Visual loss and blindness

Question 1

Amaurosis fugax

Answer 1

Painless, transient monocular vision loss
Transient CRAO
Lasts 5 mins, full recovery
May be sign of a stroke

Question 2

Emmetropia

Answer 2

Normal

Question 3

Hypermetropia

Answer 3

Long sighted

Question 4

Myopia

Answer 4

Short sighted

Question 5

Presbyopia

Answer 5

Deterioration with age, less compliant lens

Question 6

How to correct hypermetropia

Answer 6

Convex lens (+)

Question 7

How to correct myopia

Answer 7

Concave lens (-)

Question 8

ARMD vision

Answer 8

Central vision lost

Question 9

Blood to inner 2/3 retina

Answer 9

Central retinal artery

Question 10

Blood to outer 2/3 retina and optic nerve head

Answer 10

Posterior ciliary artery

Question 11

Symptoms and signs of CRAO

Answer 11

Sudden profound LOV
Painless
RAPD
Pale oedematous retina, cherry red spot

Question 12

Causes of CRAO

Answer 12

Carotid artery disease

Emboli

Question 13

Treatment of CRAO

Answer 13

Ocular massage (within 24 hours)
Induce hypercapnia (breathe into paper bag)
IV acetazolamide bolus
Surgically decompress anterior chamber
Carotid doppler
Assess risk factors

Question 14

Management of amaurosis fugax

Answer 14

Refer to TIA clinic

Aspirin

Question 15

Causes of CRVO

Answer 15

Atherosclerosis
HT
Hyperviscosity
Raised IOP

Question 16

Symptoms and signs of CRVO

Answer 16

Sudden visual loss
Retinal haemorrhages, dilated tortous veins, disc and macular swelling
Cotton wool spots

Question 17

Treatment of CRVO

Answer 17

Anti-vEGF

Question 18

Ischaemic optic neuropathy

Answer 18

Occlusion of optic nerve head
Posterior ciliary arteries occluded (outer 1/3 retina)
Ischaemia = optic nerve dysfunction

Question 19

2 types of ischaemic optic neyropathy

Answer 19

Arteritic - inflammation of BVs (GCA)

Non-arteritic - atherosclerosis

Question 20

Symptoms and signs of ischaemic optic neuropathy

Answer 20

Sudden profound visual loss
Swollen disc, pale, blurred edges
Irreversible blindness

Question 21

Symptoms of GCA

Answer 21

Jaw claudication, scalp tenderness, headache, enlarged arteries, malaise, amaurosis fugax, high CRP/PV

Question 22

Treatment of ischaemic optic neruopathy

Answer 22

High dose steroids

Question 23

Symptoms and signs of viterous haemorrhage

Answer 23

Loss of vision, floaters

Loss of red reflex one side, haemorrhages, no RAPD

Question 24

Management of vitreous haemorrhage

Answer 24

Vitrectomy

Question 25

Symptoms and signs of retinal detachment

Answer 25

Painless LOV Flashes, floaters RAPD Tear on ophthalmoscopy

Question 26

Treatment of retinal detachment

Answer 26

Surgery Laser Steroids in non-rhegmatogenous

Question 27

Dry ARMD

Answer 27

Gradual reduction in central vision Drusen (lipids) yellow dots Atrophic retina Central scotoma

Question 28

Wet ARMD

Answer 28

Rapid central vision loss Distorsion (metamorphosia) Haemorrhage, exudate New BVs grow under retina, leak, fragile = bleed

Question 29

Metamorphosia

Answer 29

Distorsion | Wet ARMD

Question 30

Treatment of wet ARMD

Answer 30

anti-vEGF

Question 31

Causes of gradua LOV

Answer 31

``` Cataract ARMD (dry) Refractive error Diabetic retinopathy Inherited (retinitis pigmentosa) Glaucoma Access to eye clinic Non-urgent ```

Question 32

Causes of cataract

Answer 32

``` Age related Congenital Traumatic Diabetes Steroids ```

Question 33

Treatment of cataract

Answer 33

Surgical removal | Lens implant

Question 34

Symptoms and signs of POAG

Answer 34

``` Asymp Increase IOP Cupped disc Visual field defect Flame haemorrhages ```

Question 35

Treatment of POAG

Answer 35

Pressure lowering eye drops | Surgery/laser

Question 36

Symptoms and signs of AACG

Answer 36

Sudden LOV Painful headache, N+V

Question 37

Flame shaped haemorrhages

Answer 37

Rupture of microaneurysm at nerve level

Question 38

Blot haemorrhages

Answer 38

Rupture of microaneurysms deep in retina

Question 39

Tractional retinal detachment

Answer 39

Vitreous membranes pull on retina. Vessels fibrous. No holes/tears Diabetic retinopathy

Question 40

Rhegmatogenous retinal detachment

Answer 40

Full thickness tear in retina, most common | Vitreous moves under retina

Question 41

Exudative retinal detachment

Answer 41

Build up of exudate between retina and pigment epithelium | Uveitis

Question 42

Normal optic disc colour

Answer 42

Pink/yellow

Question 43

If disc is pale/white

Answer 43

Problem with myelin OR vascularisation

Question 44

Disc in papilloedema

Answer 44

``` Contour not well defined Cup disappears (swelling) Flame haemorrhages ```

Question 45

Disc in glaucoma

Answer 45

``` Clear contour Large cup (loss of fibres) ```

Question 46

Disc in MS

Answer 46

Pale disc (demyelination)