Visual loss Flashcards
causes of sudden visual loss (6)
-vascular retinal detachment (wet) age related macular degeneration closed angle glaucoma optic neuritis stroke
vascular causes (4)
occlusion of: retinal circulation OR optic nerve head circulation
haemorrhage: abnormal vessels or retinal tear
central retinal artery occlusion
- presentation (5)
- cause
- management
-sudden profound visual loss
painless
RAPD
pale oedematous retina with thread like vessels, small normal area due to coriodal circulation
-carotid artery disease- emboli of cardiac origin
-ocular massage
find source of emboli and manage risk factors
Amaurosis fugax
- what is it
- presentation
- management
- transient central retinal artery occlusion
- transient visual loss for less than 5 mins with no abnormal findings
- Refer to TIA clinic and give aspirin
Central retinal vein occlusion
- causes (systemic (3) and ocular (2))
- presentation (5)
- treatment
- compliactions
- systemic: atherosclerosis, hypertension, hyper-viscoscity
ocular: raised ICP causing venous stasis
-sudden visual loss, moderate to severe retinal haemorrhages dilated torturous veins Disc and macular swelling cotton wool spots
-based on cause
monitor for neovascularisation & vitrous haemorrhage
-retina is ischaemic and gives off VEGF which stimulates the growth of new ineffective vessels, these can grow into ant chamber and pull retina off
Occlusion of optic nerve head circulation
- also called
- name the 2 types and give examples
- presentation
-ischeamic optic neuropathy
-Arteritic: GCA
non-Arteritic: atherosclerosis
-sudden, profound viusal loss
Giant cell arterities
- pathogenesis in relation to ION
- signs
- symptoms
- management
-medium/large arteries inflamed due to multinucleate giant cells
lumen of the pos ciliary arteries becomes occluded and causes visual loss due to optic nerve ischeamia
-pale swollen disc
-headache jaw claudication scalp tenderness tender/enlarged temporal arteries amaurosis fugax malaise V high ESR, PV, CRP
-immediate high dose systemic steroids
Haemorrhage
- most commonly into where
- can occur in normal and abnormal vessels- assoc
-vitreous haemorrhage
-abnormal- retinal ischaemia and new vessel formation
normal- retinal tear
Vitreous haemorrhage
- presentation
- management
symptoms: loss of vision and floaters
signs: loss of red reflex and haemorrhage viable on fundoscopy
-identify cause
vitrectomy if non-resolving
Retinal detachement
- presentation
- management
-painless loss of vision,
symptoms: sudden onset of flashes/floaters
signs: may have RAPD
tear on opthalmoscopy
-surgical
pathogenesis of a retinal tear
mechanical separation of the sensory retina from retinal pigment can occur
vitrous gel becomes more liquid and collapses so it can tug at the retina and cause flashes or a tear in the retina
liquid can seep into the tear and peel the retina off
defect in vision is on the opposite side of tear
Age related macular degeneration
-name the types
-wet (sudden VL) and dry (gradual VL)
wet ARMD
- what is it
- presentation
- treatment
-new vessels grow under the retina and begin to leak
leakage causes build up of fluid/blood, leading to scarring
-rapid central visual loss and distortion
haemorrhages and exudate around the macula
-anti VEGF injections into citrous gel
Causes of visual loss
CARDIGAN C-cataract A-age related MD (dry) R- refractive error D- diabetic retinopathy I-inherited condition G- glaucoma Access to clinic Non-urgent
Cataract
- what is it
- causes (5)
- types (4)
- management
-opacity of the lense
causes loss of the red reflex
-age congenital traumatic metabolic (diabetes) Drug induced (steroids)
-nuclear cataract
posterior subcapsular cataract
christmas tree cataract
congenital
-surgical removal and intra-ocular lense implant
