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YEAR 4 OPTHAM > Visual disturbance > Flashcards

Visual disturbance Flashcards

1
Q

What is blurred vision?

A

Loss of clarity or sharpness of vision

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2
Q

What are the main associated symptoms with blurred vision?

A

Visual loss
Double vision
Floaters

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3
Q

Main causes of blurred vision?

A

Refractive error: most common
Cataracts
Retinal detachment
Age related macular degeneration
Acute angle closure glaucoma
Optic neuritis
Amaurosis fugax

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4
Q

How do you assess for blurred vision?

A

Visual acuity with a snellen chart
- Pinhole occluders uses to check whether the blurring is due to refractive error. If blurring IMPROVES with pinhole, then likely due to refractive error

Visual Fields
Fundoscopy

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5
Q

Managment of blurred vision?

A

Depends on underlying cause.

If gradual onset and corrected with pinhole occluder–> optician review

Other pts seen by ophthalmology–> if associated sx such as visual loss or pain–> urgent

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6
Q

What is myopia?

A

Short sight

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7
Q

What is hypermetropia?

A

Long sight

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8
Q

What is astigmatism?

A

Refractive error characterised by a variation in the dioptric power of the eye from one meridian to another

Another definition: a defect in the eye or in a lens caused by a deviation from spherical curvature, which results in distorted images, as light rays are prevented from meeting at a common focus.

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9
Q

What causes myopia?

A

Long axial length and average cornea (most common)
OR
High power cornea with an average axial length

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10
Q

What causes hypermetropia?

A

Short axial length and average cornea

OR

low power cornea with an average axial length

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11
Q

What is asthenopia?

A

Frontal headache and intermittent blurry vision

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12
Q

What is presbyopia?

A

associated with older age
Declining amplitude of accommodation with age.

Better at focusing further away

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13
Q

How do you test visual acuity?

A

Snellen chart
6m test distance
6/6 is perfect vision.
Top number what pt can see vs what normal person can see at the bottom e.g 6/60 (pt can see at 6m what a normal person can see at 60m)

If pt can’t see at 6m, move them forward to 3m

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14
Q

What are cataracts?

A

Common eye condition where the lens of the eye gradually opacifies (cloudy)–> reduced/blurred vision

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15
Q

Who gets cataracts?

A

More common in women than men
Incidence increases with age

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16
Q

Causes of cataracts?

A

Normal ageing process- MOST COMMON

Other causes:
Smoking
increased alcohol consumption
Trauma
DM
Long-term corticosteroids
Radiation exposure
Myotonic dystropy
Metabolic disorders e.g. hypocalcaemia

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17
Q

Presentation of cataracts?

A

Gradual onset of:
Reduced vision
Fades colour vision- hard to distinguish
Glare
Halos around lights

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18
Q

Signs in a pt with cataracts?

A

Defect in red reflex. Cataracts prevent light getting to the retina–> defect

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19
Q

What is the red reflex?

A

Reddish- orange reflection seen through an ophthalmoscope when light in shone on the retina.

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20
Q

Investigations for cataracts?

A

Ophthalmoscopy: done after pupil dilation. Findings:normal fundus and optic nerve

Slit- lamp examination: visible cataracts

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21
Q

Classification of cataracts?

A

Nuclear: change lens refractive index, common in old age
Polar: localized, commonly inherited, lie in the visual axis
Subcapsular: due to steroid use, just deep to the lens capsule, in the visual axis
Dot opacities: common in normal lenses, also seen in diabetes and myotonic dystrophy

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22
Q

Management of cataracts?

A

Non-surgical:
Early stages- age-related cataracts can be managed conservatively by prescribing stronger glasses/contacts or by encouraging brighter lighting- will slow the progression

Surgical: only effective treatment for cataracts.
Removing cloudy lens and replacing it with an artificial one

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23
Q

What information do you need to give patients surrounding cataract surgery?

A

Prior: Information on refractive implications of various types of intraocular lenses

After: Patients should be advised on the use of eye drops and eyewear,, what to do if vision changes and the management of any other ocular problems.

24
Q

What are the complications following cataract surgery?

A

Posterior capsule opacification: thickening of the lens capsule

Retinal detachment
Posterior capsule rupture
Endophthalmitis: inflammation of aqueous and/or vitreous humour

25
Q

What is retinal detachment?

A

When the neurosensory tissue that lines the back of the eye comes away from its underlying pigment epithelium.

26
Q

Prognosis of retinal detachment?

A

Reversible cause of visual loss as long as it is recognised and treated before macula is affected.

If left untreated and symptomatic, retinal detachment–> permanent visual loss

Children–> poor prognosis

27
Q

What type of retinal detachment do diabetics face?

A

Tractional retinal detachment.
Breaks in retina due to traction by vitreous humour

28
Q

RF for retinal detachment?

A

Age
Previous surgery for cataracts (accelerates posterior vitreous detachment)
Myopia
eye trauma (boxing)
Family history
Previous hx of retinal break/detachment in either eye

29
Q

Presentation of retinal detachment?

A

New onset floaters (pigment cells entering the vitreous space) or flashers (traction in the retina)
Sudden onset, painless and progressive visual field loss–> curtain or shadow progressing to the centre of the visual field from the periphery

30
Q

Retinal detachment in children presentation?

