Acute Vision Loss

Question 1

Central Retinal Artery Occlusion

Answer 1

• Risks - a fib, HLD, carotid plaques
• Happens within seconds
• Cherry red fovea while rest of retina is pale
• APD
• Tx - massage eyeball, vasodilation, anterior chamber paracentesis, ECHO and carotid US

Question 2

Central Retinal Vein Occlusion

Answer 2

• Thick arteries in people w/ vasculopathy crush veins in retina (AV nicking) –> vessel damage –> thrombus in vein –> edema in retina
• Variable vision loss over hours to days
• See capillary hemorrhages
• Tx - anti VEGF injections to decrease capillary swelling to decrease retinal swelling
• APD

Question 3

Ischemic Optic Neuropathy

Answer 3

• Stroke of optic nerve
• Risks - vasculopathy + crowded optic nerve + event that leads to hypotension / dec blood to optic nerve
• OR GCA in elderly > 60 yo (jaw claudication, granuloma)
• Happens within seconds
• Altitudinal vision loss so whole top or whole bottom of field
• APD
• Tx - start high dose prednisone right away, temporal artery biopsy + CRP, ESR
  
  • Goal = protect other eye
• Image is pale and swollen retina

Question 4

Optic Neuritis

Answer 4

• Autoimmune demyelination (associated w/ MS)
• Get brain MRI with and without contrast + NMO antibodies
• Women > men
• Most variable in terms of degree of vision loss but almost always decrease in color saturation
• Tx = high dose IV steroids in hospital to prevent recurrence
• APD
• May see red, angry, swollen optic nerve

Question 5

Wet Macular Degeneration

Answer 5

• Older age, new vessels from choroid thru weak Bruch membrane –> CNVM
• Over hours to days
• No APD
• Tx - anti-VEGF injections

Question 6

Vitreous Hemorrhage

Answer 6

• Causes - trauma, neovascularization in DM
• Red squiggles to larger loss
• See blood in front of retin so obstructs view of retina
• Tx - wait for blood to clear +/- surgery and laser to decrease VEGF

Question 7

Retinal Detachment

Answer 7

• Vitreous tugs on retina –> flashes
• Vitreous detaches partially –> floaters
• If vitreous traction allows fluid behind vitreous in front of retina then shade over vision (decrease central acuity once fovea involved)
• Can lose red reflex
• APD when late in process
• Tx - laser or pump gas at first; later must do surgery