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Ophthalmology > Visual Loss > Flashcards

Visual Loss Flashcards

1
Q

What are the causes of SUDDEN visual loss?

A 
Vascular: retinal artery/vein occlusion, amaurosis fugax, ischaemic optic neuropathy
Vitreous haemorrhage
Retinal detachment
Age related macular degeneration (wet)
Acute angle closure glaucoma 
Optic neuritis
Giant cell arteritis
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2
Q

What are the causes of gradual visual loss?

A 
Cataract
Age related macular degeneration (dry)
Chronic open angle glaucoma
Diabetic retinopathy
Refractive error
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3
Q

What are the clinical features of central retinal artery occlusion (CRAO)?

A

Sudden, profound, painless vision loss
–> like a curtain coming down

RAPD
Pale, swollen retina with cherry red spot at macula
Thread like vessels

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4
Q

What are the causes of CRAO?

A

GCA –> always rule this out
Embolic e.g. heart valve, thrombus
Carotid artery disease

(it is a form of stroke)

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5
Q

How quickly must a CRAO be treated?

A

Only effective if treated within 12-24 hours

Although retina technically dies within 90 minutes

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6
Q

What are the treatment options for CRAO?

A

Aim to dislodge blockage + restore circulation:

  • ocular massage
  • paper bag breathing
  • IV Diamox
  • anterior chamber paracentesis
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7
Q

What does a branch retinal artery occlusion look like?

A

Only part of the retina affected –> pale window

May see the embolus on fundoscopy

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8
Q

What is amaurosis fugax?

A

Transient CRAO (like a TIA)

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9
Q

What are the features of amaurosis fugax?

A

Transient painless loss of vision –> like a curtain coming down
Lasts about 5 minutes with full recovery
Examination normal

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10
Q

What should be done for suspected amaurosis fugax?

A

Refer to stroke clinic

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11
Q

What are the clinical features of central retinal vein occlusion?

A

Sudden, painless visual loss
RAPD

Retinal flame haemorrhages (stormy sunset)
Tortuous vessels
Swollen disc
Cotton wool spots
Neovascularisation if longstanding
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12
Q

How is central retinal vein occlusion managed?

A 
No signs of ischaemia:
- observe every 3 months
Ischaemia but no neovascularisation:
- observe closely every 4-6 weeks
Ischaemia + neovascularisation:
- urgent argon laser pan-retinal photocoagulation
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13
Q

What is ischaemic optic neuropathy?

A

Occlusion of the optic nerve head circulation –> infarction of the optic nerve head

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14
Q

Which arteries are occluded in ischaemic optic neuropathy?

A

Posterior cilliary arteries

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15
Q

Which condition must be ruled out as the cause of ischaemic optic neuropathy?

A

Giant cell arteritis

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16
Q

Where does the bleeding come from in a vitreous haemorrhage?

A

Abnormal vessels:
- e.g. retinal ischaemia in DM or CRVO –> new, fragile vessels

OR normal retinal vessels:
- e.g. bridging a retinal tear

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17
Q

What are the features of a vitreous haemorrhage?

A

Loss of vision
Floaters
Loss of red reflex
May see haemorrhage on fundoscopy

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18
Q

What are the features of retinal detachment?

A

Persistent flashing lights
Burst of new floaters
Dark shadow in peripheral vision, increasing in size

19
Q

How does retinal detachment occur?

A

Most commonly due to separation of vitreous gel from retina

- traction –> retinal tear –> detachment

20
Q

How is a retinal detachment managed?

A

If picked up early as a tear –> laser therapy

If retina detached –> surgery required

21
Q

What are the surgical options for repairing a retinal detachment?

A

Most common:
- internal approach with vitrectomy/laser or cryotherapy/bubble of gas to act as tamponade

In very young patients:
- external approach with scleral bubble

22
Q

What are the symptoms of optic neuritis?

A

Variable loss of vision over a few days
Washed out colour vision
Dull ache on eye movements

23
Q

What might be seen on examination of a patient with optic neuritis?

A 
Decreased visual acuity
RAPD
Reduced colour vision
Increased blind spot
Optic disc swelling
24
Q

What is the most common cause of optic neuritis?

A

MS

25
Q

What is the most common cause of blindness in the western world?

A

Age related macular degeneration (ARMD)

26
Q

How do macular problems affect vision?

A

Cause changes in CENTRAL vision

27
Q

What causes dry ARMD?

A

Wear and tear of retinal pigment epithelium

28
Q

What are the clinical features of dry ARMD?

A

Gradual decline in VA
Central vision missing –> scotoma
Drusen - build up of waste products below retinal epithelium
Atrophic patches of retina

29
Q

What is the management for dry ARMD?

A

Supportive (no active treatment):

  • visual aids
  • dietary/smoking advice
  • Amsler grid
  • blind registration
30
Q

What causes wet ARMD?

A

Eye grows new blood vessels (neovascularisation) within the macula to ‘repair’ dry ARMD
- vessels then leak fluid or bleed into retinal tissue

31
Q

What are the clinical features of wet ARMD?

A

SUDDEN devastating drop in central VA
Associated metamorphopsia (distortion)
Haemorrhage + exudate

32
Q

Which investigations may be done for wet ARMD?

A

Ocular coherence tomography (OCT)

Fundus fluorescence angiography

33
Q

What is the treatment for wet ARMD?

A

Intravitreal injection of anti-VEGF (Ranibizumab)

34
Q

How does anti-VEGF work?

A

Aborts growth of abnormal vessels
Shrinkage of neovascular membrane
Reduced fluid leakage/bleeding into tissue

35
Q

What is a cataract?

A

Cloudiness of the lens –> gradual blurring of vision

36
Q

What are the causes of cataract?

A 
Age related (most common)
Congenital
Traumatic (blunt or penetrating injury)
Metabolic (diabetes)
Drug induced (steroids)
Intra-uterine infection (rubella, CMV, toxoplasmosis)
37
Q

What is the treatment for cataract?

A

Surgery: phaco-emulsification with intra-ocular lens implantation

38
Q

How does cataract surgery work?

A

Phaco breaks up cataract using ultrasound
Lens fragments removed portion by portion
Artificial IOL inserted
Wounds are self healing

39
Q

What are the different types of refractive error?

A

Myopia
Hypermetropia
Astigmatism
Presbyopia

40
Q

What does myopia mean?

A

Short sighted (can’t see far away)

41
Q

What does hypermetropia mean?

A

Long sighted (can’t see near)

42
Q

What does presbyopia mean?

A

Age related loss of accommodation

43
Q

What is astigmatism?

A

Irregular corneal curvature –> light not focused evenly on retina

44
Q

What is the management for refractive error?

A

Glasses/contact lenses

Ophthalmology (12 decks)

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