Visual Loss Flashcards by Ben Young

List the main causes of sudden visual loss

Vitreous haemorrhage
Retinal detachment
Wet age-related macular degeneration
Closed-angle glaucoma
Optic neuritis
Stroke

How well did you know this?

Not at all

Perfectly

What are the 2 main branches of the ophthalmic artery?

Central retinal artery

Posterior ciliary artery

How well did you know this?

Not at all

Perfectly

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

Inner 2/3 (including ganglion cells)

How well did you know this?

Not at all

Perfectly

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

Outer 1/3 (photoreceptors, pigment layer)

How well did you know this?

Not at all

Perfectly

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

False

Painless unless assoc. with GCA

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

Describe the appearance of the retina in central retinal artery occlusion

Pale
Oedematous
Thread-like vessels
Swelling

How well did you know this?

Not at all

Perfectly

Outline ophthalmic management of central retinal artery occlusion within 24hrs

Ocular massage (try to convert CRAO into BRAO)

How well did you know this?

Not at all

Perfectly

Outline vascular management of central retinal artery occlusion

Carotid Doppler (establish source)
Manage risk factors

How well did you know this?

Not at all

Perfectly

What is another name for transient central retinal artery occlusion?

Amaurosis fugax

How well did you know this?

Not at all

Perfectly

Describe visual loss in amaurosis fugax

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

How well did you know this?

Not at all

Perfectly

Amaurosis fugax patients require immediate referral to which clinic?

TIA clinic

How well did you know this?

Not at all

Perfectly

List causes of central retinal vein occlusion

Atherosclerosis
Hypertension
Hyperviscosity
Raised intra-ocular pressure

How well did you know this?

Not at all

Perfectly

How does atherosclerosis cause central retinal vein occlusion?

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

How well did you know this?

Not at all

Perfectly

Describe the appearance of the retina in central retinal vein occlusion

Haemorrhages
Dilated, tortuous veins
Disc swelling
Macular swelling

How well did you know this?

Not at all

Perfectly

Which growth factor may be suppressed as part of treatment for central retinal vein occlusion?

VEGF

How well did you know this?

Not at all

Perfectly

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

True

How well did you know this?

Not at all

Perfectly

Give another name for occlusion of the optic nerve head

Ischaemic optic neuropathy

How well did you know this?

Not at all

Perfectly

Describe the pathogenesis of ischaemic optic neuropathy

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

What are the 2 types of ischaemic optic neuropathy?

Arteritic (painful, inflammation, GCA)

Non-arteritic (painless, atherosclerosis)

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

Snellen chart
Counting fingers
Directional hand movement
Perception of light

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

True

List clinical features of giant cell arteritis

Jaw claudication
Pulsating temporal artery
Headache
Visual loss
Tender scalp
Malaise

List clinical signs of a vitreous haemorrhage

Sudden visual loss
Floaters
Loss of red reflex

How is a vitreous haemorrhage managed?

Identify + treat cause | Vitrectomy for non-resolving cases

List clinical features of retinal detachment

Painless visual loss Flashes of light, floaters Relative afferent pupil defect

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

Age-related macular degeneration (ARMD)

What is the difference between the two types of ARMD?

Wet - sudden visual loss | Dry - gradual visual loss

Describe the pathogenesis of wet ARMD

Angiogenesis under the retina with leakage/build up of fluid

Describe the appearance of an Amsler grid showing wet ARMD

Missing boxes = blind spot | Distorted lines = metamorphopsia (wavy lines)

Outline management of wet ARMD

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

List the main causes of gradual visual loss (CARDIGAN)

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

What is cataract? Describe pathogenesis

Clouding of the lens | Glucose converts to sorbitol which exerts osmotic effect to draw fluid in

Outline management of cataract

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

Drusen may be seen in dry ARMD. What is this?

Waste products (yellow fat/protein deposits) below retinal pigment epithelium

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

True | Supportive vision aids may help

What is meant by refractive error?

Eye cannot clearly focus image

What is myopia?

"Short-sightedness" | Light focuses in front of the retina

What is hypermetropia?

"Long-sightedness" | Light focuses behind the retina

What is astigmatism?

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

What is presbyopia?

Loss of visual accommodation with age

What is glaucoma?

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

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

Closed-angle

List clinical features of closed-angle glaucoma

Painful red eye Visual loss Headache Nausea, vomiting

Describe the appearance of the optic disc in glaucoma

Cupped disc