurosis fugax?

A

transient painless visual loss
‘like a curtain coming down’
lasts~5mins with full recovery

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10
Q

How should you manage Amaurosis fugax?

A

Immediate referral TIA clinic

Aspirin

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11
Q

Name the ocular cause of central retinal vein occlusion.

A

raised IOP (venous stasis)

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12
Q

What are the clinical signs of central retinal vein occlusion?

A

Retinal haemorrhages
Dilated tortuous veins
Disc swelling and macular swelling

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13
Q

What may be required in central retinal vein occlusion to avoid complications from new vessels formed eg vitreous haemorrhage)?

A

laser treatment
or more recently,
anti- VEGFs used

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14
Q

What is Occlusion of optic nerve head circulation also known as?

A

Also known as ‘Ischaemic optic neuropathy’

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15
Q

What happens in Occlusion of optic nerve head circulation?

A

Posterior ciliary arteries (PCA) become occluded, resulting in infarction of the optic nerve head
(PCA not end arteries)

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16
Q

What are the two types of Ischaemic Optic Neuropathy (ION)?

A

Arteritic 50% - inflammation (Giant Cell Arteritis)
Non-arteritic 50% - atherosclerosis
(Both cause sudden, profound visual loss with swollen disc)

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17
Q

What happens in arteritic ION?

A

Medium to large sized arteries inflamed (multinucleate giant cells)
Lumen of artery becomes occluded (posterior ciliary arteries)
Visual loss from ischaemia of optic nerve head

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18
Q

What is a sign of ION?

A

Pale, swollen disc

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19
Q

What are the visual symptoms of ateritic ION?

A

Sudden visual loss
Profound (CF – NPoL)
Irreversible blindness

20
Q

What are 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
21
Q

What can prevent the other eye going blind in ateritic ION?

A

Immediate high dose systemic steroid may prevent other eye going blind.

22
Q

What is bleeding from retinal vessels usually associated with?

A

retinal tear

23
Q

What is bleeding from abnormal vessels usually associated with?

A

with retinal ischaemia and new vessel formation eg after retinal vein occlusion or diabetic retinopathy

24
Q

What are the symptoms of a Vitreous Haemorrhage?

A

vision loss

floaters

25
Q

What are the signs of Vitreous Haemorrhage?

A

Loss of red reflex

No RAPD – unless associated with other pathology

26
Q

What are the symptoms of retinal tear?

A

Painless loss of vision

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

27
Q

Signs of retinal tear?

A

May have RAPD

May see tear on ophthalmoscopy

28
Q

What are the two types of macular degeneration?

A

dry (gradual reduction in vision)

wet (sudden reduction in vision)

29
Q

What happens in wet ARMD?

A

New blood vessels grow under retina – leakage causes build up of fluid/blood and eventually scarring

30
Q

What are the symptoms and signs of wet ARMD?

A

Symptoms
Rapid central visual loss
Distortion (metamorphopsia)

Signs
haemorrhage/exudate

31
Q

What is the treatment of wet ARMD?

A

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

32
Q

Is gradual vision loss usually bilateral or unilateral?

A

bilateral

33
Q

What does CARDIGAN stand for with regard to the causes of gradual vision loss?

A

Cataract
Age related macular degeneration (dry type)
Refractive error
Diabetic retinopathy (covered in other lecture)
Inherited diseases e.g. retinitis pigmentosa
Glaucoma
Access (to eye clinic) Non-urgent

34
Q

Give 5 causes of cataracts.

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

What is a Christmas tree cataract?

A

polychromatic cataract

36
Q

Management of cataracts?

A

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

37
Q

What are the symptoms and signs of dry ARMD?

A

Symptoms
Gradual decline in vision
Central vision ‘missing’

Signs 
Drusen – build up of waste 
	products below RPE
RPE changes – atrophy/
	hyperplasia
38
Q

What is the treatment for dry ARMD?

A

no treatment, just supportive management

39
Q

What is Myopia?

A

short sightedness

40
Q

What is Hypermetropia?

A

long sightedness

41
Q

What is Astigmatism?

A

usually irregular corneal curvature

42
Q

Presbyopia

A

long sightedness with age

43
Q

What happens in open angle glaucoma?

A

Intra ocular pressure increases gradually
Damage of retinal nerve fibres
Visual field contracts

44
Q

What are the signs of glaucoma (often no symptoms)?

A

Increased intraocular pressure
Cupped disc
Visual field defect

45
Q

Treatment of open angle glaucoma?

A

pressure-lowering eye drops or occasionally surgery

Opthamology (22 decks)

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