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YA - Interactive seminars/University lectures > OPTH - Visual loss > Flashcards

OPTH - Visual loss Flashcards

1
Q

What 3 things should you always test and record in a visual loss clinical examination?

A
  1. visual acuity
  2. pupil reactions
  3. intraocular pressure
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2
Q

What is ice-test useful for?

A

Ruling in Myasthenia Gravis as the cause for ptosis leading to visual impairment.

With ice on the eyes, the ptosis is temporarily & partially resolved in MG.

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3
Q

If Transient blurring of vision +/- epiphora (watering), what should you think of?

A

Tear-film disruption

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4
Q

Describe trachoma

A
  • Agent: Chlamydia Trachomatis
  • Prolific in arid poverty-stricken regions with poor hygiene practices
  • Chronic infection leads to scarring of the conjunctiva, entropion and blindness

A big health concern in outback Australia

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5
Q

Describe corneal oedema

  • Hx
  • O/E
  • Rx
A
  • “My vision has been gradually getting blurry over months. I’m in my 50s. Maybe I have cataracts?”
  • Corneal oedema. Descemet’s Membrane Folds, normal IOP
  • Decompensation of corneal endothelial pump leads to corneal oedema. Usually bilateral
  • Rx: topical 5% sodium chloride to dehydrate cornea. Corneal graft surgery
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6
Q

Describe keratoconus

  • Hx
  • O/E
  • Rx
A

= Progressive thinning, weakness and protrusion of the cornea

  • “My vision has been getting blurry again. I’ve had several new pairs of glasses this year, but it keeps getting worse”
  • vision fixed with pin hole, normal IOP, irregular curvature of cornea
  • Rx: hard contact lens, cross-linking, corneal transplant
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7
Q

Describe acute angle closure glaucoma

  • Hx
  • O/E
  • Rx
A
  • 2 hour history of painful UNILATERAL red eye with worsening vision
  • increased IOP, cloudy oedematous cornea
  • EMERGENCY (high IOP can lead to blindness)
  • Rx: IOP reduction. Acetazolamide stat (IV & oral). topical beta blocker, topical steroid. Peripheral iridotomy laser once IOP reduced
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8
Q

Describe Cataract

  • Hx
  • O/E
  • causes
  • Rx
A
  • “My vision has been getting progressively more blurry. I experience glare and colours don’t seem as bright anymore.”
  • VA not improved with pin hole. Nuclear sclerosis
  • age-related, drugs (steroids, amiodarone), trauma, DM, etc
  • Rx: lens removal & intraocular lens isnertion
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9
Q

What is lens dislocation usually associated with?

A

Connective tissue disorders (e.g. Marfan’s)

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10
Q

What does “I lost vision in my left eye today. It was like a curtain came down over my vision” indicate?

A

Vitreous haemorrhage

  • Often resolves slowly over weeks/months.
  • Can require vitrectomy to clear blood.
  • Risk of re-bleed.
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11
Q

What are important causes of vitreous haemorrhage?

A
  • Retinal Detachment.
  • Proliferative Diabetic Retinopathy
  • Trauma
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12
Q

What does “Flashes of light and floaters in the visual field of my left eye” indicate?

A

Retinal detachment

  • emergency. Review by opthal within 24 hrs
  • Rx: surgical repair
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13
Q

What is a Weiss ring?

A

A floater that is not due to retinal detachment

Sign of posterior vitreous detachment (PVD)

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14
Q

What does “Sudden, painless unilateral loss of vision” indicate?

A

Central Retinal Artery Occlusion

  • Affected eye may have RAPD
  • Emergency (irreversible ischaemic damage to retina >90mins). Lie pt flat to help maintain circulation, acetazolamide IV stat & ocular massage to decrease IOP.
  • Urgent priority to rule out GCA (ESR, CRP)
  • Poor prognosis of maintaining good vision

It could also indicate central retinal VEIN occlusion.

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15
Q

What are common causes of central retinal artery occlusion?

A
  • Atherosclerosis
  • Embolic Sources
  • Haematological disorders (eg: hypercoagulable states)
  • Inflammatory Causes. e.g. Giant Cell Arteritis (GCA) (approx 3%)
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16
Q

What is “cherry red spot” a keyword for?

