Visual Loss Flashcards
What are the possible causes of sudden visual loss?
Vascular, retinal detachment, age-related macular degeneration (ARMD, wet type), closed angle glaucoma, optic neuritis, stroke
What are the vascular causes of sudden visual loss?
Occlusion of retinal circulation/optic nerve head circulation. Haemorrhage from abnormal blood vessels (e.g. DM, wet ARMD), retinal tear
What are the symptoms of central retinal artery occlusion?
Sudden visual loss, profound loss, painless
What are the signs of central retinal artery occlusion?
Pale oedematous retina, thread-like retinal vessels
What is the management of central retinal artery occlusion?
If presents within 24hr-ocular massage. Establish source of embolus-carotid doppler
What are the variants of retinal artery occlusion?
Branch RAO, amaurosis fugax
What are the symptoms of transient CRAO (amaurosis fugax)?
Transient painless visual loss, ‘like a curtain coming down’, lasts ~5 mins
What are the signs of transient CRAO (amaurosis fugax) ?
Abnormal to see on examination
What is the management of transient CRAO?
Immediate referral TIA clinic. Aspirin
What are the systemic causes of CRVO?
Atherosclerosis, hypertension, hyperviscosity
What are ocular causes of CRVO?
Raised IOP (venous stasis)
What are the symptoms of CRVO?
Sudden visual loss, moderate to severe visual loss (6/9-P of L)
What are the signs of CRVO?
Retinal haemorrhages, dilated tortuous veins, disc swelling and macular swelling
What is the treatment of CRVO?
Treat cause. Monitor-complications may develop. Anti VEGFs can be used
What nerves become occluded in ischaemic optic neuropathy?
Posterior ciliary arteries (PCA)
What are the 2 types of ischaemic optic neuropathy?
Arteritic 50%-inflammation, non-arteritic 50%- atherosclerosis
What is the pathogenesis of ischaemic optic neuropathy?
GCA occurs. Medium to large arteries inflamed (Multinucleate giant cells). Lumen of artery becomes occluded, visual loss from ischaemia of optic nerve head
What are the signs in ION?
Pale, swollen disc
What are the symptoms of ION?
Sudden visual loss, profound loss, irreversible blindness
How is ION treated?
Treat the GCA- high dose steroids
What is bleeding from abnormal vessels associated with?
Retinal ischaemia and new vessel formation e.g. after RVO or diabetic retinopathy
What is bleeding from normal vessels associated with?
Retinal tear
What are the symptoms of vitreous haemorrhage?
Loss of vision, floaters
What are the signs of vitreous haemorrhage?
Loss of red reflex, may see haemorrhage on fundoscopy
What is the management of vitreous haemorrhage?
Identify cause, vitrectomy for non-resolving cases
What are the symptoms of retinal detachment?
Painless loss of vision, sudden onset of flashes/floaters (mechanical separation of sensory retina from retinal pigment epithelium)
What are the signs of retinal detachment?
May have RAPD, may see tear on ophthalmoscopy
What is the management of retinal detachment?
Usually surgical
What is wet ARMD?
New blood vessels grow under retina, leakage causes build up of fluid/blood and eventually scarring
What are the symptoms of wet ARMD?
Rapid central visual loss, distortion (metamorphopsia)
What are the signs of wet ARMD?
Haemorrhage/exudate
What is the treatment for wet ARMD?
Anti-VEGF treatment-injected into vitreous cavity.
What are the causes of gradual visual loss?
CARDIGAN-Cataract, ARMD (dry), Refractive error, Diabetic Retinopathy, Inherited disease (e.g. retinitis pigmentosa), Glaucoma, Access (to eye clinic), Non-urgent
What are the causes of cataracts?
Age related, congenital (intrauterine infection, red reflex check in neonates), traumatic, metabolic-diabetes, drug-induced (steroids)
What is the management for cataracts?
Surgical removal with intra-ocular lens implant if symptomatic
What are the symptoms of dry ARMD?
Gradual decline in vision, central vision missing (scotoma)
What are the signs of dry ARMD?
Drusen-build up of waste products below RPE, atropic patches of retina
How is dry ARMD treated?
Supportive-magnifiers etc
What does glaucoma result in?
Progressive optic neuropathy
How do closed angle glaucoma patients present?
Painful, red eye, visual loss, headache, nausea, vomiting
How is closed angle glaucoma managed?
Need to lower IOP with drops/oral medication
What are the symptoms of open-angle glaucoma?
Often none-optician may find it
What are the signs of open-angle glaucoma?
Cupped disc, visual field defect, may or may not have high IOP
What is the management for open angle glaucoma?
Aim to preserve vision with eye drops/laser/surgery. Regular monitoring
