Acute painless loss of vision Flashcards
List the monocular causes of APLV (10)
Vitreous haemorrhage (more common) Optic neuritis Anterior ischaemic optic neuropathy Central retinal aa occlusion Central retinal vv occlusion Branch retinal vv occlusion Branch retinal aa occlusion Retinal detachment Macular haemorrhage
How may a vitreous haemorrhage present?
What are some common causes? (3)
Acute floaters/flashes (signify vision loss if dense → vitrectomy)
Neovascular (PDR, Branch/Central retinal vv occlusion)
Retinal tears / detachment
Trauma
Where are the causes of ischaemic optic neuropathy?
Arteritic AION (Giant cell arteritis) Non-arteritis AION (High BP/lipids, DM, smoking)
What would be seen O/E in ischaemic neuropathy? (Fields + Fundoscopy)
Visual field defect but doesn’t cross midline (unless other pathology)
Pale/swollen optic disc (blurred margins)
How does a giant cell arteritis present?
What is the treatment?
> 50
Jaw pain
Headache / tender scalp / neck pain
Raised ESR/CRP
Urgent prednisolone
Where does the pathology lie in binocular APLV? (3)
Optic chiasm (e.g. pituitary) Optic nerve (infiltrative disease, severe papilloedema, optic neuritis e.g. sarcoid) Cortex (migraine, CVA)
How may a branch retinal vv occlusion present?
What may be seen O/E? (4)
What are the RFs? (2)
What is the prognosis like in mild/extensive?
Variable central vision loss on waking
Retinal signs ONLY in corresponding area (h’ages, CWS)
Age, Ocular hypertension, High BP, Hyperlipidaemia/BMI
Mild = good (resolves + collaterals develop) Extensive = bad (VEGF release ∴ risk future neovasc + need for photocoag) NOT URGENT (refer to outpts)
How may a central retinal vv occlusion (CRVO) present?
What may be seen O/E? (Acuity/fundoscopy/pupils)
All vision affected (not just central) on waking - perceived as sudden
Acuity: from 6/6 → CF
Retinal signs: haemorrhages (few/extensive), oedema
RAPD (in severe)
What further investigations should be done for central retinal vv occlusion? (3)
BP
Bloods
IOP (+ check contralateral eye)
What are the complications of central retinal vv occlusion? (2)
Permanent severe vision loss
Rubeotic/neovascular glaucoma (RAPD is good sign of this) (therefore give photocoagulation)
How does a central retinal aa occlusion present?
What may be seen O/E? (Acuity/Fundoscopy/Pupils)
“Curtain going down over eye” (may have had previous temporary events of vision loss)
Acuity: V poor (CF→NPL)
Fundoscopy: macular cherry red spots w. surrounding ischaemia (pale), emboli
Pupils: APD/RAPD (dep on acuity)
How initial Ix + management is done for central retinal aa occlusion? (5)
How Ix may be done in secondary care?
Check BP Breathe into paper bag (raise CO2 + dilate/move emboli) Ocular massage (move emboli) Antihypertensives Surgical aqeuous removal
Secondary: ESR (arteritis), Carotid USS, Cardiac ECHO
What 5 questions should be asked in APLV? (HELLP)
And what basic Ix are done? (3)
Headache? Eye movements hurt? Lights/flashing preceding loss? Like a curtain? Poorly controlled DM?
Acuity / Fundoscopy / Pupils
What are the causes of central retinal vv occlusion? (5)
Arteriosclerosis High BP Diabetes Polycythaemia Glaucoma (all types)
What are the 2 different types of central retinal vv occlusion and the different signs seen with it?
Ischaemia: CWSs, swollen optic nerve, macular oedema, neovascular risk)
Non-ischaemic: better acuity
