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Opthalmology > Visual loss and blindness > Flashcards

Visual loss and blindness Flashcards

1
Q

what can cause sudden visual loss

A

vascular aetiology (retinal artery/ vein occlusion), vitreous haemorrhage, retinal detachment, ARMD wet type, closed angle glaucoma, optic neuritis, stroke

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2
Q

what is the main blood supply to the eye

A

branches of the ophthalmic

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3
Q

what supplies the optic nerve head

A

posterior cilliary artery

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4
Q

what vessel supplies the retina

A

central retinal artery

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5
Q

occlusion of what vasculature can cause sudden visual loss

A 
retinal circulation (retinal artery and vein) 
optic nerve circulation
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6
Q

what haemorrhage can cause sudden visual loss

A 
abnormal vessels (DM, wet ARMD)
normal vessels (bridging a retinal tear)
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7
Q

what are the signs and symptoms of central retinal artery occlusion

A

sudden visual loss
painless

RAPD
pale oedematous retina, thread like retinal

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8
Q

why do oedematous retinal ganglions make the eye appear pale

A

as choroid blood vessels underneath that make the eye appear red are no longer visible

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9
Q

why doesnt the macula get paler when ganglion cells become odematous (in central retinal artery occlusion)

A

as macula doesnt have ganglion cells over it

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10
Q

what can cause central retinal artery occlusion

A

carotid artery disease

emboli from the heart (vegetations/ thrombus on heart valve)

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11
Q

what is branch retinal artery occlusion

A

only one branch affected so partial vision loss

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12
Q

how do you tell the vessels apart in a fundoscopy

A

lighter one is the artery

darker one is the vein

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13
Q

what is amaurosis fugaxyout

A

transient central retinal artery occlusion

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14
Q

what are the symptoms of amaurosis fugaxyout

A

transient painless visual loss
‘like a curtain coming down’
last about 5 mins with full recovery
nothing abnormal on examination

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15
Q

what should you do in amaurosis fugaxyout

A

urgent referral to stroke clinic

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16
Q

what is central retinal vein occlusion associated with

A 
endothelial change (diabetes) 
abnormal blood flow (hypertension) 
hypercoaguable state (cancer)

(neighbouring artery may stiffen and occlude vein)

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17
Q

what are the symptoms of central retinal vein occlusion

A

sudden visual loss

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18
Q

what are the signs of central vein occlusion

A

retinal haemorrhages, dilates tortous veins, disc swelling and macular swelling, cotton wools spots

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19
Q

what are cotton wool spots

A

ischaemia- small infarcts of the nerve fibres

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20
Q

what are the differences in artery and vein occlusion

A

artery will cause oedema

vein will cause haemorrhages

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21
Q

what is ischaemic optic neuropathy

A

occlusion of optic nerve head circulation (posterior ciliary arteries)

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22
Q

what inflammatory condition can cause ischaemic optic neuropathy

A

giant cell arteritis - lumen of artery becomes occluded due to gross thickening of artery wall

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23
Q

what cells id GCA

A

multinucleated giant cells

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24
Q

what are the visual symptoms and signs of ischaemic optic neuropathy

A

sudden severe visual loss
irreversible blindness
swollen optic disc, pale

25
Q

what can immediate treamtment of ischaemic optic neuropathy prevent

A

bilateral visual loss

26
Q

what are the symptoms of GCA

A 
headache (temporal)
jaw claudication 
scalp tenderness (painful to comb hair)
tender/enlarged scalp arteries 
amaurosis fugax (transient darkness)
malaise
27
Q

what is a vitreous haemorrhage

A

a haemorrhage that occurs in the vitreous cavity of the eye

28
Q

what can cause an abnormal vessel haemorrhage

A

e.g. in retinal ischaemia in diabetes/ retinal vein occlusion new fragile (curly) blood vessels form which bleed easily

29
Q

what are the signs and symptoms of vitreous haemorrhage

A

loss of vision
floaters

loss of red reflex
may see haemorrhage on fundoscopy

30
Q

what does the red reflex tell you

A

that the media is clear

31
Q

what are the signs and symptoms of retinal detachment

A

painless loss of vision
sudden onset of flashes/ floaters (mechanical separation of sensory retina from retinal pigment epithelium)

may have RAPD
may see tear on ophthalmoscopy

32
Q

what causes ARMD

A

multifactoral- age, smoking, family history, poor nutrition

33
Q

what are the types of ARMD

A

wet- sudden visual loss

dry- gradual

34
Q

describe wet ARMD

A

new blood vessels grow under retina from pigment epithelium up through the choroid

leakage causes build up of fluid/ blood and eventually scarring

35
Q

what are the signs and symptoms of wet ARMD

A

rapid central visual loss
distortion (metamorphosia)

haemorrhage/ exudate
eye pale due to oedema
flecks in eye exudates from vessels

36
Q

what is glaucoma

A

progressive optic neuropathy leads to optic nerve damage

37
Q

what is the angle in glaucoma

A

angle between the iris and the cornea

38
Q

what is the path of aqueous fluid

A

produced by the ciliary body, travels between the iris and lens into the trabecular meshwork

39
Q

what causes closed angle glaucoma

A

aqueous humour encounters increased resistance through the iris/lens channel

increased pressure gradient causes peripheral iris to bow forward, obstructing trabecular meshwork- increasing pressure

40
Q

what are the signs and symptoms of closed angle glaucoma

A

acute (ophthalmic emergency)

painful, red eye, sudden visual loss, headache, N&V

red eye, cloudy cornea, dilated pupil

41
Q

what is the treatment for closed angle glaucoma

A

lower IOP with drops/ oral medication to prevent blindness

42
Q

what are the causes of gradual visual loss

A

cataract, ARMD (dry type), refractive error, glaucoma, diabetic retinopathy

43
Q

what is cataracts

A

cloudiness of the lens- abnormal changes in lens proteins (crystallins) causes changes in their chemical and structural nature causing them to loose their transparency

44
Q

what causes cataracts

A

age, congenital (intrauterine infection), traumatic, metabolic (diabetes- reductase glucose to sorbitol), drugs (steroids)

45
Q

what are the different types of cataracts

A

nuclear
posterior (subcapuslar)
christmas tree (polychromatic)
congenital

46
Q

what are the symptoms of cataracts

A

gradual decline in vision (hazy/blurred)

glare

47
Q

when is surgery done for cataracts

A

is patient is symptomatic

48
Q

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

A

ARMD

49
Q

what type of of ARMD do you get drusens in

what are they?

A

dry type- they are bi products of pigment cells which build up and stop nutirents diffusing through the choroid- retina becomes atrophic

50
Q

what are the signs and symptoms of dry type ARMD

A

gradual decline in vision
central vision missing (scrotoma)

drusen (yellow flakes)
atrophic patches of retina

51
Q

what is the treatment for dry type ARMD

A

none- vision aids

52
Q

what is myopia

A

short sighted- image focused infront of the retina of the retina

53
Q

what is hypermetropia

A

long sighted- image focused behind the retina

54
Q

what is astigmatism

A

usually irregular corneal curvature

55
Q

what is presbyopia

A

loss of accommodation with age

56
Q

what is the treatment for refractive error

A

glasses

57
Q

describe open angle glaucoma

A

Trabecular meshwork gets clogged up and doesn’t allow the fluid draining from the eye
Pressure increases gradually

58
Q

what are the signs and symptoms of open angle glaucoma

A

often none

cupped disc
visual field defect
may/ not have raised IOP

Opthalmology (16 decks)

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