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GEM Year 1 Part II > W136 Sudden Visual Loss > Flashcards

W136 Sudden Visual Loss Flashcards

1
Q

Signs and symptoms pf lens dislocation?

A
  • diplopia (blurry)
  • can’t focus properly
  • iridodensis (iris may quiver)
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2
Q

Management of dislocation?

A

First line: glasses

Then: remove and replace lens if fully dislocated (rare)

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3
Q

Signs and symptoms of lens haemorrhage?

A
  • Sudden, painless vision loss
  • No RAPD
  • Can be haziness, floaters or full loss
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4
Q

Causes of lens haemorrhage?

A
  1. Trauma
  2. Diabetic retinopathy

Together account for 90% cases

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5
Q

What is found on fundoscopy for haemorrhage of lens?

A
  • Decreased red reflex
  • Hazy red (blood)
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6
Q

Investigations for haemorrhage of lens?

A
  • Fluorescein angiography to find nevascularisation
  • Fundoscopy
  • Intra-occular pressures
  • Slit lamp examination
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7
Q

Management of lens haemorrhage?

A

Laser photo-coagulation for stopping neovascularisation

Anterior retinal cryotherapy (ARC) for clearance of fresh blood

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8
Q

What is wet age-related macular degeneration?

A

Sometimes called neovascular AMD –

Develops when abnormal blood vessels form underneath the macula and damage its cells.

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9
Q

How is wet AMD different to dry?

A
  • more acutely severe
  • no drusen (deposits) in wet AMD
  • no macular neovascularisation in dry AMD
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10
Q

Signs and symptoms of wet AMD?

A
  • No RAPD (ususally)
  • Sudden visual distortion
  • Central blank patch or blurring
  • Typically >55 years old
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11
Q

Findings on fundoscopy for wet AMD?

A
  • macular oedema
  • usually subretinal haemorrhages (from neovascularisation)

centred around the macular

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12
Q

Management of wet AMD?

A
  • Intra-ocular injections of anti-angiogenic drugs (anti-VEGF).
  • Fluorescein angiography (find nevascularisation sites)
  • Colour fundus photography (to provide record of retina).
  • Psychological support.
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13
Q

What is (central) retinal artery occlusion? (CRAO)

A

Central - artery occluded more medially and so has more drastic effect on vision and orbit function.

Elsewhere- occlusion of retinal artery more distil-ly into the orbit; has bifurcated and will have less severe effect.

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14
Q

Signs and symptoms of Central Retinal Artery Occlusion?

A
  • RAPD
  • Reduced acuity
  • Sudden, unilateral, painless, loss of vision
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15
Q

What is seen on fundoscopy for central retinal artery occlusion?

A

Cherry red spot!

Pale retina

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16
Q

What do you want to make sure you rule out before diagnosing central retinal artery occlusion?

A

Giant cell arteritis!

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17
Q

Causes of central retinal artery occlusion?

A
  • hypertension
  • diabetes
  • embolus
  • giant cell arteritis (make sure to rule out)
18
Q

Management of central retinal artery occlusion?

A
  • Lower intra-ocular pressure
  • Re-perfuse ischaemic tissue quickly.

Nothing else to do really.

19
Q

Signs and symptoms of (central) retinal vein occlusion?

A
  • Sudden, painless, unilateral loss of vision (complete or partial depends on vein occluded)
  • RAPD if severe
  • Papilloedema - enlargement of blind spot and blurring; that can develop into optic atrophy
20
Q

What do you find on fundoscopy for Central Retinal Vein Occlusion?

A
  • Mottled appearance; ‘ketchup’ fundus
  • Retinal haemorrhages (tortuous, dilated retinal veins)
  • Macular oedema
  • Cotton wool spots
21
Q

Management of ventral retinal vein occlusion?

A

Treat the macula oedema!

  • pan-retinal photocoagulation laser treatment
  • dexamethasone implants
  • Triamcinalone

Nothing else really. Treat underlying cause.

22
Q

Signs and symptoms of retinal detachment?

A
  • Painless
  • RAPD
  • Progressive loss of vision - see floaters, flashing lights, peripheral vision loss (localised defect).
  • Suspect on history
23
Q

What would you find on fundoscopy for retinal detachment (RD)?

A
  • Red reflex abnormal
  • Detached retina looks grey and wrinkled (not always visible)
  • Follow on with a slit lamp examination of retina.
24
Q

Management of retinal detachement?

A
  • Laser therapy
  • Cryo therapy
  • Reattachment surgery

Good prognosis.

25
Q

Causes of retinal detachment?

A
  • retinal tear - allowing fluid behind
  • trauma
  • diabetic retinopathy
26
Q

What is acute angle closure glaucoma?

A

Is a less common type of glaucoma:

Occurs when the part of the eye that drains fluid becomes blocked, causing pressure to build up in the eye.

27
Q

Signs and symptoms of acute angle closure glaucoma?

A
  • Bilateral and painful
  • Blurred vision - diplopia
  • Headaches
  • Nausea
  • Seeing ‘halo’s’ around lights
  • (RAPD sometimes)
28
Q

On investigation and examination what would you find in acute angle closure glaucoma?

A
  • Raised intraoccular pressure (IOP)
  • Red eye
  • Hazy cornea
  • Irregular pupil
  • Firm globe (due to raised IOP)
  • ‘Shadow sign’ seen in pupil when light flashed in (indicates shallow anterior chamber)
29
Q

Management of acute angle closure glaucoma?

A
  • Pilocarpine eye drops
  • Anti-emetics (if acute phase)
  • Laser treatment
  • Surgery; iridotomy

Main treatment focuses on reducing IOP.

30
Q

What does pilocarpine do?

A
  • Is a parasympathomimetic
  • Mimics effect of ACh on muscarinic receptors.
  • Opens up network in trabecular meshwork.
  • Reverses myadriasis (dilated pupil)
31
Q

Side affects of pilocarpine/ parasympathomimetics?

A
  • Headache,
  • burning,
  • stinging,
  • myopia,
  • risk of retinal detachment.
32
Q

What is anterior ischaemic optic neuropathy?

A

If optic blood vessels become very narrow or blocked for any reason, the nerve cannot function properly and the sight in the eye may be very poor.

33
Q

Causes of anterior ischaemic optic neuropathy (AION)?

A
  • VIAGRAAAAAA
  • Multiple sclerosis
  • Atherosclerotic causes
34
Q

Signs and symptoms of AION?

A
  • Painless
  • RAPD
  • Signs of temporal arteritis
  • Rapidly progressive loss of vision
  • Decreased colour vision.
35
Q

What do you see on fundoscopy for AION?

A

A pale, swollen optic disk.

36
Q

Why does blood supply affect the optic nerve?

A

Because anatomy.

37
Q

Management for AION?

A

Treat underlying cause.

e.g. MRI if suspect multiple sclerosis

38
Q

What is this called and where would the lesion be?

A

Bitemporal hemianopia

Chiasmal lesion

39
Q

What is this called and where would lesion be?

A

Homonymous hemianopia

Optic tract lesion

40
Q

What is mononuclear field loss and where would lesion be?

A

Loss of sight in one eye.

Optic tract lesion.

GEM Year 1 Part II (8 decks)

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