Ophthalmology - Loss of Vision

Question 1

What is used for examination of loss of vision?

Answer 1

Best corrected visual acuity
Snellen chart
Fundal exam
Ancillary tests

Question 2

What does a fundal examination include?

Answer 2

Direct ophthalmoscope, slit lamp and volk lens

Question 3

What are some ancillary tests?

Answer 3

Amsler chart
Colour vision
Visual field assessment
Fluorescein angiography
Optical coherence tomography

Question 4

Describe a asmler chart

Answer 4

Usually taken home
Look at central spot one eye at time and see if there is distortion
If changed then alert for eye exam

Question 5

What does colour vision assess?

Answer 5

Optic nerve and red + green colour blindness

Question 6

Describe fluorescein angiography

Answer 6

Retinal conditions and dye injected
Arteries appear white first then after time veins

Question 7

Describe optical coherence tomography

Answer 7

Cross section of retina and good for macula conditions
Can see fovea

Question 8

Describe central retinal artery occlusion

Answer 8

Sudden complete loss of vision due to vascular reasons
Cherry red spot as perfusion of macula by choroidal vessels
Detect CVS risk factors

Question 9

What is the management for central retinal artery occlusion?

Answer 9

CROA
Identify and treat CV risk factors
Aspirin sometimes given

Question 10

Describe branch retinal artery occlusion

Answer 10

Emboli can be seen on fundal exam
Pale artery
Treated same as CROA
Identify and treat CV risk factors

Question 11

Describe central retinal vein occlusion

Answer 11

CRVO - vein drains blood of all of retina
Haemorrhages may be seen and in all 4 quadrants may develop macular oedema

Question 11

What is the management for central retinal vein occlusion?

Answer 11

Identify and treat risk factors
Intravitreal anti Vegf if macular oedema

Question 12

What are the 2 types of anterior ischaemic optic neuropathy (AION)?

Answer 12

Arteritic - giant cell arteritis (optic nerve is pale and borders indistinct)
Non arteritic

Question 13

What are the signs and symptoms of giant cell arteritis?

Answer 13

Loss of vision, unilateral headache, loss of appetite, scalp tenderness and jaw claudication
Tenderness of superficial temporal arteries, raised CRP, ESR and platelets

Question 14

What is the management of giant cell arteritis?

Answer 14

High dose systemic steroids - oral prednisolone

Question 15

Describe non arteritic anterior ischaemic optic neuropathy?

Answer 15

Painless
Half of vision can be missing, disc is swollen, raised CV risks
Management is identify and treat CV risk factors

Question 16

What can cause a vitreous haemorrhage?

Answer 16

Posterior vitreous detachment
Proliferative diabetic retinopathy
Trauma
Causes rapid loss of vision

Question 17

What is the management of vitreous haemorrhage?

Answer 17

Conservative or vitrectomy - remove VH and blood

Question 18

What are the risk factors for retinal detachment?

Answer 18

Myopia, trauma and cataract surgery

Question 19

Describe retinal detachment

Answer 19

Have realised flashing lights and floating spots in vision
If caught early with no detachment just tear then managed with laser retinal pelxi
Surgical repair is needed

Question 20

What could cause a gradual loss of vision?

Answer 20

Cataract, glaucoma, age related macular degeneration and diabetic retinopathy

Question 21

What are the symptoms of cataracts?

Answer 21

Loss of vision and dazzle/gaze especially at night/ evening

Question 22

What is the management for cataracts?

Answer 22

Surgery - phacoemulsification with intraocular lens implant

Question 23

What is a glaucoma?

Answer 23

Optic neuropathy with typical optic nerve damage and associated field changes usually associated with raised IOP
Open or closed angle and can be chronic or acute

Question 24

What are the symptoms of a glaucoma?

Answer 24

Asymptomatic, gradual loss of peripheral field of vision Presents usually later symptoms

Question 25

What are the signs of chronic glaucoma?

Answer 25

Raised IOP, visual field defects and optic nerve damage

Question 26

What is the management for chronic glaucoma?

Answer 26

Topical treatment - prostaglandins, BB and carbonic anhydrase inhibitors Surgery - trabeculectomy and drainage services

Question 27

What are the symptoms of age related macular degeneration?

Answer 27

Progressive loss of central vision and distortion Can be wet or dry (mainly dry) Wet is more significant

Question 28

What are the signs of age related macular degeneration?

Answer 28

Distortion on amsler chart Drusen - yellow patched on fundoscopy (calcium and protein deposits) Normal retina and Atrophy in dry

Question 29

What is the management of dry age related macular degeneration?

Answer 29

Low vision aids Registration - sight impaired SSI

Question 30

Describe wet age related macular degeneration

Answer 30

Neovascular Choroidal new vessels Bleeding out of abnormal vessels at macula

Question 31

What investigations are used for wet age related macular degeneration?

Answer 31

OCT - macular oedema may be seen Fluorescein angiography - hyperfluorescent shows leakages

Question 32

What is the management of wet age related macular degeneration?

Answer 32

Intravitreal antivegf Low vision aids Registration - SI/SSI

Question 33

What are the signs of diabetic retinopathy?

Answer 33

Gradual loss of vision Microaneurysms Retinal haemorrhages and exudates Neovascularisation

Question 34

What are the investigations for diabetic retinopathy?

Answer 34

Fluorescein angiography OCT - macular oedema

Question 35

What is the management of diabetic retinopathy?

Answer 35

Control BP, BM and cholesterol Intravitreal antivegf Laser - panretinal phtocoagulation Low vision aids Registration