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Ophthalmology > Vision Loss > Flashcards

Vision Loss Flashcards

1
Q

Give 5 causes of sudden visual loss?

A

Vascular aetiology, vitreous haemorrhage, retinal detachment, wet ARMD, closed angle glaucoma

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2
Q

What type of visual loss do optic neuritis and stroke cause?

A

Sudden

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3
Q

Where does the main blood supply to the eye come from?

A

Branches of the ophthalmic artery

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4
Q

What artery supplies the inner two thirds of the retina?

A

Central retinal artery

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5
Q

What gives the blood supply to the outer third of the retina?

A

Choroid

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6
Q

Where do the posterior ciliary arteries supply?

A

Optic nerve head (optic disc)

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7
Q

Sudden visual loss of a vascular aetiology can be caused by occlusion of what?

A

Retinal circulation or optic nerve head circulation

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8
Q

Sudden visual loss of a vascular aetiology can be caused by haemorrhage of what?

A

Abnormal blood vessels or a retinal tear

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9
Q

What 2 conditions can cause abnormal blood vessels to form in the eye?

A

Diabetic retinopathy or wet ARMD

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10
Q

Describe the visual loss which is encountered in CRAO?

A

Sudden, painless and profound

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11
Q

What are some signs of CRAO?

A

Relative afferent pupil defect. Pale, oedematous retina with thread like vessels. Cherry red spot on macula

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12
Q

What does this show?

A

Central retinal artery occlusion.

(pale, oedematoous retina with thread like vessels)

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13
Q

CRAO is a type of stroke. What can this occur secondary to? Which is most common?

A

Occurs secondary to carotid artery disease mostly, very rarely as a result of an emboli from the heart.

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14
Q

What is the first line management for CRAO if it presents within 24 hours?

What is the purpose of this treatment?

A

Ocular massage- try to convert it to a branch occlusion which causes less overall damage.

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15
Q

If the patient presents with a CRAO after more than 24 hours, or an ocular massage has already been performed, what is the next management?

A

Find the source of the embolus with a carotid doppler, and assess and manage risk factors.

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16
Q

What is amaurosis fugax?

A

Transient CRAO causing visual loss ‘like a curtain coming down’. Usually lasts about 5 minutes with full recovery and no abnormalaities on examination.

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17
Q

What is the management for amourosis fugax?

A

Urgent referral to the stroke clinic and possibly start aspirin therapy

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18
Q

What are systemic causes of CRVO?

A

Atherosclerosis, hypertension, hyperviscosity

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19
Q

What is the ocular cause of CRVO?

A

Raised IOP

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20
Q

Describe the visual loss in CRVO?

A

Sudden, moderate-severe

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21
Q

What are some signs of CRVO?

A

Retinal haemorrhages, dilated, torturous veins, swollen disc and macula

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22
Q

What does this show?

A

Central retinal vein occlusion

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23
Q

What does this show?

A

Normal macula

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24
Q

What does this show? (Not anything specific, just in general)

A

Macular oedema

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25
Q

Why do you need to monitor patients with CRVO?

A

They may develop complications due to new vessel growth

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26
Q

What new treatment can be used for CRVO? What do these do?

A

Anti-VEGF- prevent new vessel growth

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27
Q

What does this show?

Why are these patients likely to have visual loss?

A

Branch retinal vein occlusion- likely to have visual loss as a result of macular oedema

28
Q

What is the major difference on fundoscopy between an artery and vein occlusion?

A

Artery occlusion will be pale and vein occlusion will be dark

29
Q

What is occlusion of the optic nerve head circulation known as?

A

Ischaemic optic nerve neuropathy

30
Q

What arteries supply the optic nerve head?

A

Posterior ciliary arteries

31
Q

Are the posterior ciliary arteries end arteries?

A

No

32
Q

What are the 2 types of optic nerve head occlusion? How common are each one?

A

Arteritic and non-arteritic (each make up 50% of cases)

33
Q

What causes arteritic optic nerve head occlusion?

A

Inflammation due to GCA

34
Q

What causes non-arteritic optic nerve head occlusion?

A

Atherosclerosis

35
Q

What does optic nerve head occlusion cause?

A

Sudden, profound vision loss with a swollen disc

36
Q

What does this show?

A

Ischaemic optic nerve

(pale, swollen disc)

37
Q

What are the optic symptoms of arteritic ION?

Why is diagnosis of this very important?

A

Sudden, profound, irreversible blindness

To prevent visual loss in the other eye

38
Q

What test is important in diagnosis of GCA?

What immediate treatment may be required?

A

Temporal artery biopsy

Immediate high dose steroids

39
Q

Where does haemorrhage normally occur in the eye?

A

Into the vitreous cavity

40
Q

What are symptoms of vitreous haemorrhage?

A

Loss of vision and floaters

41
Q

What are signs of vitreous haemorrhage?

A

Loss of red reflex and may see haemorrhage on fundoscopy

42
Q

What is the management for vitreous haemorrhage?

A

Identify the cause and if there is no cause then vitrectomy

43
Q

What does this show?

A

Vitreous haemorrhage

44
Q

What are symptoms of retinal detachment?

A

Painless loss of vision and sudden onset of flashes/floaters

45
Q

What are signs of retinal detachment?

A

RAPD, may see tear on retina, pale retina

46
Q

What does this show?

Where will the visual disturbance be?

What is the management?

A

Retinal detachment

Superior

Usually surgical

47
Q

What does this show?

What type of visual loss does it cause?

A

Wet ARMD

Rapid, central vision loss

48
Q

What happens in wet ARMD?

A

New blood vessels grow under the retina, and leakage causes a build-up of fluid/blood and eventually scarring.

49
Q

What are some risk factors for wet ARMD?

A

Smoking, poor nutrition, positive family history

50
Q

What is the treatment for wet ARMD?

A

Anti-VEGF

51
Q

What happens in closed angle glaucoma?

A

Aqueous humour encounters increased resistance through the iris/lens channel. This obstructs the trabecular meshwork and causes the IOP to rise.

52
Q

How may closed angle glaucoma present acutely?

A

Present with painful red eyes, visual loss, headaches, nausea and vomiting.

53
Q

What is the treatment for closed angle glaucoma?

A

Lower IOP with drops/oral medication to prevent the patient going blind and then do a laser iridotomy.

54
Q

How may gradual visual loss present early?

How may gradual visual loss present late?

A

Decreased visual acuity

Decreased visual fields

55
Q

Give 5 causes of gradual visual loss?

A

Glaucoma, dry ARMD, diabetic retinopathy, cataract, refractive error

56
Q

What is a cataract?

What drug commonly causes this?

A

Clouding of the lens

Steroids

57
Q

What are some symptoms of cataract?

A

Gradual decline in vision which cannot be corrected with glasses

Glare

58
Q

What is the treatment for a cataract?

A

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

59
Q

What condition may result in the gradual loss of central vision?

A

Dry ARMD

60
Q

What is the treatment for dry ARMD?

A

No treatment- can use magnifiers

61
Q

What is myopia?

A

Short sightedness- patients focus images too far forward

62
Q

What is hypermetropia?

A

Long sightedness- patient focus images too far back

63
Q

What is astigmatism?

A

Irregular corneal curvature

64
Q

What is presbyopia?

A

Loss of accomodation with age

65
Q

Open angle glaucoma is often asymptomatic. What are some signs?

A

Cupped disc

Visual field defect

May or may not have high IOP

66
Q

What does this show?

A

Open angle glaucoma

Ophthalmology (12 decks)

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