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Ophthalmology Week 2 > Visual Loss and Blindness > Flashcards

Visual Loss and Blindness Flashcards

1
Q

what are the major branches of the ophthalmic artery?

A
  • central optic artery

- posterior ciliary artery

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2
Q

what artery supplies the inner 2/3rds of the retina?

A

the central retina branch of ophthalmic artery

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3
Q

what artery supplies the outer 1/3rd of the retina?

A

posterior ciliary branch of ophthalmic

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4
Q

what are two types of basic vascular problems that can cause sudden visual loss?

A

occlusion or haemorrhage

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5
Q

what can become occluded that can cause sudden visual loss?

A

retinal circulation or optic nerve head circulation

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6
Q

what can haemorrhage to cause sudden visual loss?

A

abnormal blood vessels or a retinal tear

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7
Q

what kind of process/diseases can cause abnormal retinal blood vessels to haemorrhage?

A

diabetes , wet ARMD

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8
Q

what artery is occluded to cause an occlusion of the retinal circulation?

A

central retinal artery occlusion (CRAO)

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9
Q

is central retinal artery occlusion a painful vision loss?

A

no it is painless

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10
Q

symptoms of CRAO?

A

sudden profound vision loss

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11
Q

what would you expect a patient with a CRAO to be able to see on examination?

A

counting fingers a meter away from them or less

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12
Q

what clinical signs are present in a CRAO?

A

RAPD- relative afferent pupil defect

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13
Q

what is meant by RAPD? (relative afferent pupil defect)

A

showing that the message coming from one eye is weaker than the other. normal pupil will constrict to light, however affected pupil may dilate

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14
Q

how ill the retina appear in a CRAO?

A

pale oedematous retina with thread-like retinal vessels

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15
Q

in a CRAO, why can there sometimes be a small area of the retina that is preserved?

A

small area may contain a vessel from a choroidal artery that is supplying it

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16
Q

main cause of a CRAO?

A

carotid artery disease

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17
Q

what is a unusual and more rare cause of CRAO?

A

emboli from the heart

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18
Q

what is someone with a CRAO at risk of?

A

having a full-blown stroke

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19
Q

what is the ophthlamic managment of a CROA if they present within 24 hours and what is the aim of this managment?

A

ocular massage to try encourage blood flow though central retinal artery and reduce the occlusion to a BRAO (branch retinal artery occlusion)

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20
Q

what is the vascular management of a CRAO?

A
  • establish source of emboli

- assess and manage risk factors

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21
Q

what is used to establish source of emboli in a CRAO?

A

carotid doppler

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22
Q

what is the other name for a transient CRAO?

A

amaurosis fugax

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23
Q

what are the classical symptoms of a transient CRAO?

A
  • transient painless visual loss
  • ‘like a curtain coming down over eyes’
  • lasts about 5 mins with full recovery
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24
Q

what signs is there of a transient CRAO?

A

usually nothing abnormal to see on examination

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25
Q

what is the managment of a suspected transient CRAO?

A
  • immediate referral to TIA clinic

- aspirin

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26
Q

what is another common cause of transient visual loss?

A

migraine

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27
Q

what other vessel can become occluded to cause sudden visual loss?

A

central retinal vein

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28
Q

what are the systemic causes of a central retinal vein occlusion (CRVO)

A

VIRCHOW’S TRIAD

  • atherosclerosis
  • hypertension
  • hyperviscosity
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29
Q

ocular causes of CRVO?

A

raised intra-ocular pressure causing venous stasis

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30
Q

how severe is the visual loss in CRVO and what can patient normally still see?

A
  • moderate to severe

- 6/9 - perception of light

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31
Q

signs when looking in the eye in a CRVO?

A
  • retinal haemorrhages
  • dialted tortous veins
  • disc swelling and macular swelling
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32
Q

what is the treatment of a CRVO?

A

based on treatment of the systemic or ocular cause or more recently anti-VEGFs are being used

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33
Q

why is it important that CRVO is monitored?

A

may develop complications due to development of new vessels

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34
Q

what might be required to treat the development of new vessels in CRVO?

A

laser treatment

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35
Q

what is occlusion of optic nerve head circulation also known as?

A

ischaemic optic neuropathy

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36
Q

what artery is occluded that causes ischaemic optic neuropathy?

A

posterior ciliary arteries

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37
Q

what does occlusion of posterior ciliary arteries cause to infarct?

A

the optic nerve head

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38
Q

what are the 2 types of ischaemic optic neuropathy?

A
  • arteritic

- non-arteritic

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39
Q

give an example of an arteritic ischaemic optic neuropathy?

A

GCA

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40
Q

give an example of a non-arteritic ischaemic optic neuropathy?

A

non-arteritic

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41
Q

signs of a arteritis ischaemic optic neuropathy?

A

pale, swollen disc

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42
Q

visual symptoms in ateritic ischaemic optic neuropathy? what is the range of what a patient may see?

A

sudden profound visual loss, range from counting fingers to no perception of light

43
Q

is the blindness in GCA reversible?

A

no

44
Q

how can GPA present?

A

-headache, jaw claudication, scalp tenderness, tender/enlarged scalp arteries, transient visual loss, malaise

45
Q

what will be significant in a blood test in GCA?

A

very high ESR, PV and CRP

46
Q

what is in important to recognise blindess is due to GCA early?

A

to prevent blindness in other eye

47
Q

what is given to prevent blindness in GCA?

A

high dose steroids

-60-80mg prednisolone OD

48
Q

where in the eye does a haemorrhage often occur and what is this known as?

A

into the vitreous cavity, called a vireous haemorrhage

49
Q

if bleeding occurs from abnormal vessels what conditions is this normally associated with?

