Visual Loss and Blindness

Question 1

List causes of Sudden Visual Loss

Answer 1

Vascular aetiology
Retinal detachment
Age related macular degeneration (ARMD) -wet type

Closed angle glaucoma
Optic neuritis
Stroke

Question 2

What are the causes of sudden visual loss form a vascular aetiology?

Answer 2

Occlusion of - retinal circulation

• optic nerve head circulation (posterior ciliary arteries)

Haemorrhage from

• abnormal blood vessels (eg diabetes, wet ARMD)
• retinal tear

Question 3

What are the signs and symptoms of CRAO?

Answer 3

Symptoms
Sudden visual loss

Painless

Signs
RAPD (relative afferent pupil defect)
Pale oedematous retina, thread-like retinal vessels

Question 4

What is the manin cause of central retinal artery occlusion?

Answer 4

Carotid Artery Disease

Question 5

What is the management of CRAO?

Answer 5

Carotid Doppler to assess location of embolism

If patient presents within 24 hours give an occular massage to try and convert CRAO to BRAO

Question 6

What condition presents with:
transient painless visual loss
‘like a curtain coming down’
lasts~5mins with full recovery

How would you treat it?

Answer 6

amaurosis fugax

Immediate referal

Aspirin

Question 7

What are causes of central retinal vein occlusion?

Answer 7

Systemic causes

Atherosclerosis
Hypertension

Hyperviscosity

**Ocular causes **
raised IOP (venous stasis)

Question 8

What are the signs and clinical features of CRVO?

Answer 8

Sudden, moderate to severe visual loss

Retinal haemorrhages
Dilated tortuous veins
Disc swelling and macular swelling

Question 9

CRVO treatment

Answer 9

Based on treatment of systemic or ocular causes (eg hypertension, diabetes, glaucoma)

Monitor : may develop complications due to development of new vessels (laser treatment may be required to avoid complications from these vessels eg vitreous haemorrhage)

anti- VEGFs used (VEGF = vascular endothelial growth factor)

Question 10

What are the causes of venous and arterial occlusion?

Answer 10

Arterial- embolic

Venous- Stasis

Question 11

Which arteries become occluded in ischaemic optic neuropathy?

Answer 11

the posterior ciliary arteries

Question 12

what are the two causes of ischaemic optic neuropathy?

Answer 12

Arteritic- Inflammation (Giant Cell Arteritis)

Non-Arteritic- Atherosclerosis

Question 13

what are the signs and symptoms of Giant Cell Arteritis?

Answer 13

Headache (usually temporal)
Jaw claudication

Scalp tenderness (painful to comb hair)
Tender/enlarged scalp arteries

Amaurosis fugax
Malaise
Very High ESR , PV and CRP
Temporal artery biopsy may help diagnosis

Question 14

how do you treat giant cell arteritis

Answer 14

High Dose Steroids

Question 15

What are the signs, symptoms and mangement of a vitreous haemorrhage?

Answer 15

Symptoms
Loss of vision
‘Floaters’

Signs
Loss of red reflex
No RAPD – unless associated with other pathology

Management
Identify cause
Vitrectomy for non-resolving cases

Question 16

Signs and symptoms of sudden retinal detachment

Answer 16

Symptoms
Painless loss of vision
Sudden onset of flashes/floaters (mechanical separation of sensory retina from retinal pigment epithelium)

Signs
May have RAPD
May see tear on ophthalmoscopy

Management
usually surgical

Question 17

Describe the pathology of ‘wet’ age related macular degeneration

Answer 17

New blood vessels grow under retina – leakage causes build up of fluid/blood and eventually scarring

Question 18

What are the signs and symptoms of ‘Wet’ ARMD?

Answer 18

Symptoms
Rapid central visual loss
Distortion (metamorphopsia)

Signs
haemorrhage/exudate

Question 19

What is the treatment for ‘wet’ ARMD?

Answer 19

Anti-VEGF treatment – injected into vitreous cavity. Stops new blood vessels growing by binding to VEGF (vascular endothelial growth factor)

Question 20

What are the causes of gradual visual loss?

Answer 20

• *C**ataract
• *A**ge related macular degeneration (dry type)
• *R**efractive error
• *D**iabetic retinopathy
• *I**nherited diseases e.g. retinitis pigmentosa
• *G**laucoma
• *A**ccess (to eye clinic) Non-urgent

Question 21

Different causes of cataracts

Answer 21

Age related
Congenital – intrauterine infection (importance of checking red reflex in neonates)
Traumatic
Metabolic – diabetes
Drug-induced (steroids)

Question 22

what is the treatment of cataracts

Answer 22

removal with intra-ocular lens implant

Question 23

what are the signs and symptoms of ‘Dry’ ARMD?

Answer 23

Symptoms
Gradual decline in vision
Central vision ‘missing’

Signs
Drusen – build up of waste products below RPE

RPE changes – atrophy/ hyperplasia

Question 24

what is the treatment of ‘Dry’ ARMD?

Answer 24

No cure – treatment is supportive with low vision aids eg magnifiers

Question 25

Name the different types of refractive errors

Answer 25

Myopia (‘short-sighted’) Hypermetropia (‘long- sighted’) Astigmatism (usually irregular corneal curvature) Presbyopia (loss of accommodation with aging)

Question 26

What is the pathology of open angle glaucoma?

Answer 26

Intra ocular pressure increases gradually Damage of retinal nerve fibres

Question 27

what are the signs and symptoms of open angle Glaucoma?

Answer 27

**Symptoms** Often NONE Optician screening important **Signs** Increased intraocular pressure Cupped disc Visual field defect

Question 28

How does vision loss develop in Glaucoma?

Answer 28

Question 29

What is the management of Glaucoma?

Answer 29

Treatment - pressure-lowering eye drops or occasionally surgery Patients need regular monitoring in eye clinic

Question 30

how do the numbers relate to the letters on the snellen chart?

Answer 30

Question 31

list causes of sudden blindness

Answer 31

wet ARMD CRAO/ CRVO Retinal detachment Giant cell arteritis Optic Neuritis Trauma