visual loss and blindness Flashcards
(34 cards)
What can cause a painful sudden vision loss?
• Angle closure glaucoma • Uveitis • Corneal ulcer keratitis • Endophthalmitis • Retrobulbar optic neuritis • Orbital cellulitis Giant cell arteritis
What can cause a painless fleeting visual loss?
• Embolic retinal artery occlusion
• Migraine
• Raised ICP
Prodromal in giant cell arteritis
What can cause a painless prolonged vision loss
- Ischaemic optic neuropathy
- Retinal artery occlusion
- Retinal vein occlusion
- Retinal detachment
- Age-related macular degeneration (wet)
- Other macula disease
- Vitreous haemorrhage
- Orbital disease affecting optic nerve
- Intracranial disease affecting the visual pathway
What can cause a gradual vision loss with a cloudy media?
Opacities in cornea, lens, or vitreous appear black against the red reflex
• Corneal opacity
• Cataract
Vitreous haemorrhage
What can cause a gradual visual loss with a clear media?
Retinal disorder: • Age-related macular degeneration (dry) • Macular/retinal dystrophy Optic nerve/pathyway disorder: • Optic neuropathy Central nervous disease affecting visual pathways
What are the symptoms of a CRAO?
- Sudden visual loss
- Profound (counting fingers or less)
- Painless
What are the signs of a CRAO?
- RAPD (relative afferent pupil defect)
- Pale oedematous retina, thread-like retinal vessels
- Retinal nerve fibre layer becomes swollen except at fovea (cherry red spot)
What are the causes of a CRAO?
NB this is a type of stroke
• Carotid artery disease
• Emboli from heart – unusual
What is the management of a CRAO?
• Ophthalmic management
o If presents within 24 hours - ocular massage (try to convert CRAO to BRAO)
• Vascular management
o Establish source of embolus – carotid doppler
o Assess and manage risk factors
What is amaurosis fugax?
transient CRAO
What are the symptoms, signs and management of amaurosis fugax?
Symptoms
ν transient painless visual loss
ν ‘like a curtain coming down’
ν lasts~5mins with full recovery
Signs
ν Usually nothing abnormal to see on examination
Treatment:
-Immediate referral TIA clinic
ν Aspirin
ν Other cause of TVL: Migraine – visual loss usually followed by headache
What are the causes of a CRVO?
Can be either branched vein or central vein
If branched may be asymptomatic or may be aware loss of part of field
Systemic causes: • Atherosclerosis } • Hypertension } Virchow’s triad • Hyperviscosity } The vein lies underneath artery and if the artery becomes hardened with atherosclerosis it can push down on vein and occlude it
Ocular causes:
• raised IOP (venous stasis)
what are the symptoms and signs of a CRVO?
Symptoms:
• Sudden visual loss
• Moderate to severe visual loss (6/9 – P of L)
Signs:
• Retinal haemorrhages (flame shaped haemorrhages)
• Dilated tortuous veins
• Disc swelling and macular swelling
What is the treatment for CRVO?
- Based on treatment of systemic or ocular causes (eg hypertension, diabetes, glaucoma)
- Monitor : may develop complications due to development of new vessels (laser treatment may be required to avoid complications from these vessels eg vitreous haemorrhage)
- More recently, anti- VEGFs used (VEGF = vascular endothelial growth factor)
What is ischaemic optic neuropathy?
This is the occlusion of optic nerve head circulation
• Posterior ciliary arteries (PCA) become occluded, resulting in infarction of the optic nerve head
• (PCA not end arteries)
Flame haemorrhages may be seen
What are the two types of ischaemic optic neuropathy?
- Arteritic 50% - inflammation (GCA)
- Non-arteritic 50% - atherosclerosis
Both cause sudden, profound visual loss with a pale, swollen disc
What is the pathogenesis of artheritic ION?
- Giant cell arteritis (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
What are the symptoms of giant cell arteritis in the eye?
- Sudden visual loss
- Profound (CF – NPoL)
- Irreversible blindness
- Important as diagnosis and immediate treatment may prevent bilateral visual loss
Risk of sudden complete blindness in second eye and can be fatal
What are the systemic symptoms of giant cell arteritis?
- Headache (usually temporal)
- Jaw claudication
- Scalp tenderness (painful to comb hair)
- Tender/enlarged scalp arteries
- Amaurosis fugax
- Malaise
- Very High ESR , PV and CRP
- Temporal artery biopsy may help diagnosis
What is the management of giant cell arteritis?
- Prompt recognition (approx. 40 cases each year in Tayside)
- REFER URGENTLY
- Immediate high dose systemic steroid may prevent other eye going blind.
Vitreous haemorrhage:
-what vessels can this stem from?
Bleeding occurs from abnormal vessels
• Associated with retinal ischaemia and new vessel formation eg after retinal vein occlusion or diabetic retinopathy
Bleeding occurs from retinal vessels
• Usually associated with a retinal tear
What are the symptoms of a vitreous haemorrhage? what are the signs?
Symptoms of vitreous haemorrhage:
• Loss of vision
• ‘floaters’
Signs of vitreous haemorrhage:
• loss of red reflex
• No RAPD – unless assoc. with other pathology
What is the treatment of a vitreous haemorrhage?
- Identify cause
* Vitrectomy for non-resolving cases
Retinal detachment:
- What are the symptoms
- what are the signs?
Symptoms
• Painless loss of vision
• Sudden onset of flashes/floaters (mechanical separation of sensory retina from retinal pigment epithelium)
• ‘like a curtain falling down’
Signs
• May have RAPD
May see tear on ophthalmoscopy
