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Year 2 > Visual loss & blindness > Flashcards

Visual loss & blindness Flashcards

1
Q

List the causes of sudden visual loss

A

Vascular (vein/artery obstruction or haemorrhage)
Wet age related macular degeneration (ARMD)
Retinal detachment
Closed angle glaucoma
Stroke
Optic neuritis

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2
Q

What are the two important branches of the ophthalmic artery?

A

Posterior cillary and central retinal

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3
Q

Which branch of the ophthalmic artery supplies the retina?

A

Central retinal artery

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4
Q

What are the symptoms of central retinal artery occlusion?

A

Sudden severe vision loss

Painless

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5
Q

What are the signs of central retinal artery occlusion?

A

Relative afferent pupillary defect (RAPD)
Pale oedematous retina
Thread-like vessels

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6
Q

When might central retinal artery occlusion be painful?

A

When it is associated with giant cell arteritis

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7
Q

Central retinal artery occlusion is a type of stroke. T/F

A

True - often a warning sign for things to come

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8
Q

Which two underlying diseases can cause central retinal artery occlusion?

A

Carotid artery disease

Emboli from heart (rare)

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9
Q

How can central retinal artery occlusion be managed ophthalmically and vascularly?

A

Ophthalmic - if within 24 hours can try to convert occlusion to a branch artery with massage
Vascular - carotid doppler to locate source of emboli and management of other risk factors

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10
Q

How does branch retinal artery occlusion present?

A

Sudden visual field defect

Painless

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11
Q

What is amaurosis fugax?

A

Transient central retinal artery occlusion

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12
Q

What are the symptoms of amaurosis fugax?

A

Transient visual loss (“curtain coming down”)
Painless
5-10 minute duration with complete recovery

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13
Q

What are the signs of amaurosis fugax?

A

Typically normal fundus examination

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14
Q

How is amaurosis fugax managed?

A

Immediate referral to TIA clinic

Aspirin (if no contraindications)

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15
Q

Name a cause of transient visual loss

A

Migraine

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16
Q

How does migraine typically present in the context of ophthamology?

A

Transient visual loss followed by headache

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17
Q

What are the causes of central retinal vein occlusion?

A

Vascular (Virchow’s triad - hypertension, diabetes)

Ocular (Glaucoma - raised IOP)

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18
Q

What are the components of Virchow’s triad?

A

Stasis of blood flow (artherosclerosis)
Endothelial injury (hypertension)
Hypercoagulability

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19
Q

How does central retinal vein occlusion present?

A

Sudden severe visual loss

Painless

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20
Q

What are the signs of central retinal vein occlusion?

A

Retinal haemorrhages
Dilated tortuous veins
Disc and macular swelling
Cotton wool spots

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21
Q

How are central retinal vein occlusions treated?

A

Treatment of underlying cause
Monitor for the development of complications
Anti-VEGF

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22
Q

How do branch retinal vein occlusions present?

A

Visual field defect
Painless
Sudden

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23
Q

What is ischaemic optic neuropathy?

A

Occlusion of optic nerve head circulation

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24
Q

Which blood vessels are affected in ischaemic optic neuropathy?

A

Posterior ciliary arteries

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25
Q

How can ischaemic optic neuropathy be classified?

A

Arteritic

Non-arteritic

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26
Q

What is the cause of arteritic ischaemic optic neuropathy?

A

Inflammation (GCA)

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27
Q

What is the cause of non-arteritic ischaemic optic neuropathy?

A

Artherosclerosis

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28
Q

How does ischaemic optic neuropathy present?

A

Sudden
Profound vision loss
Swollen optic disc

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29
Q

Giant cell arteritis is a vasculitis affecting which size of vessels? Name the commonly affected vessels

A

Medium
Temporal
Posterior ciliary

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30
Q

How does vision loss occur in ischaemic optic neuropathy?

A

Ischaemia causes death of the optic nerve

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31
Q

How does ischaemic optic neuropathy appear on fundoscopy?

A

Pale & swollen optic disc

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32
Q

How does vision loss from GCA present?

A

Sudden vision loss
Associated with headache
Profound loss
Irreversible

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33
Q

After vision loss associated with GCA, what is the ultimate goal of treatment? What is the treatment?

A

Prevention of bilateral vision loss

High dose systemic steroids

34
Q

How does GCA present?

A 
Temporal headache
Scalp tenderness
Amaurosis fugax
Jaw claudication
Enlarged temporal arteries 
Raised inflammatory markers
35
Q

Where do most haemorrhages within the eye occur?

A

Vitreous (i.e vitreous haemorrhages)

36
Q

Haemorrhages within the eye come from abnormal blood vessels. T/F

A

False - can come from abnormal or normal vessels

37
Q

Bleeding within the eye coming from abnormal vessels is associated with what? Name two cases where this might occur

A

Retinal ischaemia and new blood vessel formation
Diabetic retinopathy
Retinal vein occlusion

38
Q

Bleeding within the eye coming from normal vessels is associated with what?

