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Neuro and geriatrics > Visual problems > Flashcards

Visual problems Flashcards

1
Q

What questions should you ask in a visual problems history?

A 
What is the visual problem?
Eye movements? Pain?
Exacerbating/relieving factors?
Onset?
Course?
Associated symptoms? - redness, trauma, headache, other focal neurology?
PMH?
Happened before? Treatment? Did it work?
Quality? 
Any previous trauma?
FHx?
Age? Weight?
Monocular/binocular?
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2
Q

What does monocular partial field loss suggest?

A

Subtotal retinal detachment
Ischaemic optic neuropathy
Branch retinal vascular occlusion

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3
Q

What does bilateral vision loss suggest?

A

Retrochiasmal visual pathway disorder

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4
Q

What does monocular vision loss suggest?

A

Issue before optic chiasm

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5
Q

What eye examinations should you do?

A

Fundoscopy
MRI
CN examination for those related to eye

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6
Q

What related to the aqueous humour can cause unilateral vision loss?

A

Acute angle glaucoma

Primary open angle glaucoma

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7
Q

What is acute angle glaucoma?

A

Sudden onset painful red eye and blurred vision due to occlusion of drainage of aqueous humour causing a rapid rise in IOP - iris pushed forwards against trabecular mesh

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8
Q

What are the symptoms of acute angle glaucoma?

A 
N&V
Sudden onset painful red eye
Blurred vision
Headache
Eye injected, tender, feels hard
Cornea hazy
Pupil semi-dilated
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9
Q

What is the treatment of acute angle glaucoma?

A 
Bright room
Pilocarpine (constricts pupil)
Timolol drops (beta-blocker)
Surgical intervention
IV acetazolamide 500mg (reduced IOP)
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10
Q

What is primary open angle glaucoma?

A

Most common glaucoma
Reduced outflow of aqueous humour
Gradual, insidious, painless loss of peripheral visual fields = normal blind spot with scotomas
Tends to only be discovered when extremely advanced or on a routine examination of eyes

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11
Q

What are the risk factors for getting primary open angle glaucoma?

A

Increasing age
Black African heritage
FH
Myopia

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12
Q

How is primary open angle glaucoma treated?

A

Beta blockers
Prostaglandin analogues
Carbonic anhydrase inhibitors
Selective laser trabeculoplasty

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13
Q

What related to the vitreous humour can cause vision problems?

A

Vitreous haemorrhage

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14
Q

What is are the symptoms of vitreous haemorrhage?

A

Flashes/floaters with decrease in vision
Tends to be unilateral
Red tinge to vision
Blurring of vision

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15
Q

What is vitreous haemorrhage associated with?

A

Diabetic retinopathy
CRVO
Macular degeneration

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16
Q

What related to the retina can cause vision problems?

A

Retinal detachment

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17
Q

What is retinal detachment?

A

Retina pulled away from underlying surface

Often due to trauma eg RTA

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18
Q

What are the symptoms of retinal detachment?

A

Painless, progressive visual field loss

Flashes/floaters with decrease in vision

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19
Q

How is retinal detachment treated?

A

Surgical repair

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20
Q

What vascular problems can cause vision loss?

A

Central retinal artery occlusion
Central retinal vein occlusion
Anterior ischaemic optic neuropathy

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21
Q

What is central retinal artery occlusion?

A

Infarction of inner 2/3 of retina

Ophthalmic emergency

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22
Q

What are the symptoms of CRAO?

A

Sudden, painless loss of vision
Arteries narrow and retina opaque and oedematous
Cherry red spot at fovea

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23
Q

How is CRAO treated?

A

Ocular massage
IV acetazolamide
Breathing into paper bag - builds up CO2 so acts as vasodilator to dislodge emboli

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24
Q

What are the symptoms of CRVO?

A

Dilatation of branch veins
Multiple retinal haemorrhages
Cotton wool patches
Retinal oedema

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25
Q

How is CRVO treated?

A

Mild - no treatment

Anti-VEGF/steroid injections

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26
Q

What can cause anterior ischaemic optic neuropathy?

A

Arteritis (GCA) or non-arteritic

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27
Q

What are the symptoms of anterior ischaemic optic neuropathy?

A

Papilloedema

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28
Q

What is anterior ischaemic optic neuropathy?

A

Occlusion of posterior ciliary artery - supplies optic nerve

Check ESR

29
Q

What amaurosis fugax?

A

Central retinal artery occlusion

30
Q

What nerve problems can cause vision loss?

A

Optic neuritis

Papillitis

31
Q

What other inflammation can cause vision loss?

A

Keratitis

Uveitis

32
Q

What is keratitis?

A

Corneal inflammation

33
Q

What can cause keratitis?

A

HSV
Contact lens-associated infection
Blepharitis

34
Q

What are the symptoms of keratitis?

