Vitreous Causes

Question 1

Vitreous haemorrhage is bleeding into the vitreous humour. It is one of the most common causes of sudden painless loss of vision. What is the incidence of this?

1 - 7 cases per 100,000
2 - 70 cases per 100,000
3 - 700 cases per 100,000
4 - 7000 cases per 100,000

Answer 1

1 - 7 cases per 100,000

Equally as likely in men and women

Question 2

What age does Vitreous haemorrhage typically peak at?

1 - >40
2 - >50
3 - >60
4 - >70

Answer 2

4 - >70

Question 3

Which of the following is NOT a typical cause of Vitreous haemorrhage?

1 - Diabetic retinopathy
2 - Autoimmune conditions
3 - Retinal tear or detachment
4 - Retinal vein occlusion
5 - Trauma:
6 - Age-related macular degeneration
7 - Posterior vitreous detachment
8 - Tumours

Answer 3

2 - Autoimmune conditions

Most commonly this will be a diabetic patient who has had a previous vitreous haemorrhage secondary to proliferative diabetic retinopathy

Question 4

Vitreous haemorrhage can cause sudden loss of vision. Is this typically associated with pain?

Answer 4

• no

The vision loss is painless

Question 5

In addition to vision loss, which 2 of the following do patients typical describe in vitreous haemorrhage?

1 - photopsia
2 - floaters
3 - hazy vision
4 - distorted vision

Answer 5

2 - floaters
3 - hazy vision

Question 6

What imaging modality can be used to ensure there is no retinal detachment in a patient with suspected vitreous haemorrhage?

1 - CT
2 - MRI
3 - ultrasound
4 - PET scan

Answer 6

3 - ultrasound

Question 7

What is the standard treatment for vitreous haemorrhage?

1 - surgery (vitrectomy)
2 - wait and see
3 - laser therapy
4 - steroids and lubricating drops

Answer 7

1 - surgery (vitrectomy)

Locate the tear in the vitreous and identify the cause

Question 8

Subhyloid haemorrhage is another acute condition that can cause vision loss. Where does the subhyloid haemorrhage occur?

1 - between macula and fovea
2 - between vitreous and retina
3 - between lens and sclera
4 - between sclera and retina

Answer 8

2 - between vitreous and retina

Question 9

Which condition can subhyloid haemorrhage occur in more than others?

1 - sarcoidosis
2 - lupus
3 - COPD
4 - diabetes

Answer 9

4 - diabetes

Normally following neovascularisation

Diabetic patients will need laser therapy to stop neovascularisation

Question 10

In children, which 2 of the following are the most common causes of a lack of red light refelex?

1 - cataracts
2 - glaucoma
3 - retinoblastoma
4 - carotid cavernous fistula

Answer 10

1 - cataracts
3 - retinoblastoma

Question 11

Can a squint in a child affect their vision as the child grows up?

Answer 11

• yes
  Can cause a lazy eye

Needs to be addressed and treated to reduce this risk

Question 12

A 56 yr old man attends the emergency eye clinic with sudden, painless loss of vision in his right eye. He describes ‘floaters’ and ‘hazy’ vision in the preceding four days. He has type-2 diabetes for which he takes metformin and gliclazide.
On examination his pulse is 89 bpm and regular, and BP 136/80 mmHg. Visual acuity in the right eye is reduced (only able to perceive shapes) with loss of the red reflex; normal in the left eye. Eye movements and pupillary reflexes are normal. There is no photophobia, erythema, conjunctival swelling or streaming.

Which is the most likely cause of his visual loss?

1 - Conjunctivitis
2 - Ischaemic optic neuropathy
3 - Vitreous haemorrhage
4 - Occipital stroke
5 - Ocular migraine

Answer 12

3 - Vitreous haemorrhage

Common in diabetics, and the key here is that there is a prodrome before vision loss, such as the floaters

Commonly caused by proliferative retinopathy