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Ophthalmology > Visual loss and blindness > Flashcards

Visual loss and blindness Flashcards

(62 cards)

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1
Q

What are some causes of sudden visual loss?

A

vascular aetiology retinal detachment age related macular degeneration - wet type Close angle glaucoma optic neuritis stroke

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2
Q

What is the major arterial blood supply to the eye?

A

ophthalmic artery

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3
Q

What are the two types of vascular events that can lead to sudden visual loss?

A

occlusion haemorrhage

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4
Q

Occlusion of what can result in sudden visual loss?

A

retinal circulation optic nerve head circulation

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5
Q

haemorrhage from what can cause sudden visual loss?

A

abnormal blood vessels - diabetes retinal tear

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6
Q

What are the symptoms of central retinal artery occlusion?

A

sudden painless visual loss

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7
Q

What signs are seen in central retinal artery occlusion?

A

relative afferent pupil defect pale oedematous retina thread-like retinal vessels

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8
Q

What does this image show?

A

central reinal artery occlusion

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9
Q

What are some causes of central retinal artery occlusion?

A

carotid artey disease

emboli from the heart - unusual

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10
Q

What is the management of a central retinal artey occlusion

A

if presents within 24 hrs - occular massage

Establish source of embolus - carotid doppler

assess and manage risk factors

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11
Q

What are the 3 main variants of retinal artery occlusion?

A

Central retinal artey occlusion

Branch retinal artery occlusion

Amaurosis fugax

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12
Q

what is Amaurosis fugax?

A

TRANSIENT CRAO

(transient - short lasting)

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13
Q

what are the symptoms of amaurosis fugax?

A

transient painless visual loss

like a curtain coming down

lasts 5 mins with full recovery

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14
Q

what are the signs in amaurosis fugax?

A

usually nothing abnormal on examination

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15
Q

What is the treatment for amaurosis fugax?

A

immediate referral to the TIA clinic

aspirin

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16
Q

What are some causes of transient vision loss?

A

amaurosis fugax

migraine - visual loss usually followed by a headache

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17
Q

what are some systematic causes of central retinal vein occlusion?

A

Virchow’s triad

atherosclerosis

hypertension

hyperviscosity

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18
Q

What is an ocular cause of central retinal vein occlusion?

A

raised IOP

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19
Q

what are the symptoms of central retinal vein occlusion?

A

sudden visual loss (moderate to severe)

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20
Q

What are the signs of a central retinal vein occlusion?

A

retinal haemorrhages

dilated tortuous veins

disc swelling and macular swelling

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21
Q

What does this image show?

A

central retinal vein occlusion

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22
Q

what is the treatment for central retinal vein occlusion?

A

treat systemic / ocular cause

monitor - complications due to development of new vessels

anti-VEGFs

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23
Q

what is occlusion of the optic nerve head circulation also known as?

A

ischaemic optic neuropathy

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24
Q

In nOcclusion of optic nerve head circulation what vessels become occluded?

What does this result in?

A

posterior ciliary arteries - infarction of the optic nerve head

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25
what are the 2 types of ischaemic optic neuropathy?
arteritic - inflammation non-arteritic - atherosclerosis
26
How does ischaemic optic neuropathy present?
sudden, profound visual loss with swollen disc
27
outline the pathogenesis for arteritic ischaemic optic neuropathy
Giant cell arrteritis (GCA) Medium to large sized arteries inflamed (multinucleate giant cells) Lumen of artery becomes occluded (posterior ciliary arteries) Visual loss from ischaemia of optic nerve head
28
what are the symptoms of arteritic ischaemic optic neuropathy?
sudden visual loss irreversible blindless
29
what is giant cell arteritis also known as?
temporal arteritis
30
What are the symptoms of temporal arteritis?
* Headache (usually temporal) * Jaw claudication * Scalp tenderness (painful to comb hair) * Tender/enlarged scalp arteries * amaurosis fugax * malaise
31
what invesigations could be done for suspected temporal arteritis?
very high ESR, PV and CRP temporal artery biopsy may be helpful
32
In arteritic iscahemic optic neuropathy how can visual loss in the other eye be prevented?
prompt recognition immediate high dose systemic steroid
33
in sudden visual loss due to haemorrhage where doe the haemorrhage often occur?
into the vireous cavity
34
what are symptoms of virteous harmorrhage?
loss of vision floaters
35
what are signs of virteous haemorrhage?
lossof red reflex may see haemorrhage on fundoscopy
36
What is the managemet of virteous haemorrhage?
idenify the cause Vitrectomy for non-resolving cases
37
what are the symptoms of retinal detachment?
painless loss of vision sudden onset of flashes / floaters
38
what is the commonest cause of blindness in the western world in patients over 65?
Age related macular degeneration (ARMD)
39
what are the 2 types of ARMD?
dry and wet
40
What is the key difference between wet and dry ARMD?
dry - gradual vision loss wet - sudden vision loss
41
what happens in wet ARMD?
New blood vessels grow under retina – leakage causes build up of fluid/blood and eventually scarring
42
What are the symptom of wet ARMD?
rapid central visual loss distorsion
43
What signs may be seen in wet ARMD?
haemorrhage / exudate
44
what does VEGF stand for?
vascular endothelial growth factor
45
What is the treatment for wet ARMD?
Anti-VEGF treatment – injected into vitreous cavity. Stops new blood vessels growing by binding to VEGF
46
what are some common features of gradual visual loss?
usually bilateral often asymmetrical may present early with reduced visual acuity may present late with decreased field
47
What are some causes of gradual visial loss? (CARDIGAN)
* Cataract * age related macular degeneration - dry * refractive error * diabetic retinopathy * inherited diseases * glaucoma * access (to eye clinic) Not urgent
48
What is a cataract?
cloudiness of the lens
49
What are some differen types of cataract?
Nuclear cataract posterior subcapsular cataract christmas tree cataract - polychromatic cataract congenital cataract - check red reflex in neonates
50
how are cataracts managed?
surgical removal with intra-ocular lens implant if patient is symptomatic
51
what are the symptoms of dry ARMD?
gradual decline in vision central vision missing
52
What are some signs of dry ARMD?
drusen - build up of waste atrophic patches of retina
53
what is the treatment of dry ARMD?
no cure - treatment i supportive with low vision aids
54
what is a refractive error?
when the eye cannot clearly focus on image
55
What are the different types of refractive errors?
Myopia - short sighted hypermetropia - long sighted astigmatism - rugby ball shaped cornea presbyopia - loss of accomodation with ageing
56
what is the main treatment for refractive errors?
Glasses
57
what is glaucoma?
progressive optic neuropathy resulting in visual loss
58
which type of glaucoma can be acute?
closed angle type - ophthalmic emergency
59
How do patients with closed angle type glaucoma present?
with painful, red eye/visual loss/headache/nausea/vomiting
60
how is closed angle type glaucoma treated?
Need to lower IOP with drops/oral medication to prevent patient going blind
61
what are the symptoms of open-angle glaucoma?
often none - tends to be discovered by opticians
62
what signs are commonly seen in open angle glaucoma
cupped disc visual field defect may/may not have high IOP

Ophthalmology (9 decks)

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