A

Squint or white pupillary reflex

31
Q

Referral guidelines for ?retinal detachment?

A

Any pt with new onset flashes or floaters should be referred urgently (<24hrs) to an opphthalmologist for assessment

32
Q

Investigations for retinal detachment?

A

Visual acuity: may not be reduced in peripheral RD but if vision it is decrease, central retina probably affected

Swinging light test: may highlight relative afferent pupillary defect if optic nerve is involved.

Fundoscopy: red reflex lost and retinal folds may appear pale, opaque or wrinkled.

Slit lamp exam: retinal detachment, retinal break, vitreoretinal pathology (traction or presence of pigment)

Indirect ophthalmoscopy: Vitreous haemorrhage may be present.

33
Q

Causes of optic neuritis?

A

Multiple sclerosis
Diabetes
Syphilis

34
Q

Features of optic neuritis?

A

Unilateral decrease in visual acuity over hours/days
Poor colour discrimination- red desaturation
Pain worse on eye movement
Relative afferent pupillary defect
Central scotoma

35
Q

Management of optic neuritis?

A

IV methylprednisolone
Recovery usually takes 4-6 weeks

36
Q

Features of central retinal vein occlusion?

A

sudden painless loss of vision, severe retinal haemorrhages on fundoscopy

37
Q

RF for central retinal vein occlusion?

A

increasing age
hypertension
cardiovascular disease
glaucoma
polycythaemia

38
Q

Management of central vein occlusion?

A

the majority of patients are managed conservatively
indications for treatment in patients with CRVO include:
macular oedema - intravitreal anti-vascular endothelial growth factor (VEGF) agents
retinal neovascularization - laser photocoagulation

39
Q

Fundoscopy findings central retinal vein occlusion?

A

widespread hyperaemia
severe retinal haemorrhages - ‘stormy sunset’

40
Q

When do you use dye for the slit lamp?

A

To look at the front of the eye, therefore shows any corneal or conjunctival abnormalities

41
Q

types of retinal detachment?

A

Rhegmatogenous- separation due to a retinal discontinuity (break or tear)

Tractional- Proliferative membranes on the retinal surface or under it (less common). No break, but it may develop due to the traction

Serous/haemorrhagic- fluid/blood accumulates under the neuroretina and separates it

42
Q

RF for central retinal artery occlusion?

A

Hypertension
Diabetes mellitus
coronary artery disease
peripheral vascular disease

43
Q

Presentation of central retinal artery occlusion?

A

Acute monocular loss of portion of visual field (often inferior), likely to have central vision loss

44
Q

Examination findings for central retinal artery occlusion?

A

afferent pupillary defect, ‘cherry red’ spot on a pale retina

45
Q

What non-ophthalm investigations would you do for central retinal artery occlusion?

A

Lipid panel- elevated LDLs and triglycerides; reduced HDLs
Echo: valvular or intramural thrombi
PT time: elevated or normal
INR: elevated or normal
Clotting panel: may be abnormal in young patients

46
Q

What is ‘transient monocular visual loss’

A

Sudden, transient loss of vision that lasts less than 24 hrs

47
Q

What are the most common causes of sudden painless loss of vision?

A

Ischaemic/vasuclar
Vitreous haemorrhage
Retinal detachment
Retinal migraine

48
Q

Describe ischaemic/vascular causes for sudden loss of vision

A

Large artery disease (atherothrombosis, embolus, dissection),

small artery occlusive disease (anterior ischaemic neuropathy, vasculitis e.g. GCA),

venous disease

hypo perfusion

May represent a form of TIA- 300mg aspirin

49
Q

How does ischaemic neuropathy differ from central retinal artery occlusion?

A

Ischaemic neuropathy is due to occlusion of the short posterior ciliary arteries causing damage to the optic nerve

CRAO- central retinal artery occluded and no damage to the optic nerve but the aetiology may be the same (thromboembolism and arteritis)

50
Q

Causes of vitreous haemorrhage?

A

Diabetes, bleeding disorders, anticoagulants

51
Q

Features of vitreous haemorrhage?

A

Sudden visual loss, dark spots, may precede retinal detachment

52
Q

What is vitreous haemorrhage?

A

bleeding into the vitreous humour. It is one of the most common causes of sudden painless loss of vision.

53
Q

Causes of vitreous haemorrhage?

A

proliferative diabetic retinopathy (over 50%)
posterior vitreous detachment
ocular trauma: the most common cause in children and young adults

54
Q

Presentation of vitreous haemorrhage?

A

painless visual loss or haze
red hue in the vision
floaters or shadows/dark spots in the vision

55
Q

Signs in vitreous haemorrhage?

A

decreased visual acuity: variable depending on the location, size and degree of vitreous haemorrhage
visual field defect if severe haemorrhage

56
Q

Investigations in vitreous haemorrhage?

A

dilated fundoscopy: may show haemorrhage in the vitreous cavity
slit-lamp examination: red blood cells in the anterior vitreous
ultrasound: useful to rule out retinal tear/detachment and if haemorrhage obscures the retina
fluorescein angiography: to identify neovascularization
orbital CT: used if open globe injury

57
Q

Ddx sudden painless loss of vision?

A

Vitreous haemorrhage
Retinal detachment
Central retinal artery occlusion
Central retinal vein occlusion

YEAR 4 OPTHAM (17 decks)

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