visual loss and blindness

Question 1

causes of sudden visual loss can be vascular - (2?), retinal __, ___ haemorrhage, ARMD (?, what type?), closed angle __, optic neuritis and stroke

Answer 1

retinal artery or vein occlusion 
retinal detachment 
vitreous haemorrhage 
age related macular degeneration - wet type 
closed angle glaucoma 
optic neuritis 
stroke

Question 2

what is the major bloodv supply t the eye

Answer 2

branches of opthalmic artery

Question 3

where is the (incomplete) circle of zinn located

Answer 3

where optic nerve arrives at retina

Question 4

a haemorrhage can be due to abnormal/normal blood vessels - outline when each causes this

Answer 4

abnormal - DM, wet ARMD

normal - retinal tear bridging

Question 5

central retinal artery occlusion

sudden/gradual
pain/painless

2 signs

Answer 5

sudden
painless

relative afferent pupil defect
pale oedematous retina - v thin vessels

Question 6

CRAO is a type of stroke - t.f

Answer 6

true

Question 7

amaurosis fugax is __ CRAO. The patient will describe painless visual loss- ‘lika a curtain coming down’, lasts about 5mins. what referall is required

Answer 7

transient

STROKE

signs - usually nothing abnormal

Question 8

central retinal vein occlusion is assoc with endothelial damage (eg ___), abnormal blood flow (eg___), and a hypercoaguable state (___)

what is virchows triad?

Answer 8

diabetes
HT
cancer

hypercoaguability + stasis + endothelial injury

Question 9

signs of CRVO

Answer 9

retinal haemorrhages
dilated tortuous veins
discs and macular swelling

Question 10

CRVO - sudden or gradual visual looss

Answer 10

trick q can vary sorry hun

Question 11

why is artery occlusion pale, and vein dark?

Answer 11

artery - no blood coming in

vein - blood cannot escape - swelling

Question 12

occlusion of optic nerve head circulation - also knows as __ __ __ (ION). which arteries are occluded?

Answer 12

ischaemic optic neuropathy
posterior ciliary arteries

results in optic nerve head infarction

Question 13

GCA is an inflam condition which can cause ___, it is due to med/large sized arteries becoming inflamed (what cell responsible?)
what causes the occlusion specifically?

Answer 13

`ION
multinucleate giant cells
gross thickening of artery wall

Question 14

ION causes sudden severe visual loss and irreversible blindess. what sign suggests?

Answer 14

swollen optic nerve

pale, not as pale as CRAO

Question 15

other than ION, GCA can cause headaches (where?), transient CRAO (other name?) jaw ___, scalp tenderness (how is this indicated?).

Answer 15

temporal usually 
amaurosis fugax 
jaw claudication 
painful to touch/comb hair 
enlarged scalp arteries also seen

Question 16

in vitreous haemorrhage, bleeding occurs from abnormal vessels (2 examples) what then forms?
or
from normal vessels - example

Answer 16

diabetes - retinal ischaemia
retinal vein occlusion

fragile new blood vessels form

bridging a retinal tear

Question 17

symptoms of vitreous haemorrhage 2

would there be a red reflex?

Answer 17

loss of vision
floaters

no

Question 18

what is red light reflex?

Answer 18

light enters and reflects back, refracts through the anterior segment giving a red colour

Question 19

retinal detachment
pain/painless loss of vision?
classic symptom of retinal detachment

they may have __, or see a __ on opthalmoscopy

Answer 19

painless
flashes/floaters

RAPD
tear

Question 20

most common cause of blindness >65

Answer 20

age relatd macular degeneration

Question 21

dry ARMD causes gradual/sudden visual loss

wet ARMD causes gradual/sudden visual loss

Answer 21

dry = Gradual 
wet = Sudden (variable))

Question 22

wet ARMD describes new blood vessels growing under ___ -leakage causes build up of fluid/blood - what does this cause eventually

Answer 22

retina

scarring

Question 23

wet ARMD - rapid __ visual loss and distortion (another name?)

you will see a __ on opthalmoscopy

Answer 23

central
metamorphopsia

haemorrhage/exudate

Question 24

in closed-angle glaucoma, ___ ___ encounters incr resistance through the iris/___ ___. This causes the periphral iris to bow forward, this obstructs what?
acute?

assoc symptoms/signs of glaucoma

treatment is directed at what

Answer 24

aqueous humour
lens channel
trabecular meshwork
it can be- emergency

symptoms 
red,painful eye 
sudden visual loss
headache
vomiting 
nausea 

signs
red eye
cloudy corna
dilated pupil

lower IOP

Question 25

gradual visual loss is unilateral/bilateral usually

2 things the patient may present with

Answer 25

bilateral

reduced VA, decreased v. field

Question 26

cataract is caused by abnormal changes in lens proteins (name) - leading to loss of transparency.

Answer 26

crystallins

Question 27

polychromatic cataract is also called

Answer 27

christmas tree cataract

Question 28

cataract symptoms
gradual or sudden?
blurred vision, but what also changes in their vision (causes driving at night to b shite)

management

Answer 28

gradual - hazy/blurred

glare

surgical removal + intra-ocular lens implant if symptomatic

Question 29

dry ARMD is more likely to be a gradual decline, and patients also experience scotoma - what is this?

2 signs

treatment

Answer 29

central vision missing

drusen - build up waste, yellow spots
atrophic patches of retina

supportive w low vision aids - magnifiers

Question 30

refractive errors 
myopia 
hypermetropia
astigmatism 
presbyopia 
what is each

Answer 30

myopia - short sighted

hypermetrophia - long sighted

astigmatism - usually irregular corneal curvature

presbyopia - loss of accommodation (w aging)

Question 31

in open-angled glaucoma
symptoms

signs 3

Answer 31

often asymptomatic - opticians find

signs
cupped disc
visual field defect
may/may not have high IOP