Vision loss Flashcards
Retinal artery occlusion
proximal emboli, loss of entire retina. amaurosis fugax (transient vision loss) (TIA)
painless, unilateral loss of vision, pmhx of IHD, diabetes, AF
IX: fundoscopy cherry red spot, pale retina (hypoperfusion)
fluroscen
angiography
carotid bruit
tx: occular massage, acetolazine to lower IOP, thrombolysis (occular emergency)
look for underyling cause and prevent.
cherry red macula
Retinal vein occlusion
sudden painless loss of vision
blood cannot be drained (pizza slices / haemorrhage)
neoavascularation (VEGF induced hypoxia)
- non ischaemic: sudden unilateral painless. loss of vision, minor RAPD
ischaemia: severe loss of vision, disc oedema, cotton wool spot
flame haemorrhage
dot and blot
tx: acetazolamine, anti VEGF
IV steroids, anti-VEGF
retinal laser treatment
central= fiery in all 4 quadrans
Giant Cell Arteritis
arteries on the side of the face become inflammed (auto immune attack)
sensitive scap (pain on touching/brushing hair)
treatment: IV high dose steroid
Hypertensive retinopathy
blurred vision
headache
AV nicking (artery crosses over the venule and compresses it= buldges)
cottol wool spots
yellow hard exudates
optic disc is blurred
mx: BP (labetalol if malignant)
Diabetic retinopathy
PC: floaters, blurred vision, distortion, progressive visual loss. microaneurysms
dot and blot
cotton wool
hard exudates
tx: glucose control, laser photocoagulation
stages:
- background
- maculopathy
- pre proliferation
- proliferative
- advanced
laser therapy, aimed at vessel leakage, antiVEGF
Optic neuritis
painful and temporary loss of vision.
desaturatoin of colour
pain worse on movement
RAPD
associated with MS (Ahoff’s phenomenon = worse with heat)
MRI of brain
Tx: opthalmology, methyl prednisolone,
disc cupping (cup takes up more than 1/3 of the optic disc) central part of the optic nerve/disc begins to cup in response to ischaemic changes
Retinal detachement
curtain descending
no pain
neural retina has detached from the epithelium
sudden loss of vision with flashers and floaters
visual acuity decreases
mx: slit lamp, opthalmology
Vitreous detachment
bleeding into the viterous humour of the eye caused by rupture of the vessel on the surface of the retina / neovascularisation
large haemorrhage= complete vision loss
small haemorrhage= black dot floaters
red reflex down
virectomy
Posterior viterous detachement
viterous membrane becomes seperated from the retina
viterous humour liquifies and reduces in volume (collapses and peels aay)
flashers and floaters
refer to opthalmology
Dry age related macular degeneration
most common cause of blindness in the UK
degeneration of the central retina (macula) retinal photoreceptors degenerate= drusen
dry= develops slowly, gradual changes in central vision. macula degeneration, drusen, yellow spots in both membrane (atrophy)
no tx- exlude potential vit/antioxidant
Wet macular degeneration
exudative, neovascular
macula degeneration
choroidal neovascularisation
leakage of serous fluid and blood
quick development, angiodenesis of new blood vessels leading to bleeding and scaring.
tx: anti VEGF stopping blood vessel proliferation (alifecept, ranibimuzab)
acute closed angle glaucoma
halos around lights painful (pressure) blurred vision red eye nausea and vomiting made worse by dilating Transient attacks worse at night (halos) compression on the optic nerve
amaurosis fugax
sudden painless loss of vision- then returns (TIA embolus0
age related macular degeneration
makes central vision distorted and blurry
does not lead to total sight loss
2 types: dry and wet (neovascular)
retinoblastoma
classic paediatric tumour of the retina. hereditary/ sporadic. two genes (knuden’s two hit hypothesis)
loss of red reflex
