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Ophthalmology 2023 > Acute visual disturbance 1 > Flashcards

Acute visual disturbance 1 Flashcards

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1
Q

elderly patients with painless loss of vision may commonly have

A

age-related macular degeneration
giant cell arteritis

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2
Q

middle aged patients with painless loss of vision may commonly have

A

retinal arterial occlusions
retinal vein occlusions
diabetic macular oedema
vitreous haemorrhages

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3
Q

which common causes of painless vision loss present at any age?

A

retinal detachment
vitreous haemorrhages

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4
Q

onset of painless loss of vision over minutes

A

retinal arterial occlusions
retinal venous occlusions
vitreous heamorrhages

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5
Q

onset of painless loss of vision over hours

A

retinal detachments

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6
Q

onset of painless loss of vision over days

A

diabetic macular oedema
age related macular degeneration

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7
Q

is acute painless loss of vision usually bilateral?

A

no this is very rare
sudden loss of vision is usually unilateral
if its bilateral there is usually a central cause and not an ocular cause

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8
Q

what does hard exudate on the fundoscopy indicate

A

lipid leaking out of damaged blood vessels in people with diabetes may cause this
fluid leaking into the macula = diabetic macula oedema

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9
Q

how the vision loss processes

A

started in the centre = probably a macula problem ie. either age related macula degeneration or diabetic macular oedema
started on the sides like a curtain = retinal detatchment
progressive red haze = vitreous haemorrhage

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10
Q

progressive peripheral loss like a curtain

A

retinal detatchment

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11
Q

usual cause of vitreous haemorrhage

A

diabetes

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12
Q

painless loss of vision with a red haze

A

vitreous haemorrhage

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13
Q

associated symptom of distortion

A

straight lines start to look wavy
usually macula cause
age related macula degeneration or diabetic macula oedema

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14
Q

associated symptom of flashes/floaters

A

retinal detachment or vitreous haemorrhage

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15
Q

associated symptoms of scalp pain or jaw claudication

A

giant cell arteritis
may have another rheumatological condition

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16
Q

inferior branche retinal artery occlusion looks like

A
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17
Q

people who are myopic

A

short sightedness
these people are at an increased risk of retinal detatchment

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18
Q

diabetes causes a higher risk of

A

diabetic macular oedema
vitreous heamorrhage

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19
Q

ischaemic heart disease, AF and cerebrovascular disease increase risk of

A

vasculopaths
increased risk of retinal artery occlusion or retinal venous occlusion

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20
Q

polymyalgia rheumatica is associated with

A

GCA = giant cell arteritis

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21
Q

things you can have a family history of

A

retinal detachment
age related macular degeneration

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22
Q

steps of examination of the eye

A
  1. gross inspection
  2. optic nerve examination
  3. slit lamp examination
  4. eyelid eversion
  5. ocular motility
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23
Q

what’s included in the optic nerve examination

A
  1. visual acuity
  2. visual fields
  3. pupil reflexes/reactions
  4. optic nerve exam (fundoscopy)
  5. colour vision
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24
Q

