Visual Loss

Question 1

What are the possible causes of sudden visual loss?

Answer 1

Vascular, retinal detachment, age-related macular degeneration (ARMD, wet type), closed angle glaucoma, optic neuritis, stroke

Question 2

What are the vascular causes of sudden visual loss?

Answer 2

Occlusion of retinal circulation/optic nerve head circulation. Haemorrhage from abnormal blood vessels (e.g. DM, wet ARMD), retinal tear

Question 3

What are the symptoms of central retinal artery occlusion?

Answer 3

Sudden visual loss, profound loss, painless

Question 4

What are the signs of central retinal artery occlusion?

Answer 4

Pale oedematous retina, thread-like retinal vessels

Question 5

What is the management of central retinal artery occlusion?

Answer 5

If presents within 24hr-ocular massage. Establish source of embolus-carotid doppler

Question 6

What are the variants of retinal artery occlusion?

Answer 6

Branch RAO, amaurosis fugax

Question 7

What are the symptoms of transient CRAO (amaurosis fugax)?

Answer 7

Transient painless visual loss, ‘like a curtain coming down’, lasts ~5 mins

Question 8

What are the signs of transient CRAO (amaurosis fugax) ?

Answer 8

Abnormal to see on examination

Question 9

What is the management of transient CRAO?

Answer 9

Immediate referral TIA clinic. Aspirin

Question 10

What are the systemic causes of CRVO?

Answer 10

Atherosclerosis, hypertension, hyperviscosity

Question 11

What are ocular causes of CRVO?

Answer 11

Raised IOP (venous stasis)

Question 12

What are the symptoms of CRVO?

Answer 12

Sudden visual loss, moderate to severe visual loss (6/9-P of L)

Question 13

What are the signs of CRVO?

Answer 13

Retinal haemorrhages, dilated tortuous veins, disc swelling and macular swelling

Question 14

What is the treatment of CRVO?

Answer 14

Treat cause. Monitor-complications may develop. Anti VEGFs can be used

Question 15

What nerves become occluded in ischaemic optic neuropathy?

Answer 15

Posterior ciliary arteries (PCA)

Question 16

What are the 2 types of ischaemic optic neuropathy?

Answer 16

Arteritic 50%-inflammation, non-arteritic 50%- atherosclerosis

Question 17

What is the pathogenesis of ischaemic optic neuropathy?

Answer 17

GCA occurs. Medium to large arteries inflamed (Multinucleate giant cells). Lumen of artery becomes occluded, visual loss from ischaemia of optic nerve head

Question 18

What are the signs in ION?

Answer 18

Pale, swollen disc

Question 19

What are the symptoms of ION?

Answer 19

Sudden visual loss, profound loss, irreversible blindness

Question 20

How is ION treated?

Answer 20

Treat the GCA- high dose steroids

Question 21

What is bleeding from abnormal vessels associated with?

Answer 21

Retinal ischaemia and new vessel formation e.g. after RVO or diabetic retinopathy

Question 22

What is bleeding from normal vessels associated with?

Answer 22

Retinal tear

Question 23

What are the symptoms of vitreous haemorrhage?

Answer 23

Loss of vision, floaters

Question 24

What are the signs of vitreous haemorrhage?

Answer 24

Loss of red reflex, may see haemorrhage on fundoscopy

Question 25

What is the management of vitreous haemorrhage?

Answer 25

Identify cause, vitrectomy for non-resolving cases

Question 26

What are the symptoms of retinal detachment?

Answer 26

Painless loss of vision, sudden onset of flashes/floaters (mechanical separation of sensory retina from retinal pigment epithelium)

Question 27

What are the signs of retinal detachment?

Answer 27

May have RAPD, may see tear on ophthalmoscopy

Question 28

What is the management of retinal detachment?

Answer 28

Usually surgical

Question 29

What is wet ARMD?

Answer 29

New blood vessels grow under retina, leakage causes build up of fluid/blood and eventually scarring

Question 30

What are the symptoms of wet ARMD?

Answer 30

Rapid central visual loss, distortion (metamorphopsia)

Question 31

What are the signs of wet ARMD?

Answer 31

Haemorrhage/exudate

Question 32

What is the treatment for wet ARMD?

Answer 32

Anti-VEGF treatment-injected into vitreous cavity.

Question 33

What are the causes of gradual visual loss?

Answer 33

CARDIGAN-Cataract, ARMD (dry), Refractive error, Diabetic Retinopathy, Inherited disease (e.g. retinitis pigmentosa), Glaucoma, Access (to eye clinic), Non-urgent

Question 34

What are the causes of cataracts?

Answer 34

Age related, congenital (intrauterine infection, red reflex check in neonates), traumatic, metabolic-diabetes, drug-induced (steroids)

Question 35

What is the management for cataracts?

Answer 35

Surgical removal with intra-ocular lens implant if symptomatic

Question 36

What are the symptoms of dry ARMD?

Answer 36

Gradual decline in vision, central vision missing (scotoma)

Question 37

What are the signs of dry ARMD?

Answer 37

Drusen-build up of waste products below RPE, atropic patches of retina

Question 38

How is dry ARMD treated?

Answer 38

Supportive-magnifiers etc

Question 39

What does glaucoma result in?

Answer 39

Progressive optic neuropathy

Question 40

How do closed angle glaucoma patients present?

Answer 40

Painful, red eye, visual loss, headache, nausea, vomiting

Question 41

How is closed angle glaucoma managed?

Answer 41

Need to lower IOP with drops/oral medication

Question 42

What are the symptoms of open-angle glaucoma?

Answer 42

Often none-optician may find it

Question 43

What are the signs of open-angle glaucoma?

Answer 43

Cupped disc, visual field defect, may or may not have high IOP

Question 44

What is the management for open angle glaucoma?

Answer 44

Aim to preserve vision with eye drops/laser/surgery. Regular monitoring