Visual Loss

Question 1

List ten causes of sudden visual loss

Answer 1

1. Acute closed angle gluacoma
2. Retinal Detachment
3. Wet macular degeneration
4. Temporal arteritis
5. Vitreous Haemmorhage
6. Central Retinal Artery Occlusion
7. Central Retinal Vein Occlusion
8. Optic neuritis
9. Amourosis Fugax
10. Ischaemic optic neuropathy

Question 2

List four causes of gradual visual loss

Answer 2

1. Cataracts
2. Open angle gluacoma
3. Dry macular degeneration
4. Diabetic Retinopathy

Question 3

List six causes of cataracts

Answer 3

1. Age
2. Congenital
3. Traumatic
4. Metabolic (diabetic)
5. Drug induced
6. Intrauterine infection (rubella, CMV, toxoplasmosis)

Question 4

List three types of cataracts

Answer 4

1. Nuclear sclerotic
2. Cortical
3. Posterior subcapsular

Question 5

What are the important things to ask about a patient presenting with visual loss?

Answer 5

1. Sudden/Gradual
2. Painful/Painless
3. Extent (Total/Partial)
4. Associated symptoms
5. Past ocular history -myopia etc
6. Past medical history - diabetes/hypertension

Question 6

What is the treatment for cataracts in the developed world?

Answer 6

Phaco - emulsification with intra ocular lens implantation

Question 7

What is dry ARMD?

Answer 7

Wear and tear of the retinal pigment epithelium

Question 8

In what type of visual loss do you see drusen on opthalmoscopy?

Answer 8

Dry macular degeneration

Question 9

What is wet ARMD?

Answer 9

The eye grows new blood vessels within the macula to repair dry ARMD damage. The vessels then leak fluid or bleed into the retinal tissue causing a sudden devastating drop in central vision with associated metamorphopsia

Question 10

What investigation would you do for wet armd?

Answer 10

Ocular coherance tomography

Question 11

What treatment could you give for wet armd?

Answer 11

Anti VEGf injections

Monoclonal antibodies that inhibit the growth of abnormal blood vessels

Question 12

Sudden, profound visual loss (<6/60)
Relative afferent pupillary defect (RAPD)
Pale swollen retina with cherry red spot at macula

Answer 12

Central retinal artery occlusion

Question 13

What is the treatment for a CRAO?

Answer 13

Treatment is only effective if patient seen within 24 hrs. 
Occular massage
Paper bag breathing 
IV Diamox
Anterior chamber paracentesis

Question 14

Moderate to severe visual loss
RAPD
Retinal flame haemorrhages (stormy sunset)
Tortuous vessels
Swollen disc
Cotton wool spots

Answer 14

Central retinal vein occlusion

Question 15

Persisting flashing lights
Burst of new floaters
Dark shadow in peripheral vision, increasing in size

Answer 15

Retinal detachment

Question 16

Who is more likely to get a retinal detachment?

Answer 16

Myopics (short sighted)

Question 17

If you fins a retinal tear what treatment can be given to reduce the chance of detachment?

Answer 17

Laser

Question 18

What are the options for treatment of a retinal detachment?

Answer 18

Scleral buckle

Vitrectomy/Laser therapy/Gas bubble

Question 19

Variable loss of vision, usually over few days
Washed out colours
Dull ache on eye movements

Answer 19

Optic neuritis

Question 20

What is the most common cause of optic neuritis?

Answer 20

Demyelination..MS