Vision loss and blindness Flashcards
causes of sudden vision loss
vascular aetiology (haemorrhage or occlusion) retinal detachment wet ARMD closed angle glaucoma optic neuritis CVA
CRAO can be caused by __/ (unusually) __
carotid artery disease
emboli unusually
signs and symptoms of CRAO
sudden profound vision loss painless RAPD (relative afferent pupil defect) pale oedematous retina thread like retinal arteries
treatment of CRAO
if present within 24hrs = ocular massage (turn into BRAO)
carotid doppler to find source of emboli
manage risk factors for vascular disease
feature on fundoscopy of BRAO
whitening around the branch
transient CRAO aka
signs and symptoms
Amaurosis fugax
transient painless “curtain down” vision loss usually around 5 mins long
nothing abnormal on examination
treatment for amaurosis fugax =
immediate referral to TIA clinic
aspirin
CRVO can be caused by (4)
hbp
atherosclerosis
hyperviscosity (Virchows triad)
raised ICP causing venous stasis
signs and symptoms of CRVO
mod-severe sudden vision loss (roughly 6/9)
retinal haemorrhages
dilated tortuous veins
disc and macular swelling
treatment of CRVO
can use anti-VEGFs
treat underlying cause eg. hbp, ICP
laser Rx to stop neovascularisation haemorrhages
ischaemic optic neuropathy aka
due to ___ occluded
occlusion of optic head circulation
Posterior ciliary arteries (PCA)
1st type of ischaemic optic neuropathy (accounts for 50%) =
caused by ___
s+s
treatment
arterititic GCA sudden profound irreversible blindness pale swollen disc Rx = immediate high dose systemic steroids to prevent other eye going blind
2nd type of ischaemic optic neuropathy (accounts for __%) =
caused by =
s+s =
non-arteritic
50%
atherosclerosis
sudden profound vision loss and swollen disc
haemorrhage in the eye is often into the ___
vitreous cavity ie vitreous haemorrhage
in eye: bleeding from abnormal vessels is usually due to _____ and from normal usually associated with ___
abnorm = retinal ischaemia and neovascularisation eg. post CRVO/diabetes norm = retinal detachment
s+s of vitreous haemorrhage
loss of vision suddenly
loss of red reflex
“floaters”
treatment of non resolving vitreous haemorrhage
vitrectomy
s+s of retinal detachment
painless sudden loss of vision
sudden onset flashes and floaters
maybe RAPD
may see tear on ophthalmoscope
Rx of retinal detachment
Sx
pathophysiology of wet ARMD
new vessels grow under retina => leak => fluid and blood build up and eventually cause scarring
s+s of wet ARMD
rapid central vision loss
metamorphopsia
haemorrhage/exudate on fundoscopy
Rx of wet ARMD
intra-vitreal anti-VEGF
gradual visual loss usually present late if they have
visual field loss
gradual visual loss usually present early if they have
decreased visual acuity
causes of gradual visual loss
CARDIGAN Cataracts ARMD - dry Refractive error Diabetic retinopathy Inherited eg. retinitis pigmentosa Glaucoma Access to eye clinic Non-urgent
causes of cataracts (5)
trauma age congenital (IU infection) diabetes steroids
types of cataract (4)
nuclear
posterior subcapsular
Christmas tree/polychromatic
congenital
most common type of cataract
its feature
nuclear
hardened yellow lens nuclei
starts as a small cloudy area on post of lens =
posterior subcapsular cataract
christmas tree/polychromatic cataracts are associated with ___ or they are ___
myotonic dystrophy
idiopathic
treatment of symptomatic cataracts
Sx removal and lens implant
s+s of dry ARMD
gradual vision loss
central vision missing (scotoma)
Drusen ( waste build up behind retinal pigmented epithelium)
atrophic patches of retina
treatment of dry ARMD
low vision aids eg. magnifiers
presentation of acute closed angle glaucoma
painful red eye / vision loss / headache / nausea / vomiting
s+s of open angle glaucoma
usually no sympts
signs = cupped disc, visual field defect, raised IOP possibly
Rx for glaucoma
decrease IOP by drugs/laser/Sx
