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Ophthalmology > Vision loss - occlusions (all occlusions sudden vision loss) > Flashcards

Vision loss - occlusions (all occlusions sudden vision loss) Flashcards

1
Q

What are the causes of sudden vision loss (hint split the causes into painful and painless causes)

A

Note

  • Closed angle glaucoma
  • Optic neuritis
  • Stroke

Are discussed in other flashcards

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2
Q

What are some of the types of occulsion of the blood supply that can result in sudden vision loss ?

A

CRAO, CRVO, or occulsion of the branches

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3
Q

What are some of the causes of haemorrhage which results in sudden vision loss?

A
  • Due to abnormal blood vessels (e.g. diabetes, wet ARMD)
  • Retinal tears
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4
Q

What are the symptoms/signs of a CRAO (central retinal artery occlusion) ?

A

Symptoms:

  • Sudden vision loss - within seconds
  • Painless

Signs:

  • Afferent pupillary defect
  • Retina appears white
  • Cherry red spot at the macula
  • Thread like retinal vessels
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5
Q

What could potentially have caused the appearance of this retina ?

A

CRAO

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6
Q

What are the underlying causes of CRAO’s?

A
  • GCA (always rule this out)
  • Embolic - Calcific heart valves, Vegetations, Thrombus
  • Carotid Artery disease
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7
Q

What is the acute management of CRAO’s if presenting within 24hrs of onset of symptoms?

A
  • Occular massage,
  • Paper bag breathing
  • IV Diamox (acetazolemide)

to try convert it from a CRAO to a BRAO

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8
Q

What is the more chronic management of CRAO ?

A
  • Carotid doppler to find the source of emboli
  • Antihypertensive treatment
  • Hyperbaric oxygen
  • Surgical removal of aqueous from anterior chamber
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9
Q

Note that CRAO is a form of stroke

There are 2 further types of arterial occlusions relating to the eye what are they ?

A

BRAO and Amaurosis fugax

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10
Q

What are the symptoms/signs of amaurosis fugax ?

A

Symptoms:

  • Transient painless visual loss - no more than 5 mins
  • Like a curtain coming down
  • 90% of time visual acutiy is worse

Signs:

  • Usually nothing to be seen
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11
Q

What does amuarosis fugax require ?

A

Immediate referal to TIA clinic

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12
Q

How can CRAO’s be defined as ?

A
  • They are ischaemic attacks
  • Therefore amaurosis fugax can be defined as a transient ischaemic attack (TIA)
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13
Q

What are the causes of CRVO’s?

A
  • Atherosclerosis
  • Hypertension
  • Hyperviscosity
  • Raised IOP - due to gluacomas
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14
Q

What are the signs/symptoms of CRVO’s?

A

Symptoms:

  • Sudden vision loss - precieved by the patient as sudden but is less sudden that CRAO
  • Reduced visual acuity

Signs:

  • Retinal haemorrhages
  • Dilated tortuous veins (have a lot of bends)
  • Disc swelling and macular swelling
  • Cotton wool spots
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15
Q

What could the appearance of the fundoscope shown be due to ?

A

CRVO

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16
Q

What investigation is done to diagnose CRVO?

A

Fluorescence angiogram

17
Q

What is the treatment of CRVO’s?

A
  • If no signs of ischaemia - observe (every 3 months initially then less frequently)
  • If ischaemic but no neovascularition - observe closely (every 4-6 weeks )
  • If ischaemic with neovascularisation – requires urgent argon laser pan-retinal photocoagulation
18
Q

Compare the fundoscope appearance of CRVO and CRAO

A
19
Q

What is ischaemic optic neuropathy ?

A

Where the posterior ciliary arteries (PCA) become occluded due to inflammation or atheroma, resulting in infarction of the optic nerve head

20
Q

What are the 2 types of ischaemic optic neuropathy ?

A
  1. Arteritic 50% - inflammation (GCA)
  2. Non-arteritic 50% - atherosclerosis
21
Q

What are the visual symptoms/signs of ischaemic optic neuropathy ?

A

Symptoms:

  • Sudden profound vision loss
  • Irreversible blindness

Signs:

  • Pale, swollen disc
22
Q

Describe the pathogenesis of arteric ischaemic optic neuropathy

A
  • GCA caused inflammation of medium to large sized arteries
  • This results in occlusion of the arteries
  • Posterior cilliary arteries become occluded and therefore ischamia of the optic head
23
Q

What are the key symptoms (not visual ones) that suggest arteric ischaemic optic neuropathy ? (think GCA)

A
  • Headache
  • Jaw claudication
  • Scalp tenderness
  • Tender enlarged scalp arteries
  • Very High ESR , PV and CRP
24
Q

What is the risk in a patient who has gone blind in one eye due to arteric ischaemic optic neuropathy ?

A

That they will go blind in the other eye

25
Q

What is the management of arteric ischaemic optic neuropathy i.e. if someone has GCA?

A
  • Steroids immediately
  • Immediately refer to ophthalmology
26
Q

What is optic neuritis ?

A

Inflammation of the optic nerve

27
Q

What are the causes of optic neuritis ?

A
  • multiple sclerosis
  • diabetes
  • syphilis
28
Q

What are the clinical features of optic neuritis ?

A

Symptoms:

  • Variable loss of vision, usually over few days
  • Washed out colours
  • Dull ache on eye movements

Signs:

  • Decreased VA over hrs to days
  • RAPD
  • Decreased colour vision
  • Enlarged blind spot
  • Optic disc swelling (not in retrobulbar neuritis)
  • Central scotoma
29
Q

What is the treatment of optic neuritis ?

A

High-dose IV steroids - recovery usually takes 4-6 weeks

30
Q

What investigation should be considered in someone with optic neuritis ?

A

MRI - if > 3 white-matter lesions, 5-year risk of developing multiple sclerosis is c. 50%

31
Q

What is a RAPD a test of ?

A
  • Test of optic nerve function or global retinal function
  • Not reduced in macular disease

Ophthalmology (23 decks)

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