painless loss of vision

Question 1

viterous haemorrhage

Answer 1

bleeding in the viterous cavity seen in inidividuals with DM, CVS disease and retinal detachment

sudden loss of vision, floaters
signs- reduced / absent red reflex. limited / no fundal view

mx: USS to ensure no underlying retinal detachment.
vitrectomy

Question 2

retinal tear/ retinal detachment

Answer 2

seperatoin of the sensory retina from the retinal pigment epithelium

painless loss of vision
recent hisotyr of increased number of visual floaters/flashses
dark shadow in the vision of affected eye

grey area of raised retina at site of detachment.

mx: surgical repair (cryotherapy with gas tamponade)

Question 3

central retinal artery occlusion

Answer 3

blocked blood flow in CRA
sudden painless loss of vision
poor visual acuity (<6/60)
RAPD
pale retina

cherry red spot at macula due to cilioretinal sparing
delayed arterial filling on fluroescein angiogram

mx: ESR and CRP to exclude GCA
IOP lowering (ACEi, paracenthesis) work up for TIA

Question 4

central retinal vein occlusion

Answer 4

blocked blood flow through central retinal vein
sudden, painless loss of vision

signs: dilated tortous veins, cotton wool spots, optic disc swelling, retinal haemrorhage visible in all four quadrants
cotton wool spots. optic disc swelling

!age, HTN, diabetes, raised IOP

ix: screen for DM, hypertension, glaucoma.
fluroescien angiography to investigate how ischaemic the fundus is.

Question 5

central retinal vein occlusion

Answer 5

blocked blood flow through central retinal vein
sudden, painless loss of vision

signs: dilated tortous veins, cotton wool spots, optic disc swelling, retinal haemrorhage visible in all four quadrants

!age, HTN, diabetes, raised IOP

ix: screen for DM, hypertension, glaucoma.
fluroescien angiography to investigate how ischaemic the fundus is.

Question 6

papillitis

Answer 6

acute inflammation of the optic nerve
associated with moderate / severe vision loss
can lead to optic atrohy

sudden reduced vision, discomfort on eye movement
central visual field defect, optic disc swelling, RAPD

mx: exclude MS, infection of meninges, orbital tissues or paranasal sinus

tx: intensive systemic corticotherapy

Question 7

proptosis

Answer 7

acute / chronic expansion of globe content
can be unilateral or bilateral

signs- corneal exposure, displacement of globe
eye movements affected, RAPD

Question 8

TIA (amaurosis fugax)

Answer 8

monocular visual loss which lasts seconds to minutes
can last 1-2 hours. vision returns to normal.

signs: normal fundus exam (embolus in retinal arteriole can be seen). neurological signs (ischaemia of cerebral hemispheres)

ix: assess CVS risk, blood count, electrolyte, lipids, fasting blood sugar, thrombophilia screen.
echocardiogram
carotid doppler

mx: aspirin, referral to neuro/cvs/vascular

Question 9

optic neuritis

Answer 9

symptoms- painless loss of vision over hours to days.
orbital pain usually associated with eye movement

signs: female 18-45 y/o, other focal neurological signs, reduced visual acuity, color vision.
RAPD
central scotoma (area of depressed visionw hich corresponds with the point of fixation and interferes with central vision)

ix: opthalmic and neurological exam. FBC, ESR, MRI investigations, IV steroid tx required.