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Ophthalmology > Vision Loss > Flashcards

Vision Loss Flashcards

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1
Q

Give 5 causes of sudden visual loss?

A

Vascular aetiology, vitreous haemorrhage, retinal detachment, wet ARMD, closed angle glaucoma

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2
Q

What type of visual loss do optic neuritis and stroke cause?

A

Sudden

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3
Q

Where does the main blood supply to the eye come from?

A

Branches of the ophthalmic artery

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4
Q

What artery supplies the inner two thirds of the retina?

A

Central retinal artery

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5
Q

What gives the blood supply to the outer third of the retina?

A

Choroid

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6
Q

Where do the posterior ciliary arteries supply?

A

Optic nerve head (optic disc)

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7
Q

Sudden visual loss of a vascular aetiology can be caused by occlusion of what?

A

Retinal circulation or optic nerve head circulation

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8
Q

Sudden visual loss of a vascular aetiology can be caused by haemorrhage of what?

A

Abnormal blood vessels or a retinal tear

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9
Q

What 2 conditions can cause abnormal blood vessels to form in the eye?

A

Diabetic retinopathy or wet ARMD

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10
Q

Describe the visual loss which is encountered in CRAO?

A

Sudden, painless and profound

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11
Q

What are some signs of CRAO?

A

Relative afferent pupil defect. Pale, oedematous retina with thread like vessels. Cherry red spot on macula

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12
Q

What does this show?

A

Central retinal artery occlusion.

(pale, oedematoous retina with thread like vessels)

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13
Q

CRAO is a type of stroke. What can this occur secondary to? Which is most common?

A

Occurs secondary to carotid artery disease mostly, very rarely as a result of an emboli from the heart.

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14
Q

What is the first line management for CRAO if it presents within 24 hours?

What is the purpose of this treatment?

A

Ocular massage- try to convert it to a branch occlusion which causes less overall damage.

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15
Q

If the patient presents with a CRAO after more than 24 hours, or an ocular massage has already been performed, what is the next management?

A

Find the source of the embolus with a carotid doppler, and assess and manage risk factors.

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16
Q

What is amaurosis fugax?

A

Transient CRAO causing visual loss ‘like a curtain coming down’. Usually lasts about 5 minutes with full recovery and no abnormalaities on examination.

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17
Q

What is the management for amourosis fugax?

A

Urgent referral to the stroke clinic and possibly start aspirin therapy

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18
Q

What are systemic causes of CRVO?

A

Atherosclerosis, hypertension, hyperviscosity

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19
Q

What is the ocular cause of CRVO?

A

Raised IOP

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20
Q

Describe the visual loss in CRVO?

A

Sudden, moderate-severe

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21
Q

What are some signs of CRVO?

A

Retinal haemorrhages, dilated, torturous veins, swollen disc and macula

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22
Q

What does this show?

A

Central retinal vein occlusion

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23
Q

What does this show?

A

Normal macula

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24
Q

What does this show? (Not anything specific, just in general)

A

Macular oedema

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25
Why do you need to monitor patients with CRVO?
They may develop complications due to new vessel growth
26
What new treatment can be used for CRVO? What do these do?
Anti-VEGF- prevent new vessel growth
27
What does this show? Why are these patients likely to have visual loss?
Branch retinal vein occlusion- likely to have visual loss as a result of macular oedema
28
What is the major difference on fundoscopy between an artery and vein occlusion?
Artery occlusion will be pale and vein occlusion will be dark
29
What is occlusion of the optic nerve head circulation known as?
Ischaemic optic nerve neuropathy
30
What arteries supply the optic nerve head?
Posterior ciliary arteries
31
Are the posterior ciliary arteries end arteries?
No
32
What are the 2 types of optic nerve head occlusion? How common are each one?
Arteritic and non-arteritic (each make up 50% of cases)
33
What causes arteritic optic nerve head occlusion?
Inflammation due to GCA
34
What causes non-arteritic optic nerve head occlusion?
Atherosclerosis
35
What does optic nerve head occlusion cause?
Sudden, profound vision loss with a swollen disc
36
What does this show?
Ischaemic optic nerve (pale, swollen disc)
37
What are the optic symptoms of arteritic ION? Why is diagnosis of this very important?
Sudden, profound, irreversible blindness To prevent visual loss in the other eye
38
What test is important in diagnosis of GCA? What immediate treatment may be required?
Temporal artery biopsy Immediate high dose steroids
39
Where does haemorrhage normally occur in the eye?
Into the vitreous cavity
40
What are symptoms of vitreous haemorrhage?
Loss of vision and floaters
41
What are signs of vitreous haemorrhage?
Loss of red reflex and may see haemorrhage on fundoscopy
42
What is the management for vitreous haemorrhage?
Identify the cause and if there is no cause then vitrectomy
43
What does this show?
Vitreous haemorrhage
44
What are symptoms of retinal detachment?
Painless loss of vision and sudden onset of flashes/floaters
45
What are signs of retinal detachment?
RAPD, may see tear on retina, pale retina
46
What does this show? Where will the visual disturbance be? What is the management?
Retinal detachment Superior Usually surgical
47
What does this show? What type of visual loss does it cause?
Wet ARMD Rapid, central vision loss
48
What happens in wet ARMD?
New blood vessels grow under the retina, and leakage causes a build-up of fluid/blood and eventually scarring.
49
What are some risk factors for wet ARMD?
Smoking, poor nutrition, positive family history
50
What is the treatment for wet ARMD?
Anti-VEGF
51
What happens in closed angle glaucoma?
Aqueous humour encounters increased resistance through the iris/lens channel. This obstructs the trabecular meshwork and causes the IOP to rise.
52
How may closed angle glaucoma present acutely?
Present with painful red eyes, visual loss, headaches, nausea and vomiting.
53
What is the treatment for closed angle glaucoma?
Lower IOP with drops/oral medication to prevent the patient going blind and then do a laser iridotomy.
54
How may gradual visual loss present early? How may gradual visual loss present late?
Decreased visual acuity Decreased visual fields
55
Give 5 causes of gradual visual loss?
Glaucoma, dry ARMD, diabetic retinopathy, cataract, refractive error
56
What is a cataract? What drug commonly causes this?
Clouding of the lens Steroids
57
What are some symptoms of cataract?
Gradual decline in vision which cannot be corrected with glasses Glare
58
What is the treatment for a cataract?
Surgical removal with intra-ocular lens implant if patient is symptomatic
59
What condition may result in the gradual loss of central vision?
Dry ARMD
60
What is the treatment for dry ARMD?
No treatment- can use magnifiers
61
What is myopia?
Short sightedness- patients focus images too far forward
62
What is hypermetropia?
Long sightedness- patient focus images too far back
63
What is astigmatism?
Irregular corneal curvature
64
What is presbyopia?
Loss of accomodation with age
65
Open angle glaucoma is often asymptomatic. What are some signs?
Cupped disc Visual field defect May or may not have high IOP
66
What does this show?
Open angle glaucoma

Ophthalmology (12 decks)

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