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Flashcards in Sudden Loss of Vision Deck (63)
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1

What are the most common causes of sudden painless loss of vision and what is it in elderly

Ischaemic optic neuropathy
Vascular
Vitreous haemorrhage
Retinal detachment
Retinal vein or artery occlusion
GCA - usually pain

If elderly = vascular till proven otherwise

2

What do you do if someone presents with acute visual loss

Stay calm and reassure
Get a clear Hx
Treat Sx e.g. pain / nausea
Early referral to ophthalmology and urgent senior review

3

What does loss of vision tend to indicate

Problem in posterior part of eye

4

What are the 4 categories

Vascular / ischaemic problem
Vitreous problem
Retinal detachment
Macular problem

5

What are vitreous issues

Posterior vitreous detachment
Proliferative retinopathy

6

What are macular problems

Age related = gradual
Macular hole
Central serous retinopathy

7

What causes vascular / ischaemic issues

Atherosclerosis
Embolism
Dissection
Vasculitis
Hypo-perfusion
Venous disease

8

What would cause unilateral loss

Problem in eye or optic nerve
Retinal vein or artery occlusion
Can be central or branch
Ischaemic optic neuropathy

9

What causes bilateral

After decussation of fibres at chasm
CVA / TIA
- Amourosis fujax
Retinal migraine

10

Is someone presents with visual loss what do you want to ask

General PMH / drug review
Uni or bilateral
When did you lose vision
- Sudden
- Gradual
What is vision loss like
- General blur
- Particular part lost (suggest branch)
- Whole field (central vein)
- Any tunnel
- Lke a curtain
Is there anything else in vision?
- Flashes?
- Floaters?
- Any distortion
Any pain associated
- Pain on eye movement
- Photophobia
- Headache
Is the eye red
Any trauma
Is BP / DM well controlled
Any thrombotic / haematological conditions./ use of OCP

11

What does curtain coming down suggest

Amourosis fujax
DM
Vitreous haemorrhage

12

What causes amaurosis fujax

Embolism in retinal artery

13

How do you Rx

Aspirin 300mg
Refer urgent to TIA clinic

14

What does CVA cause

Hemianopia

15

How does migraine present

Zig zag or blobs
Prior to headache forming

16

What causes ischaemic optic neuropathy

Occlusion of ciliary artery damaging optic nerve

17

What does it present with

Monocular visual loss
Afferent pupil defect
Pale disc on fundoscopy if long term

18

What causes central retinal vein occlusion

Age
Hypertension
Hyperviscosity e.g. polycythaemia
Glaucoma - raised IOP
Vasculitis - GCA

19

How does it present

Sudden painless loss of vision
Tends to be more over days to weeks
where as arterial = seconds - minutes
Pupil defect

20

How do you differentiate ischaemic from non-ischaemic causes of occlusion

Ischaemic
- Extensive
- Deep haemorrhage
- Relative afferent pupil defect
- Severe visual loss

21

What is seen in the retina on fundoscopy ???

Blood leaks everywhere + fluid build up as vein to take away = blocked
Margarita pizza
Swollen optic disc
Blot haemorrhage 4+
Dilated vessel
Cotton wool

22

What investigations do you do

Ophthalmology blood screen + referral
- FBC, U+E, CRP, ESR, clotting + vasculitis screen
Inflammatory markers to rule out GCA
BP check
FBC for hyperviscosity
Blood sugar
Lipids and cholesterol

23

How do you Rx

Refer opthamology within 2 weeks or urgent if young
Monitor for complications
Treat vascular RF

24

What are complications

90% chance of long term visual loss
Neovascularisation due to release of VEGF to create collateral
- May cause vitreous haemorrhage
Macular oedema

25

How do you Rx complications

Anti-VEGF
Laser photocoagulation to burn off vessels
Dexamethasone for oedema

26

What causes central retinal artery occlusion

Atherosclerosis
Hypertension
Emboli
Inflammation - GCA
Glaucoma

27

What is CRAO

A form of stroke
Ophthalmic emergency
Time critical as can cause permanent damage to retinal ganglion cell

28

What must you do

Look for cause
- DM
- Smoking
- Cholesterol

29

How does it present

Sudden painless loss of vision
Seconds - minutes
Afferent pupil defect
Usually monocular
Branch = certain part
Retinal vein = whole field

30

What is seen on retina

Cherry red spot
Pale optic disc
Pale as no blood
May still have red arteries due t collateral
If chronic = complete pale as retinal cells dead