sudden loss of vision

Question 1

what are common causes of sudden painless loss of vision?

Answer 1

1. ischaemic/vascular
   
   • e.g. thrombosis, embolism, temporal arteritis
   • recognised syndromes e.g. occlusion of central retinal vein, occlusion of central retinal artery
2. vitreous haemorrhage
3. retinal detachment
4. retinal migraine

Question 2

what are ischaemic/vascular sudden painless loss of vision often referred to as?

Answer 2

amaurosis fugax

Question 3

what are differentials for ischaemic / vascular causes of sudden painless loss of vision?

Answer 3

1. large artery disease (atherothrombosis, embolus, dissection, small artery occlusive disease (anterior ischaemic optic neuropathy, vasculitis e.g. temporal arteritis)
2. venous disease
3. hypoperfusion

Question 4

ischaemic/vascular causes of sudden painless loss of vision may represent a form of TIA. what should therefore be given?

Answer 4

aspirin 300 mg

Question 5

altidutindal field defects e.g. ‘curtain coming down’

Answer 5

ischaemic/vascular

Question 6

what is ischaemic optic neuropathy due to?

Answer 6

occlusion of the short posterior ciliary arteries, causing damage to the optic nerve

Question 7

which one is more common? central retinal vein occlusion or central retinal artery occlusion?

Answer 7

CRVO

Question 8

what are causes of CRVO?

Answer 8

glaucoma, polycythaemia, HTN

Question 9

what can be seen on fundoscopy for CRVO?

Answer 9

severe retinal haemorrhages

Question 10

what is CRAO due to?

Answer 10

thromboembolism (from atherosclerosis) or arteritis (e.g. temporal arteritis)

Question 11

what are the features CRAO?

Answer 11

afferent pupillary defect

‘cherry red’ spot on pale retina

Question 12

what are causes of vitreous haemorrhage?

Answer 12

diabetes, bleeding disorders, anticoagulants

Question 13

what are the features of vitreous haemorrhage?

Answer 13

sudden visual loss

dark spots

Question 14

what are the features of retinal detachment?

Answer 14

features of vitreous detachement, which may precede retinal detachment

flashes of light / floaters

Question 15

how do you differentiate posterior vitreous detachment, retinal detachment and vitreous haemorrhage?

Answer 15

Question 16

• flashes of light (photopsia) - in the peripheral field of vision
• floaters - often on temporal side of central vision

dx?

Answer 16

posterior vitreous detachment

Question 17

• dense shadow that starts peripherally progresses towards central vision
• veil or curtain over field of vision
• straight lines appear curved
• central visual loss

dx?

Answer 17

retinal detachment

Question 18

• large bleeds: sudden visual loss
• moderate bleeds: numerous dark spots
• small bleed: floaters

dx?

Answer 18

vitreous haemorrhage

Question 19

This man presents with unilateral visual loss. On examination he has a relative afferent pupillary defect. Fundoscopy shows the following.

What is the most likely diagnosis?

Answer 19

central retinal artery occlusion

(pale retina)

Question 20

peripheral curtain over vision + spider webs + flashing lights in vision.

Dx?

Answer 20

retinal detachment

urgent referral to eye casualty!

Question 21

pt with poorly controlled T1DM presents with painless loss of vision with floater and ‘red hue’. Dx?

Answer 21

vitreous haemorrhage

Question 22

A woman presents with reduced vision in her right eye. She is unsure when it started but can now only make out hand movements with the right eye. Fundoscopy of the affected eye shows the following.

What is the diagnosis?

Answer 22

retinal detachment

(a retinal tear is also clearly visible)