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Y2 OPHTHALMOLOGY > Visual Loss > Flashcards

Visual Loss Flashcards

1
Q

List the main causes of sudden visual loss

A 
Vascular - ischaemic optic neuropathy
Vitreous haemorrhage
Retinal detachment
Wet age-related macular degeneration
Closed-angle glaucoma
Optic neuritis
Stroke
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2
Q

What are the 2 main branches of the ophthalmic artery?

A

Central retinal artery

Posterior ciliary artery

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3
Q

Which part of the retina does the central retinal artery supply?

A

Inner 2/3 (including ganglion cells)

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4
Q

Which part of the retina does the posterior ciliary artery supply?

A

Outer 1/3 (photoreceptors, pigment layer)

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5
Q

Visual loss caused by central retinal artery occlusion is associated with pain. True/False?

A

False

Painless unless assoc. with GCA

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6
Q

Relative afferent pupillary defect is evident in central retinal artery occlusion. What is this?

A

When a light is shone on the right eye, the right eye constricts but the left eye dilates

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7
Q

Describe the appearance of the retina in central retinal artery occlusion

A 
Pale
Oedematous
Thread-like vessels
Swelling
NO BLOOD CAN GET INTO EYE
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8
Q

Outline ophthalmic management of central retinal artery occlusion within 24hrs

A

Ocular massage (try to convert CRAO into BRAO)

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9
Q

Outline vascular management of central retinal artery occlusion

A 
Carotid Doppler (establish source)
Manage risk factors
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10
Q

What is another name for transient central retinal artery occlusion?

A

Amaurosis fugax

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11
Q

Describe visual loss in amaurosis fugax

A

Transient/partial loss “like a curtain” that lasts up to 5mins with full recovery

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12
Q

Amaurosis fugax patients require immediate referral to which clinic? What medication should be prescribed?

A

TIA clinic

Aspirin

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13
Q

List causes of central retinal vein occlusion

A

Atherosclerosis
Hypertension
Hyperviscosity
Raised intra-ocular pressure

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14
Q

How does atherosclerosis cause central retinal vein occlusion?

A

Arterial thickening presses on vein to cause altered blood flow, resulting in stasis and occlusion

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15
Q

Describe the appearance of the retina in central retinal vein occlusion

A 
Haemorrhages
Dilated, tortuous veins
Disc swelling
Macular swelling
NO BLOOD CAN GET OUT OF EYE
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16
Q

Which growth factor may be suppressed as part of treatment for central retinal vein occlusion? What is the other management?

A

VEGF (anti-VEGF drugs)
Manage risk factors
Monitor for complications

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17
Q

The retina appears pale in central retinal artery occlusion and dark in central retinal vein occlusion. True/False?

A

True

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18
Q

Give another name for occlusion of the optic nerve head. Describe the appearance of the retina.

A

Ischaemic optic neuropathy

Pale swollen disc

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19
Q

Describe the pathogenesis of ischaemic optic neuropathy

A

Posterior ciliary arteries become occluded which results in infarction of the optic nerve head

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20
Q

What are the 2 types of ischaemic optic neuropathy?

A

Arteritic (painful, inflammation, GCA)

Non-arteritic (painless, atherosclerosis)

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21
Q

What are the 4 stages of visual loss, defined by testing?

A

Snellen chart
Counting fingers
Directional hand movement
Perception of light

22
Q

Blindness in giant cell arteritis is irreversible. True/False?

A

True

23
Q

List clinical features of giant cell arteritis

A 
Jaw claudication
Pulsating temporal artery
Temporal headache
Visual loss
Tender scalp (notice when combing hair)
Malaise
24
Q

List clinical signs of a vitreous haemorrhage

A

Sudden visual loss
Floaters
Loss of red reflex

25
Q

How is a vitreous haemorrhage managed?

A

Identify + treat cause

Vitrectomy for non-resolving cases

26
Q

List clinical features of retinal detachment. How does the retina appear? What is the management?

A 
Painless visual loss
Flashes of light, floaters
Relative afferent pupil defect
Tear on ophthalmoscopy
Surgical
27
Q

What is the commonest cause of blindness in the Western world in patients over 65?

A

Age-related macular degeneration (ARMD)

28
Q

What is the difference between the two types of ARMD?

A

Wet - sudden visual loss

Dry - gradual visual loss

29
Q

Describe the pathogenesis of wet ARMD

A

Angiogenesis under the retina with leakage/build up of fluid causing scarring

30
Q

Describe the appearance of the retina in wet ARMD. What is the main clinical symptom described?

A

Metamorphopsia causing distortion
Haemorrhage/ exudate
Rapid central loss of vision

31
Q

Outline management of wet ARMD

A

OCT
Laser and PDT (traditionally)
Anti-VEGF injection (nowadays)

32
Q

List the main causes of gradual visual loss (CARDIGAN)

A 
Cataract
ARMD (dry)
Refractive error
Diabetic retinopathy
Inherited diseases
Glaucoma
Access to eye-clinic is Non-urgent
33
Q

What is cataract? What are the clinical features?

A

Clouding of the lens
Gradual hazy/blurred loss of vision
Can’t be reduce with glasses
Glare

34
Q

Outline management of cataract

A

Surgical removal with intra-ocular lens implant if patient is symptomatic

35
Q

Drusen may be seen in dry ARMD. What is this? What are the other clinical features

A 
Waste products (yellow fat/protein deposits) below retinal pigment epithelium
Gradual appearance of central scotoma (central LOV)
36
Q

There is no cure for dry ARMD. True/False?

A

True

Supportive vision aids may help

37
Q

What is meant by refractive error?

A

Eye cannot clearly focus image

38
Q

What is myopia?

A

“Short-sightedness”

Light focuses in front of the retina (need a - lens)

39
Q

What is hypermetropia?

A

“Long-sightedness”

Light focuses behind the retina (need a + lens)

40
Q

What is astigmatism?

A

Eye is shaped like a rugby ball as opposed to a football

Irregular corneal curvature

41
Q

What is presbyopia?

A

Loss of visual accommodation with age (inability to focus on near objects due to stiff lens - need a + lens)

42
Q

What is glaucoma?

A

Progressive optic neuropathy, probably cause by raised IOP and fluid build-up

43
Q

Which type of glaucoma is an ophthalmic emergency - open or closed -angle?

A

Closed-angle

44
Q

List clinical features of closed-angle glaucoma

A

Painful red eye
Visual loss
Headache
Nausea, vomiting

45
Q

Describe the appearance of the optic disc in glaucoma

A

Cupped disc

46
Q

Describe the pathogenesis behind closed angle glaucoma

A

Aqueous humour increases in pressure due to iris/ lens resistance which obstructs the trabecular meshwork

47
Q

Outline management for glaucoma

A

Drops/ oral meds

Laser iridotomy

48
Q

Describe the pathogenesis of cataracts

A

Glucose converts to sorbitol which exerts osmotic effect to draw fluid in

49
Q

Open angle glaucoma is usually asymptomatic. True/ False?

A

True`

50
Q

Describe the pathogenesis behind open angle glaucoma

A

Angle is open but resistance to outflow of aqueous in trabecular meshwork

Y2 OPHTHALMOLOGY (11 decks)

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