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Flashcards in Visual loss Deck (20):

What are the causes of papilloedema?

Increased intercranial pressure
- space occupying lesion
- mailigant hypertension
- hypercapnia


What is Holmes-adie pupil?

Benign dilated pupil (80% are unilateral).


How does vitreous haemorrhage present?

Sudden onset floaters in vision
Reddish tint to vision
Reduced red reflex
Recused visual acuity

Rx- exclude retinal detachment (uss)
Identify cause and treat abnormal vessels


Whats the presentation of posterior vitreous detachment?

Acute onset floaters
Photopsia (flashing lights)
Ring of floaters/ hairs in the temporal side of central vision.
Normal visual acuity and fields

Rx- none


How does retinal detachment present?

Curtain over vision
Straight lines appear curved (+ve amsler grid test)
Shadows move from peripheral vision to central vision

Rx- repair hole (or drain sub-retinal fluid),


How is retinal detachment treated?

Holes treated with laser or cryotherapy
Retina Reattached by drainage of sub-retinal fluid and scleral buckle


How does retinal artery occlusion present?

(Usually caused by atherosclerosis)
Sudden painless of vision
Can be temporary (amaurosis fugax)
Fundoscopy 'cherry red spots' (ischemic retina)
Afferent pupillary defect

Rx- branch supportive treatment
Central - reduce intraoccular pressure, CO2 rebreathing (vasodilation)


How does retinal vein occlusion present?

Often in pts. With hypertension or hyper viscosity (eg DM, myeloma, smoking)

On examination - flame haemorrhages, dilated tortuous vessels, swollen optic disc, cotton wool spots, RAPD-ischemic.


How does atrophic macular degeneration present?

Dry with 'drusen'

Currently no treatments. Just stop smoking and take high dose vitamins.


How does exudative macular degeneration present?

Wet/ neovascular.
Choroidal neovascularisation
Sudden distrubance of central vision

Ix- fundus fluorescein angiogram
Rx - intravitrial anti-VEGF (eg ranibizumab), photocoagulation, photodynamic therapy


What is the leading cause of visual loss in the elderly?

Age related macular degeneration


How does giant cell arteritis/ temporal arteritis present?

Impaired visual acuity 2' to anterior ischemic optic neuropathy.
Tender scalp, headache, neck ache,
Jaw cladication
Mailaise, weight loss
Proximal myopathy

Ix- ESR, CRP, temporal artery biopsy.
Rx- high dose steroids,


How does optic neuritis present?

Unilateral swollen disc
Reduced vision
RAPD (relative afferent pupillary defect)

Think: multiple sclerosis (demyelinating inflammation)


What is a relative afferent pupillary defect?

Non symmetrical response to the swinging light test
Therefore a defect is shown


Transient disturbance in colour vision?

Optic neuritis (often MS)


Pale retina causes?

Retinal artery occlusion

With red spot


In a stroke with homonymous hemianopia in the defect contralateral or ipsilateral to the brain lesion?

Contralateral (same side effected as body)

Eg right weakness = right side HH


Causes of central rential vein occulsion

Increases with age


Causes of central retinal artery occulsion

Thromboembolism - eg atherosclerosis

Arteritis - eg temporal arteritis


Stages of hypertensive retinopathy

1- tortuous vessels and silver wiring (increased light reflex)
2- av nipping
3- cotton wool spots and flame and blot haemorrhages
4- papillodema