A

Sensation of foreign body or pain
Photophobia
Lacrimation
Vision reduced if ulcer affecting visual axis

35
Q

What is uveitis?

A

Inflammation of uveal tract (iris, ciliary body, choroid)

36
Q

What are the different types of uveitis?

A

Anterior
Intermediate
Posterior
Panuveitis

37
Q

What is anterior uveitis?

A

Inflammation of iris or both iris and ciliary body

38
Q

What are the symptoms of anterior uveitis?

A 
Redness
Pain
Photophobia
Normal/blurred vision
IOP normal/raised
39
Q

How is anterior uveitis treated?

A

Topical steroids 0.1% dexamethasone

Cyclopentolate 1% for dilating pupil and preventing formation of posterior synechiae

40
Q

What is intermediate uveitis?

A

Inflammation of vitreous

41
Q

What are the symptoms of intermediate uveitis?

A

Painless blurred vision
Floaters
Both eyes commonly affected

42
Q

What is the treatment for intermediate uveitis?

A

Combination of treatment for anterior and posterior depending on severity of different areas

43
Q

What is posterior uveitis?

A

Inflammation of choroid, optic nerve head, retina

44
Q

What are the symptoms of posterior uveitis?

A 
Painless, blurred vision
Can progress to severe visual loss
Floaters
Scotomata
Blind spots
45
Q

What is posterior uveitis associated with?

A

Systemic autoimmune conditions

46
Q

How is posterior uveitis treated?

A

Oral steroids
Treat underlying condition
Immunosuppressants - ciclosporin, azathioprine

47
Q

What is panuveitis?

A

Inflammation affecting all of uveal tract

48
Q

What are the signs and symptoms of optic neuritis?

A 
Reduced visual acuity over a few days
Pain on eye movements
Exacerbated by heat or exercise
Relative afferent pupillary defect
Dyschromatopsia - deficiency in colour vision
49
Q

What can cause optic neuritis?

A 
Inflammation of optic nerve
MS/CIS
Infection - Lyme/syphilis/HIV
B12 deficiency
Arteritis
50
Q

What is the course of optic neuritis?

A

Recovery of vision usually occurs within 6 weeks

51
Q

What is the treatment of optic neuritis?

A

Steroids to help reduce pain and hasten recovery

52
Q

What is the relation of optic neuritis to MS?

A 
May prove to be first manifestation of MS
15 year risk of developing MS 40%
Higher if lesions on MRI
- If MRI normal 10 year risk 11%
- If MRI abnormal 10 year risk 83%
53
Q

What are the signs and symptoms of GCA?

A 
Medical emergency
Jaw claudication
Scalp tenderness
Fatigue
Anorexia
Anaemia
Age > 70
Elevated ESR/CRP
No arteriosclerotic risk factors
54
Q

What is GCA linked to?

A

Polymyalgia rheumatica

55
Q

What is a relative afferent pupillary defect?

A

One eye responds to light and the other doesn’t

Loss of direct response

56
Q

What can cause relative afferent pupillary defects?

A 
Ischaemic optic neuritis
Optic neuritis
Optic nerve compression
Asymmetric glaucoma
Trauma
57
Q

What is cataracts?

A

Most common cause of preventable blindness

58
Q

What can cause cataracts?

A

Age-related opacification of lens
Congenital - maternal infection, familial
Age - elderly
Metabolic - diabetes, galactosaemia, hypocalcaemia, Wilson’s disease
Drug-induced - corticosteroids, phenothiazines, miotics, amiodarone
Traumatic - post-intraocular surgery
Inflammatory - uveitis
Disorder-associated - Down syndrome, dystrophia myotonica, Lowe syndrome

59
Q

What are the clinical features of cataracts?

A

Gradual painless deterioration of vision

Other symptoms depends on type

60
Q

What investigations should you do with someone with cataracts?

A

Blood glucose
Serum calcium
LFTs

61
Q

What is management of cataracts?

A

Surgery

Laser treatment

62
Q

How common is macular degeneration?

A

Most common cause of visual impairment in patients over 50

63
Q

What can cause age-related macular degeneration?

A

Genetic mutations

64
Q

What are the risk factors for age-related macular degeneration?

A 
Increasing age
Smoking
Hypertension
Hypercholesterolaemia
UV exposure
65
Q

What are the 2 types of macular degeneration?

A

Non-exudative (dry)

Exudative (wet)

66
Q

What are they symptoms of dry macular degeneration?

A

Painless, progressive loss of central vision
Focal RPE detachment
Visual distortion and blurring
Lipofuscin deposits found between retinal pigment epithelium

67
Q

What is wet macular degeneration?

A

Abnormal subfoveal choroidal neovascularisation of region of macula and causes severe central vision loss

68
Q

How is macular degeneration managed?

A

Anti-VEGF with intravitrial injections

Neuro and geriatrics (21 decks)

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