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Ophthalmology > Visual loss and blindness > Flashcards

Visual loss and blindness Flashcards

1
Q

What are some causes of sudden visual loss?

A

vascular aetiology retinal detachment age related macular degeneration - wet type Close angle glaucoma optic neuritis stroke

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2
Q

What is the major arterial blood supply to the eye?

A

ophthalmic artery

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3
Q

What are the two types of vascular events that can lead to sudden visual loss?

A

occlusion haemorrhage

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4
Q

Occlusion of what can result in sudden visual loss?

A

retinal circulation optic nerve head circulation

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5
Q

haemorrhage from what can cause sudden visual loss?

A

abnormal blood vessels - diabetes retinal tear

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6
Q

What are the symptoms of central retinal artery occlusion?

A

sudden painless visual loss

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7
Q

What signs are seen in central retinal artery occlusion?

A

relative afferent pupil defect pale oedematous retina thread-like retinal vessels

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8
Q

What does this image show?

A

central reinal artery occlusion

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9
Q

What are some causes of central retinal artery occlusion?

A

carotid artey disease

emboli from the heart - unusual

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10
Q

What is the management of a central retinal artey occlusion

A

if presents within 24 hrs - occular massage

Establish source of embolus - carotid doppler

assess and manage risk factors

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11
Q

What are the 3 main variants of retinal artery occlusion?

A

Central retinal artey occlusion

Branch retinal artery occlusion

Amaurosis fugax

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12
Q

what is Amaurosis fugax?

A

TRANSIENT CRAO

(transient - short lasting)

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13
Q

what are the symptoms of amaurosis fugax?

A

transient painless visual loss

like a curtain coming down

lasts 5 mins with full recovery

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14
Q

what are the signs in amaurosis fugax?

A

usually nothing abnormal on examination

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15
Q

What is the treatment for amaurosis fugax?

A

immediate referral to the TIA clinic

aspirin

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16
Q

What are some causes of transient vision loss?

A

amaurosis fugax

migraine - visual loss usually followed by a headache

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17
Q

what are some systematic causes of central retinal vein occlusion?

A

Virchow’s triad

atherosclerosis

hypertension

hyperviscosity

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18
Q

What is an ocular cause of central retinal vein occlusion?

A

raised IOP

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19
Q

what are the symptoms of central retinal vein occlusion?

A

sudden visual loss (moderate to severe)

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20
Q

What are the signs of a central retinal vein occlusion?

A

retinal haemorrhages

dilated tortuous veins

disc swelling and macular swelling

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21
Q

What does this image show?

A

central retinal vein occlusion

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22
Q

what is the treatment for central retinal vein occlusion?

A

treat systemic / ocular cause

monitor - complications due to development of new vessels

anti-VEGFs

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23
Q

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

A

ischaemic optic neuropathy

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24
Q

In nOcclusion of optic nerve head circulation what vessels become occluded?

What does this result in?

A

posterior ciliary arteries - infarction of the optic nerve head

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25
Q

what are the 2 types of ischaemic optic neuropathy?

A

arteritic - inflammation

non-arteritic - atherosclerosis

26
Q

How does ischaemic optic neuropathy present?

A

sudden, profound visual loss with swollen disc

27
Q

outline the pathogenesis for arteritic ischaemic optic neuropathy

A

Giant cell arrteritis (GCA)

Medium to large sized arteries inflamed (multinucleate giant cells)

Lumen of artery becomes occluded (posterior ciliary arteries)

Visual loss from ischaemia of optic nerve head

28
Q

what are the symptoms of arteritic ischaemic optic neuropathy?

A

sudden visual loss

irreversible blindless

29
Q

what is giant cell arteritis also known as?

A

temporal arteritis

30
Q

What are the symptoms of temporal arteritis?

A
  • Headache (usually temporal)
  • Jaw claudication
  • Scalp tenderness (painful to comb hair)
  • Tender/enlarged scalp arteries
  • amaurosis fugax
  • malaise
31
Q

what invesigations could be done for suspected temporal arteritis?

A

very high ESR, PV and CRP

temporal artery biopsy may be helpful

32
Q

In arteritic iscahemic optic neuropathy how can visual loss in the other eye be prevented?

A

prompt recognition

immediate high dose systemic steroid

33
Q

in sudden visual loss due to haemorrhage where doe the haemorrhage often occur?

A

into the vireous cavity

34
Q

what are symptoms of virteous harmorrhage?

A

loss of vision

floaters

35
Q

what are signs of virteous haemorrhage?

A

lossof red reflex

may see haemorrhage on fundoscopy

36
Q

What is the managemet of virteous haemorrhage?

A

idenify the cause

Vitrectomy for non-resolving cases

37
Q

what are the symptoms of retinal detachment?

A

painless loss of vision

sudden onset of flashes / floaters

38
Q

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

A

Age related macular degeneration (ARMD)

39
Q

what are the 2 types of ARMD?

A

dry and wet

40
Q

What is the key difference between wet and dry ARMD?

A

dry - gradual vision loss

wet - sudden vision loss

41
Q

what happens in wet ARMD?

A

New blood vessels grow under retina – leakage causes build up of fluid/blood and eventually scarring

42
Q

What are the symptom of wet ARMD?

A

rapid central visual loss

distorsion

43
Q

What signs may be seen in wet ARMD?

A

haemorrhage / exudate

44
Q

what does VEGF stand for?

A

vascular endothelial growth factor

45
Q

What is the treatment for wet ARMD?

A

Anti-VEGF treatment – injected into vitreous cavity. Stops new blood vessels growing by binding to VEGF

46
Q

what are some common features of gradual visual loss?

A

usually bilateral

often asymmetrical

may present early with reduced visual acuity

may present late with decreased field

47
Q

What are some causes of gradual visial loss? (CARDIGAN)

A
  • Cataract
  • age related macular degeneration - dry
  • refractive error
  • diabetic retinopathy
  • inherited diseases
  • glaucoma
  • access (to eye clinic) Not urgent
48
Q

What is a cataract?

A

cloudiness of the lens

49
Q

What are some differen types of cataract?

A

Nuclear cataract

posterior subcapsular cataract

christmas tree cataract - polychromatic cataract

congenital cataract - check red reflex in neonates

50
Q

how are cataracts managed?

A

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

51
Q

what are the symptoms of dry ARMD?

A

gradual decline in vision

central vision missing

52
Q

What are some signs of dry ARMD?

A

drusen - build up of waste

atrophic patches of retina

53
Q

what is the treatment of dry ARMD?

A

no cure - treatment i supportive with low vision aids

54
Q

what is a refractive error?

A

when the eye cannot clearly focus on image

55
Q

What are the different types of refractive errors?

A

Myopia - short sighted

hypermetropia - long sighted

astigmatism - rugby ball shaped cornea

presbyopia - loss of accomodation with ageing

56
Q

what is the main treatment for refractive errors?

A

Glasses

57
Q

what is glaucoma?

A

progressive optic neuropathy resulting in visual loss

58
Q

which type of glaucoma can be acute?

A

closed angle type - ophthalmic emergency

59
Q

How do patients with closed angle type glaucoma present?

A

with painful, red eye/visual loss/headache/nausea/vomiting

60
Q

how is closed angle type glaucoma treated?

A

Need to lower IOP with drops/oral medication to prevent patient going blind

61
Q

what are the symptoms of open-angle glaucoma?

A

often none - tends to be discovered by opticians

62
Q

what signs are commonly seen in open angle glaucoma

A

cupped disc

visual field defect

may/may not have high IOP

Ophthalmology (9 decks)

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