Visual loss Flashcards
How would central retinal artery occlusion present?
Sudden, painless visual loss in one eye
What signs on examination would indicate a central retinal artery occlusion?
Cherry red spot at the macula
RAPD
Pale, oedematous retina
Thread-like retinal vessels
How is central retinal artery occlusion managed?
Ocular massage to change to branch retinal artery occlusion
Carotid Doppler to find source of clot
What is the diagnosis here?
Central retinal artery occlusion
What is the name given to transient central retinal artery occlusion?
Amaurosis fugax
How does amaurosis fugax present?
Transient painless visual loss lasting ~5 minutes
‘Like a curtain coming down’
What signs on fundoscopy would indicate central retinal vein occlusion?
Retinal haemorrhages
Dilated tortuous veins
Disc swelling and macular swelling
What is the diagnosis here?
Central retinal vein occlusion
How is central retinal vein occlusion managed?
Treat systemic cause e.g. hypertension, glaucoma
Monitor: complications may arise if new vessels develop
Anti-VEGf
What is ischaemic optic neuropathy?
Posterior ciliary arteries become occluded, resulting in infarction of the optic nerve head
What are the two kinds of ischaemic optic neuropathy?
Ateritic - inflammation
Non-arteritic - atherosclerosis
What signs on fundoscopy would indicate amaurosis fugax?
Normally no signs on fundoscopy
What is the management for amaurosis fugax?
Urgent referral to TIA clinic
Aspirin
What signs would indicate optic neuritis?
Sudden, profound visual loss
Swollen disc
What is the pathogenesis of arteritic ischaemic optic neuropathy?
Giant cell arteritis (GCA)
Medium to large sized arteries inflamed (multinucleate giant cells)
Lumen of artery becomes occluded (posterior ciliary arteries)
Visual loss from ischaemia of optic nerve head
What are the signs and symptoms of giant cell arteritis?
Headache (usually temporal)
Jaw claudication
Scalp tenderness (painful to comb hair)
Tender/enlarged
Scalp arteries
Amaurosis fugax
Malaise
What investigations should be done for giant cell arteritis?
ESR, PV and CRP (all raised in GCA)
Temporal artery biopsy
What is the treatment for visual loss due to giant cell arteritis?
Immediate high dose systemic steroid to prevent visual loss in the other eye
What is a vitreous haemorrhage?
Haemorrhage into the vitreous cavity
Where does haemorrhage occur from in the eye?
Abnomal vessels (i.e. neovascularisation or retinal ischaemia)
Retinal vessels
What are the symptom of vitreous haemorrhage?
Loss of vision
Floaters
What are the signs of vitreous haemorrhage?
Red eye
Loss of red reflex
How does retinal detachment present?
Painless loss of vision
Sudden onset flashes and floaters
What signs on examination would indicate retinal haemorrhage?
May have RAPD
May see tear on opthalmoscopy
What is the most common cause of blindness in the Western world in patients over 65?
Age-related macular degeneration
Which type of macular degeneration presents with sudden reduction in vision?
Wet
Which type of macular degeneration presents with a gradual reduction in vision?
Dry
What is the pathogenesis of wet age-related macular degeneration?
New blood vessels grow under retina
Leakage from these vessels causes build up of fluid/blood and eventually scarring
What are the symptoms of wet ARMD?
Rapid central visual loss
Metamorphosia/distortion
What signs on fundoscopy would indicate wet ARMD?
Haemorrage/exudate
New vessels
What is the treatment for wet ARMD?
VEGF injections into vitreous cavity
What is the treatment for symptomatic cataracts?
Surgical removal with intra-ocular lens implant
What are the symptoms of dry ARMD?
Central vision ‘missing’
Gradual visual loss
What is myopia?
Short-sighted refractive error
What is hypermetropia?
Long-sighted refractive error
What is astigmatism?
Usually irregular corneal curvature
What is presbyopia?
Loss of accomodation with ageing
What is the treatment for open-angle glaucoma?
Pressure-lowering eye drops
Occasionally surgery
Need monitoring in clinic