A

Retinal tear/detachment

39
Q

How does a vitreous haemorrhage present?

A

Loss of vision with floaters

40
Q

What are the signs of a vitreous haemorrhage?

A

Loss of red reflex

Haemorrhage on fundoscopy

41
Q

How is vitreous haemorrhage treated?

A

Treat underlying cause

Vitrectomy (if non-resolving)

42
Q

How does retinal detachment present?

A 
Painless
Loss of vision
Flashing
Floaters 
Halos around light
43
Q

What are the signs of retinal detachment?

A

Relative afferent pupillary defect

Tear on fundoscopy

44
Q

How is retinal detachment managed?

A

Surgical - laser or re-attachment

45
Q

A retinal detachment within the inferior optic field will cause vision loss where within the visual field? Why?

A

Superiorly

Inversion of image

46
Q

What is the commonest cause of blindness in the elderly (in the West)?

A

Age related macular degeneration

47
Q

What are the two types of macular degeneration?

A

Wet

Dry

48
Q

Both types of macular degeneration present with vision loss, what is the difference between the type of vision loss?

A

Wet - sudden

Dry - gradual

49
Q

Describe the pathogenesis of wet age related macular degeneration

A

Blood vessels grow under the retina and leak fluid/blood causing scarring

50
Q

How does wet ARMD present?

A

Rapid central vision loss
Distortion/metamorphopsia
Enlarged blind spot/scotoma

51
Q

What are the signs of wet ARMD?

A

Haemorrhage/exudate over the macula (can only be seen when patient looking directly at you during ophthalmoscopy)

52
Q

Which test can be done to check for ARMD, besides ophthalmoscopy?

A

Amsler grid

53
Q

How is wet ARMD treated?

A

Anti-VEGF injected into vitreous cavity

54
Q

How does anti-VEGF work?

A

Binds to vascular endothelial growth factor to stop neovascularisation

55
Q

How does gradual vision loss present?

A

Usually bilateral
Asymmetrical
Early presentation - reduced visual acuity
Late presentation - visual field defect

56
Q

What are the causes of gradual vision loss?

A 
C - cataract
A - age related macular degeneration (dry)
R - refractive error 
D - diabetic retinopathy
I - inherited disease 
G - glaucoma (open angle)
A - access to eye clinic
N - non-urgent
57
Q

Name an inherited disease which causes gradual vision loss

A

Retinitis pigmentosa

58
Q

What is a cataract?

A

Clouding of the lens

59
Q

What are the causes of cataract?

A 
Age
Congenital
Traumatic
Metabolic
Drug induced
60
Q

Name a congenital cause of cataract

A

Intrauterine infection

61
Q

Name a metabolic cause of cataract

A

Diabetes

62
Q

Name a drug class which causes cataract

A

Steroids

63
Q

Why is it important to check the red reflex in neonates?

A

Cataract risk due to intrauterine infection

64
Q

How are cataracts treated? When are they treated?

A

Surgical removal with intra-ocular lens implant

If patient is symptomatic

65
Q

How does dry age related macular degeneration present?

A

Gradual visual decline

Scotoma/central vision missing

66
Q

What are the signs of dry ARMD?

A

Drusen

Atrophic portions of retina

67
Q

What is drusen?

A

Build up of waste products below the retinal pigment epithelium

68
Q

How is dry ARMD treated?

A

Supportive (vision magnifiers)

69
Q

What do we call short sightedness?

A

Myopia

70
Q

What do we call long sightedness?

A

Hypermetropia

71
Q

What is astigmatism?

A

Eye shaped abnormally (like a rugby ball)

72
Q

What is presbyopia?

A

Loss of accommodation reflex with aging

73
Q

What is glaucoma?

A

Progressive optic neuropathy due to high intra-ocular pressure

74
Q

How can glaucoma be categorised?

A

Closed angle

Open angle

75
Q

What is the end point of glaucoma?

A

Vision loss due to optic nerve damage

76
Q

When we refer to angles in glaucoma, which angle to we mean?

A

Iridocorneal angle

77
Q

How does closed angle glaucoma present?

A 
Painful eye
Red eye 
Vision loss
Headache 
Nausea & vomiting (due to pain)
78
Q

How is closed angle glaucoma treated?

A

Lower IOP with eye drops or oral medication

79
Q

How does open angle glaucoma present?

A

Asymptomatic

80
Q

What are the signs of open angle glaucoma?

A

Cupped disc
Visual field defect
+/- high IOP

81
Q

How is open angle glaucoma managed?

A 
Lower IOP with
 - eye drops
 - laser
 - surgery
REGULAR MONITORING IN GLAUCOMA CLINIC

Year 2 (72 decks)

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