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Ophthalmology > Visual Loss > Flashcards

Visual Loss Flashcards

1
Q

Name four diseases that cause sudden visual loss

A

ARDM
Bleeding
Closed angle glaucoma
Detached retina

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2
Q

Briefly describe the blood supply to the eye

A

Major blood supply to the eye are the branches to the ophthalmic artery

  • central retinal artery supplies inner 2/3rds of retina
  • posterior ciliary artery supplies the nerve head
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3
Q

What are the signs and symptoms of central retinal artery occlusion?

A 
Sudden painless visual loss
RAPD
Retina appears pale and oedematous 
Thread like vessels 
Cherry red spot
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4
Q

Why does the retina appear pale in CRAO?

A

Retina is normally transparent but becomes opaque when ischaemic

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5
Q

What is the cherry red spot?

A

Occurs at the fovea where the blood supply comes from the choroid so is not affected

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6
Q

What causes CRAO?

A

It is a type of stroke - carotid artery disease or embolus from the heart

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7
Q

Name two sub-types of CRAO

A
  • branch occlusion

- amaurosis fugax

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8
Q

What is amaurosis fugax?

A

Transient painless visual loss like a black curtain, occurs for around 5 minutes then goes away

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9
Q

Where must all patients with amaurosis fugax be referred to?

A

Stroke Clinic

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10
Q

Name the three components of virchows triad

A
  • endothelial damage (diabetes)
  • abnormal blood flow (hypertension)
  • hypercoaguable state (cancer)
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11
Q

What are the signs and symptoms of central retinal vein occlusion?

A 
Sudden visual loss
Haemorrhages
Dilated tortuous veins 
Disc and macular swelling 
Cotton wool spots
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12
Q

Why is CRVO thought to occur?

A

As people age the artery gets stiffer but the vein remains pliable so the artery puts pressure on the vein and can occlude it.

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13
Q

What creates the cotton wool spot appearance?

A

Nerve fibre infarction

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14
Q

Name the investigation used to look at the retina specifically

A

OCT

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15
Q

What is the name for occlusion of the optic nerve head circulation?

A

Ischaemic Optic Neuropathy

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16
Q

How does ischaemic optic neuropathy present?

A

Sudden painless vision loss with a pale swollen optic nerve

17
Q

What disease can cause ischaemic optic neuropathy?

A

Temporal arterities - posterior ciliary arteries become so inflamed that the lumen becomes occluded

18
Q

Where can bleeding occur from in vitreous haemorrhage?

A

Abnormal vessels - ischaemia in diabetes or new vessel formation in vein occlusion
Normal vessels - bridging of a retinal tear

19
Q

How will a vitreous haemorrhage present?

A

Loss of vision, floaters, loss of red reflex, haemorrhage may be seen on examination

20
Q

How will a retinal detachment present?

A

Painless loss of vision, flashes and floaters, RAPD, visible tear

21
Q

Why do patients with a retinal detachment see a flashing light?

A

Vitreous gets more watery with age and may collapse pulling in the retina - separation of the sensory retina and pigment epithelium means the patients sees a flashing light

22
Q

How is vision lost in wet ARMD?

A

New vessels grow under the retina and leakage of fluid through the RPE and Bruch’s membrane causes build up of fluid and scarring

23
Q

How will wet ARMD present?

A

Rapid central visual loss, distortion, haemorrhage (metamorphopsia), exudate

24
Q

What causes angle closure glaucoma?

A

Increased pressure gradient causes iris to bow forward to obstruct the trabecular meshwork

25
Q

How will angle closure glaucoma present?

A

Painful red swollen eye with visual loss, headache and nausea cloudy cornea and dilated pupil

26
Q

Name four diseases that cause gradual vision loss

A 
ARMD 
Blur (refractive error)
Cataract 
Diabetes 
Glaucoma
27
Q

What is cataract?

A

Cloudiness of the lens due to abnormal changes in crystallin lens proteins

28
Q

What can cause cataract?

A

Often age related by can be due to trauma, metabolic disease or congenital

29
Q

Name four types of cataract

A
  • nuclear
  • posterior sub capsular
  • christmas tree (polychromatic)
  • congenital
30
Q

How does cataract present?

A

Gradual visual loss

31
Q

When is surgery performed in a patient with cataract?

A

When they are symptomatic

32
Q

Describe the presentation of dry ARMD

A

Gradual decline in vision , scotoma (central vision missing), drusen below RPE with atrophy

33
Q

Why does atrophy occur in dry ARMD?

A

As outer retina relies on nutrients from choroid

34
Q

How is ARMD managed?

A

No cure only supportive treatment

35
Q

When is open angle glaucoma often diagnosed?

A

Routine check, often asymptomatic and it is an incidental finding

36
Q

What are the signs of open angle glaucoma?

A

Cupped disc due to loss of ganglion cells
Visual field defect
May have high IOP

Ophthalmology (12 decks)

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