Visual loss

Question 1

What are the causes of papilloedema?

Answer 1

Increased intercranial pressure

• space occupying lesion
• mailigant hypertension
• Hydrocephalus
• hypercapnia

Question 2

What is Holmes-adie pupil?

Answer 2

Benign dilated pupil (80% are unilateral).

Question 3

How does vitreous haemorrhage present?

Answer 3

Sudden onset floaters in vision
Reddish tint to vision
Reduced red reflex
Recused visual acuity

Rx- exclude retinal detachment (uss)
Identify cause and treat abnormal vessels

Question 4

Whats the presentation of posterior vitreous detachment?

Answer 4

Acute onset floaters
Photopsia (flashing lights)
Ring of floaters/ hairs in the temporal side of central vision.
Normal visual acuity and fields

Rx- none

Question 5

How does retinal detachment present?

Answer 5

Curtain over vision
Straight lines appear curved (+ve amsler grid test)
Shadows move from peripheral vision to central vision

Rx- repair hole (or drain sub-retinal fluid),

Question 6

How is retinal detachment treated?

Answer 6

Holes treated with laser or cryotherapy

Retina Reattached by drainage of sub-retinal fluid and scleral buckle

Question 7

How does retinal artery occlusion present?

Answer 7

(Usually caused by atherosclerosis)
Sudden painless of vision 
Can be temporary (amaurosis fugax)
Fundoscopy 'cherry red spots' (ischemic retina) 
Afferent pupillary defect 

Rx- branch supportive treatment
Central - reduce intraoccular pressure, CO2 rebreathing (vasodilation)

Question 8

How does retinal vein occlusion present?

Answer 8

Often in pts. With hypertension or hyper viscosity (eg DM, myeloma, smoking)

On examination - flame haemorrhages, dilated tortuous vessels, swollen optic disc, cotton wool spots, RAPD-ischemic.

Question 9

How does atrophic macular degeneration present?

Answer 9

Dry with ‘drusen’

Currently no treatments. Just stop smoking and take high dose vitamins.

Question 10

How does exudative macular degeneration present?

Answer 10

Wet/ neovascular.
Choroidal neovascularisation
Sudden distrubance of central vision

Ix- fundus fluorescein angiogram
Rx - intravitrial anti-VEGF (eg ranibizumab), photocoagulation, photodynamic therapy

Question 11

What is the leading cause of visual loss in the elderly?

Answer 11

Age related macular degeneration

Question 12

How does giant cell arteritis/ temporal arteritis present?

Answer 12

Impaired visual acuity 2' to anterior ischemic optic neuropathy. 
Tender scalp, headache, neck ache, 
Jaw cladication
Mailaise, weight loss
Proximal myopathy 

Ix- ESR, CRP, temporal artery biopsy.
Rx- high dose steroids,

Question 13

How does optic neuritis present?

Answer 13

Unilateral swollen disc
Reduced vision
RAPD (relative afferent pupillary defect)

Think: multiple sclerosis (demyelinating inflammation)

Question 14

What is a relative afferent pupillary defect?

Answer 14

Non symmetrical response to the swinging light test

Therefore a defect is shown

Question 15

Transient disturbance in colour vision?

Answer 15

Optic neuritis (often MS)

Question 16

Pale retina causes?

Answer 16

Retinal artery occlusion

With red spot

Question 17

In a stroke with homonymous hemianopia in the defect contralateral or ipsilateral to the brain lesion?

Answer 17

Contralateral (same side effected as body)

Eg right weakness = right side HH

Question 18

Causes of central rential vein occulsion

Answer 18

Glaucoma
Polycythemia
Hypertension
Increases with age

Question 19

Causes of central retinal artery occulsion

Answer 19

Thromboembolism - eg atherosclerosis

Arteritis - eg temporal arteritis

Question 20

Stages of hypertensive retinopathy

Answer 20

1- tortuous vessels and silver wiring (increased light reflex)
2- av nipping
3- cotton wool spots and flame and blot haemorrhages
4- papillodema