A

associated with retinal ischaemia and new vessel formation eg after CRVO or diabetic retinopathy

50
Q

if bleeding occurs from normal retinal vessels, what is the usually associated with?

A

a retinal tear

51
Q

symptoms of a vitreous haemorrhage?

A

loss of vision, ‘floaters’ in vision

52
Q

clinical signs of vitreous haemorrhage?

A

loss of red reflex, may see haemorrhage on fundoscopy

53
Q

what is the management for non-resolving cases of vitreous haemorrhage?

A

vitrectomy

54
Q

symptoms of retinal detachment?

A

painless loss of vision, sudden onset of flashes/floaters

55
Q

what 2 layer are separated in a retinal detachment?

A

sensory retinal from retinal pigmented epithelium

56
Q

signs of retinal detachment?

A
  • may have RAPD (relative afferent pupil defect)

- may see tear on ophthalmoscopy

57
Q

managment of retinal detachment?

A

surgical correction

58
Q

what is the commonest cause of blindness in western world in patients over 65?

A

age related macular degeneration (ARMD)

59
Q

what are the 2 types of ARMD?

A

dry and wet

60
Q

what does dry ARMD cause?

A

gradual reduction in vision

61
Q

what does wet ARMD cause?

A

sudden reduction in vision

62
Q

what is the pathological process behind wet ARMD?

A

new blood vessels grow under the retina- leakage of these vessels causes build up of fluid/blood and eventually scarring

63
Q

symptoms of wet ARMD?

A

rapid central visual loss and distortion

64
Q

what is the proper word for distortion in vision?

A

metamophopsia

65
Q

signs in the retina in a wet ARMD?

A

haemorrhage/exudates

66
Q

what test is done to assess wet ARMD?

A

the amsler grid

67
Q

treatment of wet ARMD?

A

anti-VEGF treatment

68
Q

how is anti-VEGF treatment given? and what does it do?

A

injected into vitreous cavity. stops new blood vessels growing by binding to VEGF

69
Q

what does VEGF stand for?

A

vascular endothelial growth factor

70
Q

is gradual visual loss usually bilateral or unilateral?

A

usually bilateral but can be asymetical

71
Q

when does gradual visual loss tend to prevent early?

A

if there is a reduction in general visual ability

72
Q

when may gradual visual loss present late? and why?

A

when there is decreased field vision as takes patient a while to notice this as central vision is unaffected

73
Q

what does the acroynm ‘CARDIGAN’ stand for in relation to causes of gradual visual loss?

A
  • Cataract
  • ARMD (dry type)
  • Refractive error
  • Diabetic retinopathy
  • Inherited diseases
  • Glaucoma
  • Access (to eye clinic)
  • Non-urgent (gradual loss tends not to be urgent)
74
Q

give an example of an inherited condition that can cause gradual visual loss?

A

retinitis pigmentosa

75
Q

what is a cataract?

A

clouding of the lens

76
Q

causes of cataract?

A
  • age related
  • congenital
  • traumatic
  • metabolic -diabetes
  • drug induced (steroids)
77
Q

what are the 4 main types of cataract?

A
  • nuclear cataract
  • posterior subcapsular cataract
  • christmas tree cataract
  • congenital cataract
78
Q

what is the proper name for christmas tree cataract?

A

polychromatic cataract

79
Q

what is the appearance of a congenital cataract?

A

solid white circle in the centre with a further ring of opacity around it

80
Q

managment of cataract?

A

surgical removal with intra-ocular lens implant

81
Q

what is the artificial lens in cataract surgery placed inside?

A

in the capsular bag that previously encased normal lens

82
Q

what area of vision tends to affected in dry ARMD?

A

central vision

83
Q

what is an area of vision that is missing refered to as?

A

a scotoma

84
Q

what are the signs of dry ARMD when looking at the retina?

A
  • drusen

- atrophic patches of retina

85
Q

what is drusen?

A

a build up of waste products below the retinal pigmented epithelium

86
Q

what sits underneath the retinal pigmented epithelium?

A

choroid

87
Q

management of dry ARMD?

A

no cure - supportive treatment with low vision aids

88
Q

what is meant by myopia?

A

‘short-sighted’

89
Q

what is the word used to describe long-sighted?

A

hypermetropia

90
Q

what is an astigmatism usually due to?

A

irregular corneal curvature

91
Q

what is meant by presbyopia?

A

loss of accomodation of refractive power with aging

92
Q

what is the treatment of a refractive error?

A

glasses

93
Q

what happens in glaucoma?

A

progressive optic neuropathy

94
Q

2 main types of glaucoma?

A

open-angle and closed-angle

95
Q

what does the angle in ‘open-angle’ or ‘closed-angle’ refer to?

A

the angle between the cornea and the iris

96
Q

what causes a closed angle glaucoma?

A

fluid builds up behind the iris and is pushes the iris forward so far that it can close the angle.

97
Q

what type of glaucoma is an emergency?

A

closed-angle glaucoma

98
Q

what can be used to treat a closed-angle glaucoma in an emergency and what is its purpose?

A

use a laser to zap a hole in the iris tissue to let fluid escape through the hole and into drainage channel

99
Q

how does an acute closed-angle glaucoma present?

A

very painful, red eye, visual loss, headache, nausea, vomitting

100
Q

what must be given straight away in an acute closed-angle glaucoma?

A

drops/oral medication to lower intra-ocular pressure

101
Q

what are the symptoms of an open-angle glaucoma?

A

often there is none

102
Q

signs of an open-angle glaucoma?

A
  • cupped disc
  • visual field defect
  • may or may not have raised IOP
103
Q

management of open angle glaucoma?

A

aim to preserve vision by lowering IOP with eye drops/laser/surgery. regular monitoring

Ophthalmology Week 2 (6 decks)

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