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Year 4 - Ophthalmology > Visual loss > Flashcards

Visual loss Flashcards

1
Q

visual loss can be sudden or gradual, give sudden causes

A 
vascular occlusion 
vitreous haemorrhage 
retinal detachment 
wet ARMD
closed angle glaucoma 
optic neuritis 
stroke
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2
Q

visual loss can be sudden or gradual, give gradual causes

A 
cataracts 
dry ARMD
open angle glaucoma 
refractive errors
diabetic retinopathy
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3
Q

what is the main arterial supply to the eye and what does it branch from

A

ophthalmic artery from the internal carotid artery

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4
Q

what are the branches of the ophthalmic artery and what do they supply

A

posterior ciliary arteries - head of optic nerve

central artery of the retina - inner 2/3rd retina

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5
Q

what is CRAO

A

central retinal artery occlusion

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6
Q

symptoms of CRAO

A

painless sudden loss of vision

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7
Q

signs of CRAO

A

RAPD
pale oedematous retina
cherry red spot at fovea
thin vessels

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8
Q

causes of CRAO

A

stroke
carotid artery disease
thromboembolic

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9
Q

types of CRAO

A

central
branch
amaurosis fugax

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10
Q

what is amaurosis fugax

A

transient CRAO
visual loss like a ‘curtain coming down’
no abnormalities on examination - rely on history
urgent stroke referral

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11
Q

what is CRVO

A

central retinal vein occlusion

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12
Q

symptoms of CRVO

A

sudden visual loss

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13
Q

CRVO is associated with Virchow’s triad, what are the elements of this

A

hypercoaguability
stasis
endothelial damage

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14
Q

signs of CRVO

A

retinal haemorrhages
dilated tortuous veins
swelling of disc and macula - oedematous
cotton wool spots = infarcts of nerve fibre layer

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15
Q

buzzword description of CRVO appearance

A

cheese on toast appearance

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16
Q

types of CRVO

A

central

branch

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17
Q

what is ischaemic optic neuropathy

A

occlusion of optic nerve head

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18
Q

what vessel is occluded in ischaemic optic neuropathy

A

posterior ciliary arteries

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19
Q

causes of ischaemic optic neuropathy

A

GCA

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20
Q

symptoms of ischaemic optic neuropathy

A

sudden visual loss
may be irreversible
GCA symptoms - headache, jaw claudication, scalp tenderness…

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21
Q

management of GCA with ocular involvement

A

high dose steroids ASAP

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22
Q

causes of intra ocular haemorrhage

A

diabetic retinal ischaemia
CRVO
Hypertensive disease

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23
Q

what do you call bleeding into the vitreous cavity

A

vitreous haemorrhage

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24
Q

signs and symptoms of vitreous haemorrhage

A

sudden loss of vision
floaters
loss of red reflex
haemorrhages on fundoscopy

25
Q

features of optic neuritis

A

painful loss of vision
associated with MS
RAPD
reduced colour vision

26
Q

pathology behind retinal detachment

A

vitreous gel becomes more like liquid and collapses in on itself pulling and tearing the retina away resulting in a mechanical separation of sensory retina from pigmented epithelium

27
Q

symptoms of retinal detachment

A

sudden painless loss of vision

sudden onset flashers and floaters

28
Q

signs of retinal detachment

A

RAPD

may see detachment

29
Q

risk factors for ARMD

A

smoking
age
genetics
diet

30
Q

in wet ARMD, which is lost first, central or peripheral vision

A

central vision is lost first

31
Q

pathology behind wet ARMD

A

neovascularisation under retina

new vessels are fragile and leaky and so can bleed under the retina

32
Q

symptoms of wet ARMD

A

rapid central visual loss

distortion aka metamorphopsia

33
Q

signs of wet ARMD

A

haemorrhages
exudate
drusen

34
Q

what is glaucoma

A

progressive optic neuropathy usually from raised intra ocular pressure from build up of aqueous humour

35
Q

symptoms of closed angle glaucoma

A 
painful red eye 
severe headache
N+V 
cloudy cornea 
dilated pupil 
peripheral vision lost first
36
Q

in closed angle glaucoma, which is lost first, central or peripheral vision

A

peripheral vision is lost first

37
Q

features of gradual visual loss

A

bilateral

asymmetrical

38
Q

CARDIGAN mneumonic for gradual visual loss

A 
cataracts 
ARMD dry 
refractive error 
diabetic retinopathy 
inherited 
glaucoma - open angle 
Access is Non urgent
39
Q

what are cataracts

A

cloudiness of lens from build up of proteins

there are many different types

40
Q

what investigation should be done in all babies to rule out congenital catarcts

A

red reflex

41
Q

symptoms of cataracts

A

gradual loss of vision uncorrected by glasses

glare from TV or street signs/lights

42
Q

management of cataracts

A

phacoemulsification and lens replacement surgery

43
Q

pathology behind dry ARMD

A

build up of drusen around macula which interrupts nutrient exchange damaging the retina

44
Q

symptoms of dry ARMD

A

gradual loss of vision

central vision missing - scotoma

45
Q

signs of dry ARMD

A

drusen

atrophic patches of retina

46
Q

what can you do to fix refractive error

A

get glasses

47
Q

features of open angle glaucoma

A

asymptomatic, found on screening
cupped optic disc (bigger cup, greater damage)
loss of peripheral vision
raised IOP

48
Q

what is the difference between a swollen optic disc and papilloedema

A

swollen optic disc can be from any cause

papilloedema is a swollen disc secondary to only raised ICP

49
Q

what should you suspect in patients with bilateral optic disc swelling

A

raised ICP due to SOL

50
Q

what is the normal ICP range

A

5-15mmHg

51
Q

the optic nerve is an extension of the brain and so is covered by the 3 layers of meninges, true or false

A

true

52
Q

what 3 components influence the ICP

A

brain
blood
CSF

53
Q

what happens as a consequence of chronic optic disc swelling

A

optic atrophy
atrophic and pale looking disc
visual loss –> blindness

54
Q

if there is horizontal visual loss, the vascular defect is infront/behind the optic chiasm

A

infront

55
Q

if there is vertical visual loss, the vascular defect is infront/behind the optic chiasm

A

behind

56
Q

causes of CRVO

A 
hypertension 
raised cholesterol 
myeloma - hyperviscosity 
inflammation 
Virchows triad
57
Q

management of wet ARMD

A

anti VEGF intra vitreal injections

58
Q

management of closed angle glaucoma

A

miopics and iridotomy with laser therapy

Year 4 - Ophthalmology (12 decks)

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