acute painless loss of vision

Question 1

Acute painless vision loss causes

Answer 1

Retinal vascular occlusions
- Branch or central retinal artery occlusion
- Branch or central retinal vein occlusion
Non-arteritic ischaemic optic neuropathy
Neovascular age-related macular degeneration (nAMD)
Pre-retinal and vitreous haemorrhage associated with proliferative diabetic retinopathy
Severe systemic hypertension
Retinal detachment
Cerebrovascular accidents (CVAs)

Question 2

Where do retinal vein occlusions occur

Answer 2

IN the central retinal vein or a branch

Question 3

Risk factors for retinal vein occlusions

Answer 3

CV risks of diabetes, HTN, hyperlipidaemia, IOP
HYperviscosity syndromes: leukaemia, polycythaemia, myeloma, inflammatory disease e.g. sarcoid, behcet disease

Question 4

retinal vein occlusion presentation. investigations?

Answer 4

Sudden blurring vision
Visual acuity reduced
RAPD if severe
Central retinal vein occlusion: fundus shows multiple haemorrhages scattered over the fundus with dilated tortuous veins, cotton wool spots and swelling of the optic disc and macula
Branch retinal vein occlusion: fundus shows haemorrhages, tortuous veins confined to area drained by the occluded vein

When present for long time, may be venous sheathing and collaterals disc
Investigations: OCT and FFA

Question 5

Complications of retinal vein occlusion

Answer 5

If ischaemic may lead to neovascullarisation of iris in CRVO or disc or anywhere else on retina in BRVO

Cystic macular oedema
Neovascular glaucoma

Question 6

Retinal vein occlusion management

Answer 6

Look for associated risks, and ensure treatment (systemic) is optimal, or commenced appropriately: reduces recurrence of vein occlusion in the same or contralateral eye

Improve general health and well being

Assess CVS

Specific investigations in all cases include: baseline blood pressure, blood glucose, ESR

Look for rare diseases as necessary (chest X-ray, C-Reactive protein, plasma homocysteine level, thrombophilia screen, autoantibodies, angiotensin converting enzyme level in serum

Treat the underlying medical or ocular (IOP) cause

Question 7

Treatment of RVO

Answer 7

Depends on type of RVO
Review at 3 months then 3-6 months for at least 2 years

CRVO- treat macular oedema with intravitreal anti-VEGF or steroid injections. NVI treated with anti- VEGF and pan retinal laser photocoagulation

BRVO- treat macular oedema with intravitreal injection of anti-vEGF or steroids or macular grid laser photocoagulation
NVE or NVD treated with sector laser photocoagulation