Visual loss & blindness Flashcards Preview

Year 2 > Visual loss & blindness > Flashcards

Flashcards in Visual loss & blindness Deck (81):
1

List the causes of sudden visual loss

Vascular (vein/artery obstruction or haemorrhage)
Wet age related macular degeneration (ARMD)
Retinal detachment
Closed angle glaucoma
Stroke
Optic neuritis

2

What are the two important branches of the ophthalmic artery?

Posterior cillary and central retinal

3

Which branch of the ophthalmic artery supplies the retina?

Central retinal artery

4

What are the symptoms of central retinal artery occlusion?

Sudden severe vision loss
Painless

5

What are the signs of central retinal artery occlusion?

Relative afferent pupillary defect (RAPD)
Pale oedematous retina
Thread-like vessels

6

When might central retinal artery occlusion be painful?

When it is associated with giant cell arteritis

7

Central retinal artery occlusion is a type of stroke. T/F

True - often a warning sign for things to come

8

Which two underlying diseases can cause central retinal artery occlusion?

Carotid artery disease
Emboli from heart (rare)

9

How can central retinal artery occlusion be managed ophthalmically and vascularly?

Ophthalmic - if within 24 hours can try to convert occlusion to a branch artery with massage
Vascular - carotid doppler to locate source of emboli and management of other risk factors

10

How does branch retinal artery occlusion present?

Sudden visual field defect
Painless

11

What is amaurosis fugax?

Transient central retinal artery occlusion

12

What are the symptoms of amaurosis fugax?

Transient visual loss ("curtain coming down")
Painless
5-10 minute duration with complete recovery

13

What are the signs of amaurosis fugax?

Typically normal fundus examination

14

How is amaurosis fugax managed?

Immediate referral to TIA clinic
Aspirin (if no contraindications)

15

Name a cause of transient visual loss

Migraine

16

How does migraine typically present in the context of ophthamology?

Transient visual loss followed by headache

17

What are the causes of central retinal vein occlusion?

Vascular (Virchow's triad - hypertension, diabetes)
Ocular (Glaucoma - raised IOP)

18

What are the components of Virchow's triad?

Stasis of blood flow (artherosclerosis)
Endothelial injury (hypertension)
Hypercoagulability

19

How does central retinal vein occlusion present?

Sudden severe visual loss
Painless

20

What are the signs of central retinal vein occlusion?

Retinal haemorrhages
Dilated tortuous veins
Disc and macular swelling
Cotton wool spots

21

How are central retinal vein occlusions treated?

Treatment of underlying cause
Monitor for the development of complications
Anti-VEGF

22

How do branch retinal vein occlusions present?

Visual field defect
Painless
Sudden

23

What is ischaemic optic neuropathy?

Occlusion of optic nerve head circulation

24

Which blood vessels are affected in ischaemic optic neuropathy?

Posterior ciliary arteries

25

How can ischaemic optic neuropathy be classified?

Arteritic
Non-arteritic

26

What is the cause of arteritic ischaemic optic neuropathy?

Inflammation (GCA)

27

What is the cause of non-arteritic ischaemic optic neuropathy?

Artherosclerosis

28

How does ischaemic optic neuropathy present?

Sudden
Profound vision loss
Swollen optic disc

29

Giant cell arteritis is a vasculitis affecting which size of vessels? Name the commonly affected vessels

Medium
Temporal
Posterior ciliary

30

How does vision loss occur in ischaemic optic neuropathy?

Ischaemia causes death of the optic nerve

31

How does ischaemic optic neuropathy appear on fundoscopy?

Pale & swollen optic disc

32

How does vision loss from GCA present?

Sudden vision loss
Associated with headache
Profound loss
Irreversible

33

After vision loss associated with GCA, what is the ultimate goal of treatment? What is the treatment?

Prevention of bilateral vision loss
High dose systemic steroids

34

How does GCA present?

Temporal headache
Scalp tenderness
Amaurosis fugax
Jaw claudication
Enlarged temporal arteries
Raised inflammatory markers

35

Where do most haemorrhages within the eye occur?

Vitreous (i.e vitreous haemorrhages)

36

Haemorrhages within the eye come from abnormal blood vessels. T/F

False - can come from abnormal or normal vessels

37

Bleeding within the eye coming from abnormal vessels is associated with what? Name two cases where this might occur

Retinal ischaemia and new blood vessel formation
Diabetic retinopathy
Retinal vein occlusion

38

Bleeding within the eye coming from normal vessels is associated with what?

