Visual Loss and Blindness

Question 1

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

Answer 1

Central retinal artery

Question 2

Which arteries supply the optic nerve head?

Answer 2

Posterior ciliary arteries

Question 3

Central retinal artery occlusion causes sudden/gradual painless/painful vision loss

Answer 3

Causes sudden painless vision loss

Question 4

What light reflex is defective in central retinal artery occlusion?

Answer 4

Relative afferent pupil defect

Question 5

What is the commonest cause of central retinal artery occlusion?

Answer 5

Plaque in the carotid artery

Question 6

How should a central retinal artery occlusion be managed ophthalmically?

Answer 6

Ocular massage (convert central retinal artery occlusion to branch retinal artery occlusion)

Question 7

If a patient says ‘a curtain is coming down’ on their vision what should be suspected?

Answer 7

Amaurosis fugax - transient central retinal artery occlusion

Question 8

Give some signs of central retinal vein occlusion

Answer 8

Retinal haemorrhages
Disc swelling
Macular swelling

Question 9

How can central retinal vein occlusion be treated?

Answer 9

Laser treatment

Anti-VEGF

Question 10

In an arterial occlusion the retina is dark/pale while in a venous occlusion the retina is dark/pale

Answer 10

Arterial - pale

Venous - dark

Question 11

What is occlusion of optic nerve head circulation known as?

Answer 11

Ischaemic optic neuropathy

Question 12

What are the two common causes of ischaemic optic neuropathy?

Answer 12

Giant cell arteritis

Atherosclerosis

Question 13

Give some symptoms of giant cell arteritis

Answer 13

Temporal headache
Scalp tenderness
Jaw claudication

Question 14

How is giant cell arteritis treated?

Answer 14

Immediate high dose steroids

Question 15

What is a vitreous haemorrhage?

Answer 15

Haemorrhage into the vitreous cavity

Question 16

Give some signs of vitreous haemorrhage

Answer 16

Loss of red reflex
Floaters
Haemorrhage on fundoscopy

Question 17

How can retinal detachment occur?

Answer 17

Vitreous becomes less gel-like causing the retina to pull in on itself and detach

Question 18

Give some signs of retinal detachment

Answer 18

Sudden onset of flashes/floaters

Tear on ophthalmoscopy

Question 19

What is the commonest cause of blindness in elderly patients in developed countries?

Answer 19

Age-related macular degeneration

Question 20

What are the two types of ARMD?

Answer 20

Wet and dry

Question 21

What occurs in wet ARMD?

Answer 21

New blood vessels grow under retina which leak causing fluid build-up

Question 22

How is wet ARMD treated?

Answer 22

Anti-VEGF

Question 23

What is glaucoma?

Answer 23

Effectively damage to the optic nerve resulting in visual loss

Question 24

What are the main two types of glaucoma?

Answer 24

Open-angle and closed angle

Question 25

What occurs in closed-angle glaucoma?

Answer 25

Aqueous build up between iris and lens causing the iris to be pushed forward blocking off trabecular meshwork and preventing aqueous drainage`

Question 26

Closed-angle glaucoma is an ophthalmic emergency. True/false?

Answer 26

True

Question 27

How do patients with closed-angle glaucoma present?

Answer 27

Painful red eye Visual loss Nausea

Question 28

Give some causes of sudden visual loss

Answer 28

``` Closed angle glaucoma Vitreous haemorrhage Retinal detachment Wet ARMD Central retinal artery/vein occlusion Ischaemic optic neuropathy ```

Question 29

What is a cataract?

Answer 29

A cloudiness of the lens

Question 30

Give some symptoms of cataract

Answer 30

Gradual vision decline | Glare

Question 31

What occurs in dry ARMD?

Answer 31

Drusen (waste products) build up and pull retina away from choroid

Question 32

What occurs in open-angle glaucoma?

Answer 32

Resistance to outflow of aqueous in trabecular meshwork

Question 33

How is any glaucoma treated?

Answer 33

Aim to preserve vision by lowering IOP

Question 34

Give some examples of refractive error

Answer 34

Myopia (short-sighted) Hypermetropia (long-sighted) Presbyopia (loss of accommodation with ageing)

Question 35

Give some causes of gradual vision loss

Answer 35

Cataract Dry ARMD Refractive error Open angle glaucoma