what does a normal fundus look like

A
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25
how do you tell which fundus you're looking at
the optic nerve is always closer to the nose bearing in mind you're looking at the fundus of a person facing you nerve is nasal
26
how should the optic nerve look
yellow with a distinct border range retinal tissue blood vessels running throughout darker red for veins and lighter red for arteries veins are slightly wider than arteries
27
veins look
fatter and darker
28
arteries look
thinner and lighter
29
macula looks
more darkly pigmented than the rest of the retina temporal to the optic nerve
30
wet age related macular degeneration means
there is blood = wet
31
advanced (neovascular)/wet age related macular degeneration
commonest cause of vision loss painless acute central distortion or central scotoma - usually unilateral outer retina degenerates new blood vessels that are abnormal grow up into the retina where they don't belong abnormal blood vessels are prone to bleeding and leaking fluid causing vision loss
32
what might you see on fundus than indicates ARMD
central macular drusen +/- haemorrhage
33
management of ARMD
urgent referral to ophthalmology smoking cessation intravitreal anti-VEGF therapy initially once per month then less frequent might need it indefinitely
34
intravitreal anti-VEGF therapy
injected into the eye under anaesthetic - painless initially the treatment is needed once per month and less frequently thereafter likely to need treatment for the rest of their lives
35
most modifiable risk factor for ARMD
smoking
36
Hx of retinal vein occlusion
painless acute blurring/loss of vision (central and/or altitudinal) may only be inferior/superior visual field loss inferior retinal occlusion will cause superior field loss and vice versa middle aged or elderly, history of HTN, diabetes, hyperlipidaemia
37
aetiology of retinal vein occlusion
arteriosclerosis leading to vein occlusion at AV junction sclerosis of an artery which at the junction of the artery and vein leads to obstruction of the vein leakage of blood and other fluids into the retina macula swells leading to loss of vision
38
retinal vein occlusion on examination
haemorrhages and dilated/tortuous veins, macula oedema +/- RAPD (relative afferent pupillary defect caused by CRVO central retinal vein occlusion), cotton wool spots, disc swelling
39
severe central retinal vein occlusion will cause
relative afferent pupillary defect
40
two types of retinal vein occlusion
CRVO = central retinal vein occlusion (whole retina) BRVO = branch retinal vein occlusion (semi-retina)
41
management of retinal vein occlusion
systemic vascular risk factors (especially hypertension) urgent referral to ophthalmology intravitreal anti-VEGF or steroid therapy +/- retinal laser
42
difference between retinal vein or artery occlusion
retinal vein occlusion produce blood retinal artery technically can too but not as likely retinal artery occlusion causes retinal paleness
43
what does retinal artery occlusion look like
retinal paleness cherry red spot if central (macula sparing)
44
cherry red spot indicates
cherry red spot indicates central retinal artery occlusion
45
Hx of retinal artery occlusion
painless unilateral loss of vision, central and/pr altitudinal Middle aged/elderly vasculopathic/cerebrovascular/AF/hyperlipidaemia
46
retinal paleness indicates
retinal artery occlusion
47
aetiology of retinal artery occlusion
arteriolar embolus from carotid systemic or cardiac value
48
examination of retinal artery occlusion
pallor of whole (CRAO) or semi retina (BRAO) there may be a cherry red spot if it is CRAO or hemi-field it if is BRAO +/- RAPD (CRAO), visible emboli
49
management of retinal artery occlusion
urgent stroke work-up - CT angiogram head/neck, carotid doppler USS - trans thoracic echocardiogram, ECG +/- Holter exclude giant cell arteritis in 60+ year olds (FBC, ESR, CRP), and ask about jaw claudication urgent ophthalmology referral -> stroke referral -> thrombolysis protocol (tPA)
50
retina looks like a brain
retinal detatchment retinais detatched from the choroid is bulging forward into the vitreous
51
tear in the retina
causes the majority of retinal detachments tear usually from the vitreous gel tugging on the retina, vitreous fluid gets behind the tear and causes the detachments
52
retinal detatchment Hx
painless unilateral flashes and floaters progressive curtain scotoma middle aged, elderly, myopic, trauma, diabetes
53
determining if the macula is detached in retinal detatchment
prognosis much worse if the macula is detached if you operate quickly you can save sight macula off may been youre not able to regain vision
54
risk factors for retinal detatchement
myopia diabetes trauma middle aged/elderly
55
examination for retinal detachment
greys, corrugated looking retina - macula on or off altitudinal or total field loss normal fundus and fields possible vitreous detatchement only
56
management for retinal detatchment
fast and prepare for surgery urgent referral to opthalmology vitrectomy (most common) or scleral buckle surgery
57
vitreous haemorrhage aetiology
- vitreous detachment (normal) can cause sheering of blood vessel causing vitreous haemorrhage (not normal) - alternatively, diabetes causes abnormal blood vessels which are prone to bleeding (frilly looking blood vessels), may indicate proliferative diabetic retinopathy
58
vitreous haemorrhage looks like
59
two main causes of vitreous haemorrhage
- vitreous detatchment - diabetes
60
Hx of vitreous haemorrhage
painless unilateral floaters or 'red haze' +/- loss of vision diabetes, trauma, myopia
61
examination of vitreous haemorrhage
variable change in VA and fields visible blood on fundoscopy +/- detached retina
62
treatment for vitreous haemorrhage
vitrectomy surgery or laser surgery fast for theatre systemic management for diabetes
63
diabetic macular oedema Hx
caused by hyperglycaemia painless central visual blurring always bilateral but might be asymmetric onset days to weeks diabetes, hypertension, hyperlipidaemia
64
aetiology of diabetic macular oedema
retinal vascular hyperpermeability from chronic hypoerglycaemia swelling of the macula
65
examination of diabetic macular oedema
variable change in VA, central field loss central macular haemorrhages +/- hard exudates
66
diabetic macular oedema management
optimal metabolic management semi-urgent referral to ophthalmology intravitreal therapy (anti-VEGF or steroids) +/- retinal laser

Ophthalmology 2023 (18 decks)

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