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Ophthalmology > week 2 visual loss and blindness > Flashcards

week 2 visual loss and blindness Flashcards

1
Q

what are the two types of visual loss?

A

sudden

gradual

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2
Q

causes of sudden visual loss

A 
Vascular aetiology
Vitreous haemorrhage
Retinal detachment
Age related macular degeneration (ARMD) -wet type
Closed angle glaucoma
optic neuritis
stroke
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3
Q

what are the two branches of the ophthalmic artery we need to know?

A

PCA- posterior ciliary artery

CRA - central retina artery

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4
Q

what does the CRA supply?

A

inner 2/3rds of retina

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5
Q

the PCAs supply what?

A

optic nerve head

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6
Q

the choroid arteries supply what?

A

outer 1/3rd of retina

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7
Q

sudden loss of vision occurs why?

A

occlusion =

  • retinal circulation
  • optic nerve head circulation

haemorrhage=

  • abnormal blood vessels (eg diabetes, wet ARMD)
  • retinal tear
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8
Q

symptoms of CRAO

A
  • Sudden visual loss
  • Profound (Count Fingers or less- remember CRA is ‘end artery’)
  • Painless (unless GCA)
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9
Q

signs of CRAO

A
  • RAPD (relative afferent pupil defect)

- Pale oedematous retina, thread-like retinal vessels

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10
Q

causes of CRAO

A

Carotid artery disease (type of stroke)

Emboli from the heart (unusual)

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11
Q

management of CRAO

A

If presents within 24 hours: = Ocular massage (try to convert CRAO to BRAO)

Vascular management:
=Establish source of embolus – carotid doppler
=Assess and manage risk factors

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12
Q

what is BRAO/BRVO

A

branch retinal artery occlusion - less visual loss

branch retinal vein occlusio

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13
Q

what is amaurosis fugax

A

transient CRAO

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14
Q

symptoms of amaurosis fugax

A

transient painless visual loss
‘like a curtain coming down’
lasts~5mins with full recovery

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15
Q

amaurosis fugax: signs

A

Usually nothing abnormal to see on examination

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16
Q

amaurosis fugax treatment

A

Urgent referral Stroke clinic

Aspirin (unless contraindicated)

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17
Q

what potential other cases of amaurosis fugax/transcient vision loss other than occlusion and then unblocking?

A

Migraine – visual loss usually followed by headache

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18
Q

what is the pathogenesis being CRVO?

A

SYSTEMIC:virchow’s triad = stasis, hyper coagulability, endothelial damage

OCULAR: raised IOP (venous stasis)

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19
Q

symptoms of CRVO

A

Sudden visual loss

Moderate to severe visual loss (6/9 – Percepion of Light)

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20
Q

CRVO; signs

A

Retinal haemorrhages
Dilated tortuous veins
Disc swelling and macular swelling

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21
Q

treating CRVO

A

Monitor: may develop complications due to development of new vessels (laser treatment may be required to avoid complications from these vessels eg vitreous haemorrhage)

More recently, anti- VEGFs used to stop new blood vessel growth(VEGF = vascular endothelial growth factor)

Address underlying risk factors eg hypertension, diabetes

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22
Q

what is the difference of fundoscopy of artery vs vein occlusion?

A

pale - artery occlusion

drak - vein occlusion

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23
Q

what is Ischaemic optic neuropathy?

A

ION

Occlusion of optic nerve head circulation

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24
Q

pathology of ION

A

Posterior ciliary arteries (PCA) become occluded, resulting in infarction of the optic nerve head
(PCA not end arteries)

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25
Q

what are the two types of ION?

A

Arteritic 50% - inflammation (GCA)

Non-arteritic 50% - atherosclerosis

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26
Q

PC of ION (both arthritic and non-arteritic)

A

sudden, profound visual loss with swollen disc

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27
Q

pathogens of arthritic ION

A

Giant cell arteritis (GCA)

Medium to large sized arteries inflamed (infiltrated by multinucleate giant cells)

Lumen of artery becomes occluded (posterior ciliary arteries)

Visual loss from ischaemia of optic nerve head

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28
Q

visual symptoms of arthritic ION

A

Sudden visual loss
Profound (CF – NPoL)
Irreversible blindness

(diagnose quick to stop bilateral loss)

29
Q

systemic symptoms of arthritic ION

A

Headache (usually temporal)

Jaw claudication

Scalp tenderness (painful to comb hair)

Tender/enlarged
scalp arteries

Amaurosis fugax

Malaise

Very High ESR , PV and CRP

Temporal artery biopsy may help diagnosis

30
Q

treatment of GCA

A

refer urgent, high dose steroids urgent - then biopsy

31
Q

how can sudden visual loss occur from haemorrhage?

