vision loss (sudden) Flashcards
causes of sudden, painless vision loss
ischaemic or vascular (thrombis, occlusion, temporal arteritis) // vitreous haemorrhage // retinal detachment // retinal migraine
symptoms of amaurosis fugax
sudden curtain coming down
what causes amaurosis fugax
vascular occlusion of ICA, opthalamic, or retinal artery // TIA, stroke
what causes central retinal artery occlusion
thromboembolism (from athrosclerosis) or temporal arteritis
symptoms + fundoscope central retinal artery occlusion
sudden painless, unilateral vision loss // RAPD (swinging light) // cherry red spot on pale retina // thin vessels
RF Central retinal vein occlusion
age // HTN // cardiovascular disease // glaucoma // polycthaemia
symptoms + fundoscope Central retinal vein occlusion
sudden, painless loss of vision or acuity // widespread red fundus // disc swelling // torturous and bulging vessels // macular oedema
fundoscope branch retinal vein occlusion
limited area of fundus affected (occurs at atriovenous crossings)
mx Central retinal vein occlusion
oedema = intravitreal anti VEGF // retinal neovascularisation = laser
what causes ischaemic optic neuropathy
occlusion of posterior cilliary arteries (temporal arteritis)
fundoscopy ischaemic optic neuropathy
pale and swollen disc
what is vitreous haemorrhage
bleeding into vitreous humour from retinal vessel
causes vitreous haemorrhage
diabetes!!! // posterior vitreous detatchment // trauma
symptoms vitreous haemorrhage
painless vision loss or haze // red hue in vision // floaters or shadows // decreased visual acuity
invx vitreous haemorrhage
slit lamp + fundoscope = blood in vitreous // USS for retinal tear // flurescein angio = neovascularisation // orbit CT = globe injury
RF retinal detachment
diabetes // myopia (near sighted) // age // surgery // trauma
symptoms retinal detachment
starts peripherally (dark curtain)!!! // sudden, painless, progressive // new floaters or flashers // if macula affected reduced acuity
invx + fundoscopy retinal detachment
RAPD and loss of red reflex
when is retinal detachment reversible/ irreversible
irreversible when macula affected
mx retinal detachment
all new onset flashes/ floaters –> urgent ophthalmologist referral
post is posterior vitreous detachment
separation from vitreous membrane from retina
RF posterior vitreous detachment
age // myopic (near sighted)
symptoms posterior vitreous detachment
sudden floaters // flashes of vision // blurred vision // dark curtain descending down
invx posterior vitreous detachment
weiss ring // refer to ophthalmology
complication posterior vitreous detachment
progression to retinal detachment
mx posterior vitreous detachment
self limiting 6 months // if retinal tear –> surgery
RF closed angle glaucoma
hypermetropia (long sighted) // pupil dilated // aging
what is closed angle glaucoma
raised intraocular pressure with iris occluding trabecular meshwork so no outlet of aqueous humor
symptoms closed angle glaucoma
severe pain // decreased acuity // worse when mydriasis (dilated pupil) // red eye // halo around light // semi-dilated, non reactive pupil!!! // N+V
invx closed angle glaucoma
tonometry for IOP // slit lamp + gonioscopy
referral closed angle glaucoma
urgent
which eye drops can be used for closed angle glaucoma
combination of pilocarpine + timolol + apraclonidine
IV mx for closed angle glaucoma
acetazolamide (reduces aqueous secretions)
definite mx closed angle glaucoma
laser peripheral iridotomy
action pilocarpine
parasympathomimetic –> contriction of ciliary muscle –> constrict pulil –> open trabecular network
action timolol
decreased aqueous humour production
action apraclonidine
alpha2 agonist –> decrease aqueous humour production + increase uveoscleral outflow
action
