Acute Painless loss of Vision Flashcards
(29 cards)
What needs to be included in an ocular history of APVL
Previous ocular history
Cardiovascular disease
Family history of eye disease
drugs and eye drops
Symptoms: mono-ocular or binocular
Time of event, method of becoming aware of symptoms
Change in symptoms and associated symptoms - central only, central and peripheral loss, altitudinal, haemianopia
pupil reactions, anterior segment, red reflex, fundoscopy
What are the monocular causes of APLV?
Ischaemic/vascular - thrombosis, embolism, temporal arteritis Occlusion of retinal artery/vein ACUTE CORNEAL DISEASE anterior chamber haemorrhage uveitis haemorrhage ACUTE CATARACT VITREOUS HAEMORRHAGE RETINAL DETACHMENT OPTIC NEURITIS OR ISCHAEMIC OPTIC NEUROPATHY
What is the presentation of acute corneal disease?
(normally painful)
rarely painless - cloudy cornea
What is the presentation of anterior chamber haemorrhage?
hyphaema - blood in the anterior chamber
how do acute cataracts cause APLV?
struck by lightning
acute cataract over weals if the lens becomes porous and takes in fluid
What are the common causes of vitreous haemorrhage?
proliferative diabetic retinopathy
retinal tears
posterior vitreous detachment
What is the classic presentation of optic neuritis?
acute visual loss age over 60 headache colour vision (epspecially red) Pain on moving eyes
What % of haemorrhages affect the retina? optic nerve?
Retina - 80%
Optic nerve - 20%
Which is more common, occlusion of the vein or occlusion of the artery?
VEIN - veins present with haemorrhage whereas arteries do not
What are the clinical features of branch retinal vein occlusion?
Variable degree of central vision on waking in morning
Retinal signs on examination - variable degree of haemorrhage with cotton wool spots, that are limited to one sector of the retina
What are the risk factors for retinal vein occlusion?
Hypertension High cholesterol Diabetes Smoking Glaucoma Systemic inflammatory conditions such as systemic lupus erythematosus
What is the prognosis for branch retinal vein occlusion
not good if extensive and there is the risk of developing new blood vessels in the future (i.e. diabetic retinopathy)
If mild - good prognosis, resolution and development of collaterals
What are the clinical features of central retinal vein occlusion?
Acute painless loss of vision
Acuity varies from 6/6 to CF and may have RAPD if severe.
Opposite eye should be examined for the optic disc to check for raised IOP
Fundoscopy finings: Flame and blot haemorrhages Optic disc oedema Macula oedema (looks like a cheese and tomato pizza)
What investigations should be done for central retinal vein occlusion?
BP, bloods, IOP
How should patients with retinal vein occlusion be managed?
Referral to ophthalmology
Laser photocoagulation
Intravitreal steroids (e.g. a dexamethasone intravitreal implant)
Anti-VEGF therapies (e.g. ranibizumab, aflibercept or bevacizumab)
How does central retinal artery occlusion occur?
something blocks the flow of blood through the central retinal artery
The most common cause of occlusion of the retinal artery is atherosclerosis. It can also be caused by giant cell arteritis, where vasculitis affecting the ophthalmic or central retinal artery causes reduced blood flow
What are the risk factors for central retinal artery occlusion?
Risk factors for retinal artery occlusion by atherosclerosis are the same as for other cardiovascular diseases:
Older age Family history Smoking Alcohol consumption Hypertension Diabetes Poor diet Inactivity Obesity
GCA or PMR = higher risk
What is the presentation of central retinal artery occlusion?
Sudden painless loss of vision
RAPD
Fundoscopy shows pale retina with cherry red spot
What is the management of central retinal artery occlusion?
Immediate referral
?Dislodge thrombus
Ocular massage
Removing fluid from the anterior chamber to reduce intraocular pressure.
Inhaling carbogen (a mixture of 5% carbon dioxide and 95% oxygen) to dilate the artery
Sublingual isosorbide dinitrate to dilate the artery
Secondary prevention of CVD
What is the treatment for GCA?
Temporal artery biopsy and high dose steroids
What is retinal detachment?
where the retina separates from the choroid underneath. This is usually due to a retinal tear that allows vitreous fluid to get under the retina and fill the space between the retina and the choroid
What are the risk factors of retinal detachment?
Posterior vitreous detachment Diabetic retinopathy Trauma to the eye Retinal malignancy Older age Family history
What is the presentation of retinal detachment?
Dense shadow that starts peripherally progresses towards the central vision
A veil or curtain over the field of vision
Straight lines appear curved
Central visual loss
What is the management of retinal detachment?
Immediate referral
For tears:
Laser therapy
Cryotherapy
For detachment: vitrectomy, scleral bulking
