Visual loss - hemorrhage (haemorrhage causes of sudden vision loss)

Question 1

Where does bleeding often occur in the eye and what is this known as ?

Answer 1

Often bleed into the viterous cavity - known as vitreous haemorrhage

Question 2

What are the causes of viterous haemorrhage ?

Answer 2

• Due to bleeding of abnormal vessels which have formed as a result of retinal vein occlusion or diabetic retinopathy
• Due to bleeding of normal vessels usually associated with retinal tear
• Anticoagulants

Question 3

What are the signs/symptoms of vitreous haemorrhage ?

Answer 3

Symptoms:

• Loss of vision (sudden & painless)
• Floaters or numerous dark spots

Signs:

• Loss of red reflexes
• Haemorrhage

Question 4

What is the treatment of vitreous haemorrhage ?

Answer 4

• 1st line - usually undergoes spontaneous reabsorption
• 2nd line - vitrectomy for non-resolving cases

Question 5

How does retinal detachment occur ?

Answer 5

Holes/tears in the retina allow fluid to separate the sensory retina from the retinal pigment epithelium

Question 6

What are the signs/symptoms of retinal detachment ?

Answer 6

Symptoms:

• Sudden onset painless vision loss - Dense shadow that starts peripherally progresses towards the central vision. Like a veil or curtain over the field of vision
• Flashes/floaters (features of posterior vitreous detachment may preceed retinal detachment)

Signs:

• May see a tear
• May have Relative afferent pupil defect

Question 7

What is the treatment of retinal detachment ?

Answer 7

Surgery:

• If detached - vitrectomy and gas tamponade, sceral implants
• If tear which is symptomatic - cryotherapy or laser coagulation

Question 8

What are the 2 types of age-realted macular degeneration (ARMD)?

Answer 8

Wet and dry ARMD

Question 9

What is the main difference in wet vs dry ARMD?

Answer 9

• Wet is sudden reduction is vision
• Dry is gradual reduction in vision

Question 10

Describe the pathogenesis of wet ARMD

Answer 10

New blood vessels grow under retina – leakage causes build up of fluid/blood and eventually scarring

Question 11

What are the signs/symptoms of wet ARMD?

Answer 11

Symptoms:

• Rapid central vision loss
• Distortion (metamorphopsia)

Signs:

• Haemorrhage at the macula
• Drusen at the macula - yellow deposits (made up of lipids anf fatty deposits)
• Macular pigment changes (think usually more redish but pic shows more yellowy)
• Neovascularization - new vessels forming

Question 12

How is wet ARMD diagnosed ?

Answer 12

Fundus fluorscence angiography (used to confirm diagnosis, assess type, extent, size & location of lesions) + Ocular coherence tomography (for diagnosis & monitoring response to therapy)

Question 13

What is the treatment of Wet ARMD?

Answer 13

Anti-VEGF to stop new blood vessels growing

e.g. ranibizumab, bevacizumab, aflibercept

Question 14

What is a posterior vitreous detachment ?

Answer 14

Posterior vitreous detachment (PVD) is a condition where your vitreous comes away from the retina at the back of your eye.

Question 15

What are the clinical features of PVD?

Answer 15

• It is non-painful and doesnt cause visual loss
• Flashes of light (photopsia) - in the peripheral field of vision
• Floaters, often on the temporal side of the central vision

Question 16

What should PVD features prompt?

Answer 16

Exammination of the eye - most people with PVD will not develop retinal detachment