Vision loss and blindness

Question 1

causes of sudden vision loss

Answer 1

vascular aetiology (haemorrhage or occlusion)
retinal detachment
wet ARMD
closed angle glaucoma
optic neuritis
CVA

Question 2

CRAO can be caused by __/ (unusually) __

Answer 2

carotid artery disease

emboli unusually

Question 3

signs and symptoms of CRAO

Answer 3

sudden profound vision loss
painless
RAPD (relative afferent pupil defect)
pale oedematous retina
thread like retinal arteries

Question 4

treatment of CRAO

Answer 4

if present within 24hrs = ocular massage (turn into BRAO)
carotid doppler to find source of emboli
manage risk factors for vascular disease

Question 5

feature on fundoscopy of BRAO

Answer 5

whitening around the branch

Question 6

transient CRAO aka

signs and symptoms

Answer 6

Amaurosis fugax
transient painless “curtain down” vision loss usually around 5 mins long
nothing abnormal on examination

Question 7

treatment for amaurosis fugax =

Answer 7

immediate referral to TIA clinic

aspirin

Question 8

CRVO can be caused by (4)

Answer 8

hbp
atherosclerosis
hyperviscosity (Virchows triad)
raised ICP causing venous stasis

Question 9

signs and symptoms of CRVO

Answer 9

mod-severe sudden vision loss (roughly 6/9)
retinal haemorrhages
dilated tortuous veins
disc and macular swelling

Question 10

treatment of CRVO

Answer 10

can use anti-VEGFs
treat underlying cause eg. hbp, ICP
laser Rx to stop neovascularisation haemorrhages

Question 11

ischaemic optic neuropathy aka

due to ___ occluded

Answer 11

occlusion of optic head circulation

Posterior ciliary arteries (PCA)

Question 12

1st type of ischaemic optic neuropathy (accounts for 50%) =
caused by ___
s+s
treatment

Answer 12

arterititic
GCA
sudden profound irreversible blindness
pale swollen disc
Rx = immediate high dose systemic steroids to prevent other eye going blind

Question 13

2nd type of ischaemic optic neuropathy (accounts for __%) =
caused by =
s+s =

Answer 13

non-arteritic
50%
atherosclerosis
sudden profound vision loss and swollen disc

Question 14

haemorrhage in the eye is often into the ___

Answer 14

vitreous cavity ie vitreous haemorrhage

Question 15

in eye: bleeding from abnormal vessels is usually due to _____ and from normal usually associated with ___

Answer 15

abnorm = retinal ischaemia and neovascularisation eg. post CRVO/diabetes
norm = retinal detachment

Question 16

s+s of vitreous haemorrhage

Answer 16

loss of vision suddenly
loss of red reflex
“floaters”

Question 17

treatment of non resolving vitreous haemorrhage

Answer 17

vitrectomy

Question 18

s+s of retinal detachment

Answer 18

painless sudden loss of vision
sudden onset flashes and floaters
maybe RAPD
may see tear on ophthalmoscope

Question 19

Rx of retinal detachment

Answer 19

Sx

Question 20

pathophysiology of wet ARMD

Answer 20

new vessels grow under retina => leak => fluid and blood build up and eventually cause scarring

Question 21

s+s of wet ARMD

Answer 21

rapid central vision loss
metamorphopsia
haemorrhage/exudate on fundoscopy

Question 22

Rx of wet ARMD

Answer 22

intra-vitreal anti-VEGF

Question 23

gradual visual loss usually present late if they have

Answer 23

visual field loss

Question 24

gradual visual loss usually present early if they have

Answer 24

decreased visual acuity

Question 25

causes of gradual visual loss

Answer 25

``` CARDIGAN Cataracts ARMD - dry Refractive error Diabetic retinopathy Inherited eg. retinitis pigmentosa Glaucoma Access to eye clinic Non-urgent ```

Question 26

causes of cataracts (5)

Answer 26

``` trauma age congenital (IU infection) diabetes steroids ```

Question 27

types of cataract (4)

Answer 27

nuclear posterior subcapsular Christmas tree/polychromatic congenital

Question 28

most common type of cataract | its feature

Answer 28

nuclear | hardened yellow lens nuclei

Question 29

starts as a small cloudy area on post of lens =

Answer 29

posterior subcapsular cataract

Question 30

christmas tree/polychromatic cataracts are associated with ___ or they are ___

Answer 30

myotonic dystrophy | idiopathic

Question 31

treatment of symptomatic cataracts

Answer 31

Sx removal and lens implant

Question 32

s+s of dry ARMD

Answer 32

gradual vision loss central vision missing (scotoma) Drusen ( waste build up behind retinal pigmented epithelium) atrophic patches of retina

Question 33

treatment of dry ARMD

Answer 33

low vision aids eg. magnifiers

Question 34

presentation of acute closed angle glaucoma

Answer 34

``` painful red eye / vision loss / headache / nausea / vomiting ```

Question 35

s+s of open angle glaucoma

Answer 35

usually no sympts | signs = cupped disc, visual field defect, raised IOP possibly

Question 36

Rx for glaucoma

Answer 36

decrease IOP by drugs/laser/Sx