Vision Loss and Blindness

Question 1

what are the 2 types of visual loss

Answer 1

gradual

sudden

Question 2

what are some causes of sudden vision loss

Answer 2

vascular problems (retinal artery/vein occlusion) 
vitreous haemorrhage 
retinal detachment 
Wet ARMD
Closed angle glaucoma 
Optic neuritis 
Stroke

Question 3

what arteries supply the eye

Answer 3

branches of the ophthalmic artery

Question 4

what branches of the ophthalmic artery are most commonly occluded

Answer 4

posterior ciliary artery

central retinal artery

Question 5

What are the 2 pathologies of the arterial supply to the eye

Answer 5

occlusion (of retinal or optic nerve circulation)

haemorrhage (from normal or abnormal blood vessels)

Question 6

what are the symptoms of retinal artery occlusion

Answer 6

sudden painless vision loss

Question 7

signs of retinal artery occlusion

Answer 7

RAPD 
Pale oedematous retina 
Treat-like vessels 
Dark macula 
Can see individual blood cells trickling through vessels

Question 8

what are some causes of retinal artery occlusion

Answer 8

carotid artery disease

emboli from the heart (unusual)

Question 9

what is amaurosis fugas

Answer 9

temporary painless vision loss in one eye “like a curtain coming down’ lasts 5 mins with full recovery

Question 10

causes of amaurosis fugax

Answer 10

retinal artery occlusion

Question 11

signs of amaurosis fugax

Answer 11

often nothing to see on exam as it has gone back to normal

urgent referral to stroke clinic- sign a stroke is on the way

Question 12

what conditions are associated with central retinal vein occlusion

Answer 12

endothelial damage eg. diabetes
Abnormal blood flow eg. hypertension
Hypercoaguable states eg. cancer

Question 13

symptoms of central retinal vein occlusion

Answer 13

sudden vision loss (variable)

Question 14

signs of central retinal occlusion

Answer 14

retinal haemorrhages
dilated tortuous veins
disc swelling and macular swelling

Question 15

what is ischaemic optic neuropathy

Answer 15

occlusion of the optic nerve head circulation

the posterior ciliary arteries become occluded resulting in infarction of the optic nerve head

Question 16

which inflammatory condition causes ischaemic optic neuropathy

Answer 16

Giant cell arteritis

Question 17

symptoms of ischaemic optic neuropathy

Answer 17

sudden severe visual loss

irreversible blindness

Question 18

signs of ischaemic optic neuropathy

Answer 18

swollen optic nerve

pale swollen disc

Question 19

what are some other symptoms of Giant Cell Arteritis

Answer 19

headache (temporal) 
jaw claudication 
scalp tenderness 
tender/enlarged scalp arteries 
amaurosis fugax
malaise

Question 20

what is vitreous haemorrhage

Answer 20

bleeding in the vitreous cavity: can be from normal vessels eg, bridging a retinal tear, or abnormal vessels

Question 21

symptoms fo vitreous haemorrhage

Answer 21

loss of vision

floaters

Question 22

signs of vitreous haemorrhage

Answer 22

loss of red reflex
may see haemorrhage on fundoscopy
need to find a cause

Question 23

which type of macular degeneration causes sudden visual loss

Answer 23

Wet

Question 24

pathology of wet ARMD

Answer 24

New blood vessels grow under the retina and leakage causes a build up of blood and eventually scarring

Question 25

symptoms of wet ARMD

Answer 25

Rapid central visual loss | Distortion (straight lines become wavy)

Question 26

signs of wet ARMD

Answer 26

haemorrhage/exudate

Question 27

what is glaucoma

Answer 27

progressive optic neuropathy caused by an increase in IOP

Question 28

what is closed angle glaucoma

Answer 28

aqueous humour can't pass from posterior compartment to anterior so build up causing increased pressure this can be acute (ophthalmic emergency)

Question 29

symptoms of closed angle glaucoma

Answer 29

``` painful red eye sudden visual loss headache nausea vomiting ```

Question 30

signs of closed angle glaucoma

Answer 30

red eye cloudy cornea dilated pupil

Question 31

what are some causes of gradual visual loss

Answer 31

``` cataract ARMD (dry) Refractive error Glaucoma Diabetic retinopathy ```

Question 32

what is cataracts

Answer 32

cloudiness of the lens due to abnormal changes in lens proteins

Question 33

causes of cataracts

Answer 33

``` age related congenital traumatic metabolic drug induced (steroids) ```

Question 34

cataract symptoms

Answer 34

gradual decline in vision (hazy/blurred) that cannot be corrected with glasses may get glare

Question 35

cataract treatment

Answer 35

surgical removal with intra-ocular lens implant (if patient is symptomatic)

Question 36

symptoms of dry ARMD

Answer 36

gradual decline in vision | central vision missing (scotoma)

Question 37

what are the signs of dry ARMD

Answer 37

Drusen (build up of waste products below retina) Atrophic patches of retina

Question 38

treatment for dry ARMD

Answer 38

No cure - just supportive treatment with low vision aids eg. magnifiers

Question 39

what is a refractive error

Answer 39

when the eye cannot focus images clearly

Question 40

what is myopia

Answer 40

'short sightedness'

Question 41

what is hypermetropia

Answer 41

'long sightedness'

Question 42

what is astigmatism

Answer 42

irregular corneal curvature doesn't allow rays to be refracted to meet one point

Question 43

what is presbyopia

Answer 43

loss of accommodation with ageing

Question 44

what is open angle glaucoma

Answer 44

when the aqueous humour is not being drained properly

Question 45

what are thy symptoms of open angle glaucoma

Answer 45

often none | opticians usually discover it

Question 46

signs of opened angle glaucoma

Answer 46

cupped disc visual field defect May/may not have high IOP