A
  • abnormal blood vessels (eg diabetes, wet ARMD)

- retinal tear

32
Q

symptoms of vitreous haemorrhage

A

Loss of vision

‘Floaters’

33
Q

signs of vitreous haemorrhage

A

Loss of red reflex

May see haemorrhage on fundoscopy

34
Q

management of vitreous haemorrhage

A

indentfy casue

Vitrectomy for non-resolving cases (lots of people need surgery)

35
Q

symptoms of Retinal Detachment

A

Painless loss of vision
Sudden onset of flashes/floaters (mechanical separation of sensory retina from retinal pigment epithelium)
“curtain coming down”

36
Q

Retinal Detachment

A

May have RAPD

May see tear on ophthalmoscopy

37
Q

Retinal Detachment management

A

ususally surgical

38
Q

what are the two types of age related macular degeneration (ARMD) + PC

A

dry (gradual visual loss)

wet (sudden)

39
Q

what is the Commonest cause of blindness in Western World in patients over 65

A

ARMD

40
Q

pathogenesis of wet ARMD

A

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

41
Q

wet ARMD: symptoms

A

Rapid central visual loss

Distortion (metamorphopsia

42
Q

wet ARMD: signs

A

haemorrhage/exudate

43
Q

what is blind spot called?

A

scotoma

44
Q

treatment of Wet ARMD

A

Previously:
Laser
Photodynamic therapy

Now:
Anti-VEGF treatment – injected into vitreous cavity. Stops new blood vessels growing by binding to VEGF (vascular endothelial growth factor)

45
Q

what is Glaucoma

A

Progressive optic neuropathy, Ultimately result in optic nerve damage (and therefore, visual loss)

46
Q

risk factor for glaucoma

A

high IOP

47
Q

describe what close-angle glaucoma is?

A

Aqueous humour encounters increased resistance through iris/lens channel
Increased pressure gradient causes peripheral iris to bow forward, obstructing trabecular meshwork – pressure increases
(iris blocks drainage)

48
Q

treating closed-angle glaucoma

A

Need to lower IOP with drops/oral medication to prevent patient going blind, then do laser iridotomy
(can be acutely painful/emergencyl)

49
Q

PC of glaucoma closed angle

A

Patient presents with painful, red eye/visual loss/headache/nausea/vomiting

50
Q

characteristics of gradual vision loss

A

Bilateral – usually

Often asymmetrical

May present early with reduced Visual acuity

May present late with decreased field

51
Q

causes of gradual vision loss

A

Cataract

Age related macular degeneration (dry type)

Refractive error

Glaucoma

Diabetic retinopathy

52
Q

what is cataract

A

Cloudiness of the lens

53
Q

causes of cataract

A 
Age related
Congenital – intrauterine infection (importance of checking red reflex in neonates)
Traumatic
Metabolic – diabetes
Drug-induced (steroids)
54
Q

what is the number one cause of preventable blindness worldwide

A

cataract

55
Q

symptoms of cataract

A

Gradual decline in vision (‘hazy’ / ‘blurred’) that cannot be corrected with glasses
May get glare (can be very disabling at night when driving)

56
Q

management of cataract

A

surgical removal with intra-ocular lens implant if patient is symptomatic

57
Q

symptoms of dry ARMD

A

Gradual decline in vision

Central vision ‘missing’ (scotoma)

58
Q

signs of dry ARMD

A

Drusen – build up of waste
products below RPE

atrophic patches of retina

59
Q

treatment for dry ARMD

A

no cure - treatment is supportive with low vision aids eg magnifiers

60
Q

refractive error means what?

A

Eye cannot clearly focus image

treat by glasses

61
Q

myopia

A

short sighted

62
Q

hypermetropia

A

long sighted

63
Q

astigmatism

A

usually irregular corneal curvature

64
Q

presbyopia

A

loss of accommodation with aging

65
Q

glaucoma open-angle pathogenesis

A

angle is ‘open’ but there is resistance to outflow of aqueous in trabecular meshwork

66
Q

glaucoma open-angle symptoms

A

Often NONE

Optician may discover it

67
Q

glaucoma open-angle signs

A

Cupped disc
Visual field defect
May/may not have high IOP

68
Q

glaucoma open angle treatment

A

aim to preserve vision (by lowering IOP) with eye drops /laser/surgery

Patients need regular monitoring in eye clinic

Ophthalmology (17 decks)

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