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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
what are the two types of ION?
Arteritic 50% - inflammation (GCA) Non-arteritic 50% - atherosclerosis
26
PC of ION (both arthritic and non-arteritic)
sudden, profound visual loss with swollen disc
27
pathogens of arthritic ION
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
28
visual symptoms of arthritic ION
Sudden visual loss Profound (CF – NPoL) Irreversible blindness (diagnose quick to stop bilateral loss)
29
systemic symptoms of arthritic ION
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
treatment of GCA
refer urgent, high dose steroids urgent - then biopsy
31
how can sudden visual loss occur from haemorrhage?
- abnormal blood vessels (eg diabetes, wet ARMD) | - retinal tear
32
symptoms of vitreous haemorrhage
Loss of vision | ‘Floaters'
33
signs of vitreous haemorrhage
Loss of red reflex | May see haemorrhage on fundoscopy
34
management of vitreous haemorrhage
indentfy casue | Vitrectomy for non-resolving cases (lots of people need surgery)
35
symptoms of Retinal Detachment
Painless loss of vision Sudden onset of flashes/floaters (mechanical separation of sensory retina from retinal pigment epithelium) "curtain coming down"
36
Retinal Detachment
May have RAPD | May see tear on ophthalmoscopy
37
Retinal Detachment management
ususally surgical
38
what are the two types of age related macular degeneration (ARMD) + PC
dry (gradual visual loss) | wet (sudden)
39
what is the Commonest cause of blindness in Western World in patients over 65
ARMD
40
pathogenesis of wet ARMD
New blood vessels grow under retina – leakage causes build up of fluid/blood and eventually scarring
41
wet ARMD: symptoms
Rapid central visual loss | Distortion (metamorphopsia
42
wet ARMD: signs
haemorrhage/exudate
43
what is blind spot called?
scotoma
44
treatment of Wet ARMD
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
what is Glaucoma
Progressive optic neuropathy, Ultimately result in optic nerve damage (and therefore, visual loss)
46
risk factor for glaucoma
high IOP
47
describe what close-angle glaucoma is?
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
treating closed-angle glaucoma
Need to lower IOP with drops/oral medication to prevent patient going blind, then do laser iridotomy (can be acutely painful/emergencyl)
49
PC of glaucoma closed angle
Patient presents with painful, red eye/visual loss/headache/nausea/vomiting
50
characteristics of gradual vision loss
Bilateral – usually Often asymmetrical May present early with reduced Visual acuity May present late with decreased field
51
causes of gradual vision loss
Cataract Age related macular degeneration (dry type) Refractive error Glaucoma Diabetic retinopathy
52
what is cataract
Cloudiness of the lens
53
causes of cataract
``` Age related Congenital – intrauterine infection (importance of checking red reflex in neonates) Traumatic Metabolic – diabetes Drug-induced (steroids) ```
54
what is the number one cause of preventable blindness worldwide
cataract
55
symptoms of cataract
Gradual decline in vision (‘hazy’ / ‘blurred’) that cannot be corrected with glasses May get glare (can be very disabling at night when driving)
56
management of cataract
surgical removal with intra-ocular lens implant if patient is symptomatic
57
symptoms of dry ARMD
Gradual decline in vision | Central vision ‘missing’ (scotoma)
58
signs of dry ARMD
Drusen – build up of waste products below RPE atrophic patches of retina
59
treatment for dry ARMD
no cure - treatment is supportive with low vision aids eg magnifiers
60
refractive error means what?
Eye cannot clearly focus image | treat by glasses
61
myopia
short sighted
62
hypermetropia
long sighted
63
astigmatism
usually irregular corneal curvature
64
presbyopia
loss of accommodation with aging
65
glaucoma open-angle pathogenesis
angle is ‘open’ but there is resistance to outflow of aqueous in trabecular meshwork
66
glaucoma open-angle symptoms
Often NONE | Optician may discover it
67
glaucoma open-angle signs
Cupped disc Visual field defect May/may not have high IOP
68
glaucoma open angle treatment
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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