Retinal tear/detachment

39

How does a vitreous haemorrhage present?

Loss of vision with floaters

40

What are the signs of a vitreous haemorrhage?

Loss of red reflex
Haemorrhage on fundoscopy

41

How is vitreous haemorrhage treated?

Treat underlying cause
Vitrectomy (if non-resolving)

42

How does retinal detachment present?

Painless
Loss of vision
Flashing
Floaters
Halos around light

43

What are the signs of retinal detachment?

Relative afferent pupillary defect
Tear on fundoscopy

44

How is retinal detachment managed?

Surgical - laser or re-attachment

45

A retinal detachment within the inferior optic field will cause vision loss where within the visual field? Why?

Superiorly
Inversion of image

46

What is the commonest cause of blindness in the elderly (in the West)?

Age related macular degeneration

47

What are the two types of macular degeneration?

Wet
Dry

48

Both types of macular degeneration present with vision loss, what is the difference between the type of vision loss?

Wet - sudden
Dry - gradual

49

Describe the pathogenesis of wet age related macular degeneration

Blood vessels grow under the retina and leak fluid/blood causing scarring

50

How does wet ARMD present?

Rapid central vision loss
Distortion/metamorphopsia
Enlarged blind spot/scotoma

51

What are the signs of wet ARMD?

Haemorrhage/exudate over the macula (can only be seen when patient looking directly at you during ophthalmoscopy)

52

Which test can be done to check for ARMD, besides ophthalmoscopy?

Amsler grid

53

How is wet ARMD treated?

Anti-VEGF injected into vitreous cavity

54

How does anti-VEGF work?

Binds to vascular endothelial growth factor to stop neovascularisation

55

How does gradual vision loss present?

Usually bilateral
Asymmetrical
Early presentation - reduced visual acuity
Late presentation - visual field defect

56

What are the causes of gradual vision loss?

C - cataract
A - age related macular degeneration (dry)
R - refractive error
D - diabetic retinopathy
I - inherited disease
G - glaucoma (open angle)
A - access to eye clinic
N - non-urgent

57

Name an inherited disease which causes gradual vision loss

Retinitis pigmentosa

58

What is a cataract?

Clouding of the lens

59

What are the causes of cataract?

Age
Congenital
Traumatic
Metabolic
Drug induced

60

Name a congenital cause of cataract

Intrauterine infection

61

Name a metabolic cause of cataract

Diabetes

62

Name a drug class which causes cataract

Steroids

63

Why is it important to check the red reflex in neonates?

Cataract risk due to intrauterine infection

64

How are cataracts treated? When are they treated?

Surgical removal with intra-ocular lens implant
If patient is symptomatic

65

How does dry age related macular degeneration present?

Gradual visual decline
Scotoma/central vision missing

66

What are the signs of dry ARMD?

Drusen
Atrophic portions of retina

67

What is drusen?

Build up of waste products below the retinal pigment epithelium

68

How is dry ARMD treated?

Supportive (vision magnifiers)

69

What do we call short sightedness?

Myopia

70

What do we call long sightedness?

Hypermetropia

71

What is astigmatism?

Eye shaped abnormally (like a rugby ball)

72

What is presbyopia?

Loss of accommodation reflex with aging

73

What is glaucoma?

Progressive optic neuropathy due to high intra-ocular pressure

74

How can glaucoma be categorised?

Closed angle
Open angle

75

What is the end point of glaucoma?

Vision loss due to optic nerve damage

76

When we refer to angles in glaucoma, which angle to we mean?

Iridocorneal angle

77

How does closed angle glaucoma present?

Painful eye
Red eye
Vision loss
Headache
Nausea & vomiting (due to pain)

78

How is closed angle glaucoma treated?

Lower IOP with eye drops or oral medication

79

How does open angle glaucoma present?

Asymptomatic

80

What are the signs of open angle glaucoma?

Cupped disc
Visual field defect
+/- high IOP

81

How is open angle glaucoma managed?

Lower IOP with
- eye drops
- laser
- surgery
REGULAR MONITORING IN GLAUCOMA CLINIC

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