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NMF: Ophthalmology > Visual loss > Flashcards

Visual loss Flashcards

1
Q

What is a cataract?

A

a progressive clouding of the lens which impairs function

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2
Q

What can cause cataracts?

A 
age
congenital
trauma
metabolic eg. diabetes
steroids
intrauterine infection eg rubella
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3
Q

What is the most common type of cataract?

A

nuclear sclerotic

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4
Q

How can cataracts be managed?

A

surgically with phacoemulsification and artificial intra-ocular lens implantation

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5
Q

What is the commonest cause of blindness in the West in those over 65?

A

Age related macular degeneration (ARMD)

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6
Q

What part of the visual field is affected by macular degeneration?

A

central vision

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7
Q

What is dry ARMD?

A

wear and tear of the retinal pigment epithelium causing slow, progressive visual loss

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8
Q

What characterises dry ARMD?

A

drusen

RPE hypo/hyperpigmentation

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9
Q

What is wet ARMD?

A

dry + neovascular changes
- eye tries to repair damage but the new vessels are leaky and bleeding causing sudden devastating decrease in central visual acuity

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10
Q

What can predict wet ARMD before a devastating bleed?

A

metamorphsia (distortion of straight lines to wavy)

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11
Q

How can wet ARMD be treated?

A

anti-vegf

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12
Q

Give causes of gradual visual loss

A

cataracts
dry ARMD
chronic open angle glaucoma
diabetic retinopathy

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13
Q

Give causes of sudden painless loss of vision

A

central retinal artery occlusion (CRAO)
central retinal vein occlusion (CRVO) or branch retinal vein occlusion
anterior ischaemic optic neuropathy (AION)
retinal detachment

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14
Q

Give causes of sudden painful loss of vision

A

acute closed angle glaucoma
optic neuritis
giant cell arteritis

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15
Q

How does CRAO present?

A

sudden profound visual loss + RAPD

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16
Q

What does CRAO look like on exam?

A

pale swollen retina with a cherry red spot at the macula

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17
Q

What can cause CRAO?

A

giant cell arteritis
embolic
carotid artery disease

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18
Q

How is CRAO managed?

A

treat within 12-24hrs by dislodging blockage

  • massage
  • paper bag breathing
  • IV acetazolamide
  • anterior chamber paracentesis
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19
Q

How can paper bag breathing manage CRAO?

A

inc PaCO2 causes vasodilation

20
Q

How does CRVO present?

A

mod-severe visual loss +/- RAPD

21
Q

How does CRVO appear on exam?

A

flame haemorrhages
tortuous vessels
swollen disc
cotton wool spots

22
Q

What do cotton wool spots indicate in CRVO?

A

ischaemia

23
Q

How is CRVO managed?

A

if not ischaemic observe 3 monthly
if neovascularisation observe monthly
if ischaemic –> argon laser

24
Q

What is anterior ischaemic optic neuropathy (AION)?

A

disrupted blood supply to the anterior optic nerve

25
Q

What are the two types of AION?

A

GCA-associated

non-arteritic

26
Q

How does AION present?

A

altitudinal, mod-severe visual loss + RAPD

27
Q

How does AION appear on exam?

A

swollen hyperaemic disc which later becomes pale

28
Q

How does retinal detachment present?

A

persistent flashing lights
new floaters
dark shadow in peripheral vision which increases in size

29
Q

What can cause retinal detachment?

A

trauma

separation of vitreous gel from retina causing traction and tears

30
Q

How is retinal detachment managed?

A

surgical repair to identify tear and laser it then bubble of gas to tamponade it

31
Q

Which acute painless loss of vision is associated with short-sightedness?

A

retinal detachment?

32
Q

Which acute painful loss of vision is associated with long-sightedness?

A

acute closed angle glaucoma

33
Q

What is the leading cause of blindness in people of a working age?

A

diabetic retinopathy

34
Q

What are the risk factors for developing diabetic retinopathy?

A 
duration of diabetes
poor blood sugar control
hypertension, high cholesterol
pregnancy
dramatic improvement in control for short-term
35
Q

Why does diabetic retinopathy develop?

A

chronic hyperglycaemia leads to inflammation and oxidative stress which damages the tight capillaries causing vascular damage and inc permeability resulting in macular oedema and retinal neovascularisation

36
Q

What are features of non-proliferative diabetic retinopathy on fundoscopy?

A

microaneurysm
flame haemorrhage
intra-retinal microvascular abnormalities

37
Q

What is an intraretinal microvascular abnormality?

A

shunt between artery and vein due to ischaemia

38
Q

What are features of proliferative diabetic retinopathy on fundoscopy?

A

neovascularisation

vitreous haemorrhage

39
Q

Do vascular changes or oedema contribute more to blindness in diabetic retinopathy?

A

macular oedema

40
Q

Manage proliferative diabetic retinopathy

A

Pan-retinal photocoagulation with laser

41
Q

orbital floor fracture can damage which nerve

A

infraorbital

42
Q

A 35yo male attends the emergency department following an assault. He was punched in the right eye. He complains of double vision, made worse when looking up. The double vision disappears when he covers one eye and his visual acuity is 6/6 in both eyes. He also has an area of numbness on his face. What is diagnosis?

A

orbital floor # damaging infraorbital nerve

43
Q

A 55 year old man presents to his optometrist for a routine sight test. They have no significant past medical or ocular history. On fundoscopy, he has arteriovenous (AV) nicking and copper wire appearance of the retinal arterioles. The optometrist refers the patient to hist GP. What systemic condition do they suspect?

A

hypertension

44
Q

How is dry ARMD managed?

A

smoking cessation and a diet high in antioxidant-rich foods (green leafy vegetables and fresh fruits).

45
Q

what is the most common type of glaucoma?

A

primary open angle

NMF: Ophthalmology (8 decks)

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