A

Central retinal artery occlusion

A finding on fundal exam
Other findings:
- pale retina
- arteriolar attenuation

17
Q

Fundoscopy findings of central retinal vein occlusion

A
  • retinal haemorrhages all quadrants
  • macular oedema
  • widespread cotton wool spots
18
Q

Clinical associations & Rx of central retinal vein occlusion

A

Clinical associations

  • atherosclerosis: HTN, DM, hchol, smoking
  • inflammatory diseases: sarcoidosis, Behcet’s, SLE
  • blood dyscrasias: protein C&S deficiency, antiphospholipid syndrome
  • glaucoma, orbital mass

Rx:

  • lifestyle changes
  • IOP control
  • intravitreal steroids & Anti-VEGF
19
Q

Compare Hx of dry age-related macular degeneration & wet age-related macular degeneration

A

Dry:

  • GRADUAL decrease in central vision (years)
  • Central Scotoma
  • FHx of macular degeneration

Wet:

  • RAPID decrease central vision (weeks to months)
  • Metamorphopsia
  • central scotoma
20
Q

Compare Rx of dry age-related macular degeneration & wet age-related macular degeneration

A

Dry:

  • supportive care
  • quit smoking. Vitamin suppl

Wet:
- anti-VEGF intravitreal injections

21
Q

Compare pathology of dry age-related macular degeneration & wet age-related macular degeneration

A

Dry:

  • Loss of Retinal Pigment Epithelium (RPE)/ photoreceptors
  • Associated with increasing age and smoking

Wet:
- Choroidal Neovascularization (CNV) – growth of abnormal leaky vessels in the RPE

22
Q

What is the greatest cause for visual disability in working age people in developed nations?

A

Diabetic macular oedema

Its features on fundoscopy include:

  • circinate ring
  • lipid exudates
  • intraretinal haemorrhages
23
Q

What does “very poor night vision. Blindness tends to run in my family” & annular scotoma O/E indicate?

A

Retinitis Pigmentosa

  • Most common retinal dystrophy (1:3000-5000)
  • May be sporadic or inherited
  • Typically affects rods first (“Rod-Cone Dystrophy”)
  • Usually presents in young adults
24
Q

What are the causes of raised ICP?

A

Mass effect

  • Haemorrhage
  • Haematoma
  • Tumours

Increased CSF production
-Choroid plexus tumour

Reduced CSF reabsorption

  • Venous Sinus Thrombosis
  • Aqueduct/foramen stenosis
  • Idiopathic Intracranial hypertension
25
Q

Ix & Rx of idiopathic intracranial hypertension

A

Ix:

  • Urgent neuroimaging
  • Lumbar Puncture if cause not clear (must exclude space occupying lesion first!!!)

Rx:

  • Weight loss is the most effective treatment
  • Medical Rx: acetazolamide, other diuretics, corticosteroids
  • Surgical Rx: Optic nerve sheath fenestration, LP Shunt
26
Q

What does “I woke this morning and have very poor vision in one eye.” indicate?

A

Optic neuritis

Usually unilateral

27
Q

What neurological condition is highly associated with optic neuritis?

A

Multiple sclerosis

Prevalence of optic neuritis in patients with Multiple Sclerosis: 70%!

28
Q

Rx of optic neuritis

A
  • MRI Brain and urgent referral to a Neurologist to investigate for MS
  • High dose prednisolone regime (IV methylprednisolone 1g/day for 3/7, then oral 1mg/kg daily for 11 days, then wean over 4 days) may speed up visual recovery.
  • Does not appear to impact on long term visual prognosis
29
Q

Describe giant cell arteritis (GCA).

  • classic clinical Px
  • Ix
  • Rx
A
  • Medium to large vessel vasculitis
  • Involves arteries with a greater quantity elastic tissue in the media and adventitia

Px:

  • Headache
  • Scalp Tenderness
  • Jaw claudication
  • Associated Polymyalgia Rheumatica
  • Acute unilateral loss of vision

Ix:
- ESR (>100), CRP, temporal artery biopsy

Rx: high dose prednisolone (40-60mg/day)

30
Q

If one eye is affected, what’s the risk of the second eye losing vision if untreated in GCA?

A

20-50%

THIS IS A SIGHT THREATENING EMERGENCY

31
Q

Describe Primary Open Angle Glaucoma (POAG)

  • Px
  • Progression
A

= A chronic degenerative condition affecting the optic nerve

Px:

  • increased optic cup to disc ratio
  • progressive visual field loss (often visual loss not noticed until very advanced). RF include positive FHx, high myopia, DM, increased IOP.

Progression:
- Blind spot -> acrcuate scotoma -> progression of centrally sparing field loss -> can present as acute visual loss.

Rx: lowering IOP associated w/ delayed progression

32
Q

What are the 5 Common Causes of Visual Loss?

A
  • Refractive Error – Always check visual acuity with a pin-hole.
  • Cataract
  • Diabetic Retinopathy
  • Macular degeneration
  • Ocular surface disease

Developing world - Trachoma

YA - Interactive seminars/University lectures (87 decks)

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