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Year 2 > Visual loss & blindness > Flashcards

Visual loss & blindness Flashcards

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1
Q

List the causes of sudden visual loss

A

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

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2
Q

What are the two important branches of the ophthalmic artery?

A

Posterior cillary and central retinal

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3
Q

Which branch of the ophthalmic artery supplies the retina?

A

Central retinal artery

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4
Q

What are the symptoms of central retinal artery occlusion?

A

Sudden severe vision loss

Painless

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5
Q

What are the signs of central retinal artery occlusion?

A

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

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6
Q

When might central retinal artery occlusion be painful?

A

When it is associated with giant cell arteritis

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7
Q

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

A

True - often a warning sign for things to come

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8
Q

Which two underlying diseases can cause central retinal artery occlusion?

A

Carotid artery disease

Emboli from heart (rare)

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9
Q

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

A

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

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10
Q

How does branch retinal artery occlusion present?

A

Sudden visual field defect

Painless

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11
Q

What is amaurosis fugax?

A

Transient central retinal artery occlusion

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12
Q

What are the symptoms of amaurosis fugax?

A

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

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13
Q

What are the signs of amaurosis fugax?

A

Typically normal fundus examination

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14
Q

How is amaurosis fugax managed?

A

Immediate referral to TIA clinic

Aspirin (if no contraindications)

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15
Q

Name a cause of transient visual loss

A

Migraine

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16
Q

How does migraine typically present in the context of ophthamology?

A

Transient visual loss followed by headache

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17
Q

What are the causes of central retinal vein occlusion?

A

Vascular (Virchow’s triad - hypertension, diabetes)

Ocular (Glaucoma - raised IOP)

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18
Q

What are the components of Virchow’s triad?

A

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

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19
Q

How does central retinal vein occlusion present?

A

Sudden severe visual loss

Painless

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20
Q

What are the signs of central retinal vein occlusion?

A

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

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21
Q

How are central retinal vein occlusions treated?

A

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

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22
Q

How do branch retinal vein occlusions present?

A

Visual field defect
Painless
Sudden

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23
Q

What is ischaemic optic neuropathy?

A

Occlusion of optic nerve head circulation

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24
Q

Which blood vessels are affected in ischaemic optic neuropathy?

A

Posterior ciliary arteries

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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 ```

Year 2 (72 decks)

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