Week 2 - D - Ophthamology 3 - Sudden visual loss causes

Question 1

Name some causes of sudden visual loss

Answer 1

Central retinal artery occlusion

Central retinal vein occlusion

Retinal detachment

Vitreous hameorrhage

Transient central retinal artery occlusion

Wet age-related macular degeneratiion

Question 2

• Pale oedematous retina, thread-like retinal vessels What is this?

Answer 2

Central retinal artery occlusion

Question 3

What is the main cause of central reitnal artery occlusion? How does the patient present?

Answer 3

Usually carotid artery disease

Paitent presents with profound painless sudden vision loss

Question 4

Why is there a cherry red spot at the fovea in centra retinal artery occlusion?

Answer 4

The macula is thin and the choroidal blood supply can be seen through the cells of the macula

Question 5

If the patient presents within 100 minutes with a central retinal artery occlusion, what is the treatment?

Answer 5

Try an ocular massage to move the embolism in the artery from the central to branched retinal artery

Question 6

Patients rarely recover from CRAO, how is the source of the embolism attempted to be established?

Answer 6

Try using a doppler to identify the location

Doppler is used for arteries and viens

Question 7

Describe how a patient with a tranisent ischaemic attack would present? What is another name for the transient ischaemic attack of the eye?

Answer 7

Amaurosis fugax

Presents with a sudden painless loss of vision, which is only temporary and is like a curtain coming down over the eye

Question 8

Immediate referral TIA clinic for amurosis fugax, what drug is given? What can a TIA be a sign of?

Answer 8

Give the patient aspirin

Can be a precursor to stroke

Question 9

How does apsirin work?

Answer 9

It works by the inhibiting the acitvation COX enzyme (cyclo-oxygenase) which is required for prostoglandin (induces fever) and thromboxane (clotting) synthesis

Question 10

The major blood supply to the eye are via branches of which artery?

Answer 10

Via branches of the ophthalmic artery which is branch of the internal carotid artery (ICA)

Question 11

What type of visual defect will this cause? What is this?

Answer 11

This is a branched retinal artery occlusion

Will most likely cause an inferior visual defect as the superior retina has the defect

Question 12

Describe the findings for central retinal vein occlusion? (fundoscopy findings as well)

Answer 12

Sudden vision loss

On examination has dilated torturous veins and retinal haemorrhages

Also has a swollen optic disc and macular swelling

Question 13

What is the treatment for central retinal vein occlusion?

Answer 13

treatment would be an anti VEGF (anti vascular endothelial growth factor)

Question 14

If patients develop complications due to development of new vessels in CRVO, what may be given to prevent vitreous haemorrhage? (can lead to glaucoma)

Answer 14

Patient may be given laser therapy to prevent vitrous haemorrhage but only if neovascularisation is present

Question 15

What are the usual causes of CRVO? (virchow’s triad)

Answer 15

Hypercoagulability

Stasis of blood

Endothelial damage

Question 16

Which aartery supplies the optic nerve head?

Answer 16

The posterior ciliary arteries

Question 17

Occlusion of the posterior ciliary arteries may lead to what?

Answer 17

This may lead to ischaemic optic neuropathy

There are two type, arteritic and non-arteric ischaemic optic neuropathy

Question 18

What is arteritic ischameic optic neuropathy caused by? What is non arteritic caused by?

Answer 18

Arteritic is caused by inflammatory processes such as Giant cell arteritis

Non- arteritic - due to astherosclerosi eg hypertension, hyperlipidaemia

Question 19

sudden, profound visual loss is present in ischaemic optic neuropathy How does the optic disc look on fundoscopy?

Answer 19

Looks swollen and pale retina

Question 20

How does giant cell arteritis present?

Answer 20

Presents with a headache and jaw claudication, scalp tenderness (when coming hair) and sudden visual loss if it affects the eye

Question 21

What is the immediate treatment for giant cell arteritis?

Answer 21

Give oral prednisolone: For people with visual symptoms — 60 mg as a one-off dose (they should be seen by an ophthalmologist the same day).

For people without visual symptoms — 40 to 60 mg daily (minimum 0.75 mg/kg).

Question 22

What is giant cell arteritis also known as and describe how the associated disease presents?

Answer 22

AKA Temporal arteritis

Presents with myalgia in the hip and shoulder girdles with accompanied morning stiffness lasting greater than 1hour - the associated condition is known as polymyalgia rheumatica

Question 23

Steroids are given in GCA before a biopsy is taken to confirm, why may a biopsy be negative? What markers may be raised in GCA?

Answer 23

may be negative due to skip lesions in GCA

ESR, PV and CRP will be raised in GCA

Question 24

In GCA, what age group is it typically seen in? What percentage of patients does it associate with polymyalgia rheumatica?

Answer 24

Typically seen in patients over 50 and seen in 50% of patients with PMR

Question 25

Why is there jaw claudication in giant cell arteritis?

Answer 25

this is because there may be inflammation of the maxillary artery meaning when chewing there is no blood supply and therefore pain

Question 26

Sudden loss of vision “Floaters” Loss of red reflex What is this likely to be?

Answer 26

Vitrous haemorrhage

Question 27

What two other pathologies is vitreous haemorrhage associated with as a cause of the new vessel formation leading to haemorrhaging?

Answer 27

Associated with central retinal vein occlusion causing ischaemia and therefore new vessels arise And associated with proliferative diabetic retinopathy where new leaky vessels arise

Question 28

What is the treatment for non resolving vitreous haemorrhge?

Answer 28

Vitrectomy

Question 29

• Painless loss of vision • Sudden onset of flashes/floaters (mechanical separation of sensory retina from retinal pigment epithelium) What is this? What is the flashes known as?

Answer 29

This is retinal detachemnt The flashes are known as photopsia

Question 30

What can often be the cause of retinal detachment?

Answer 30

Vitreous detachment bringing the retinal layer with it Retinal detachment usually requires surgical treatment

Question 31

• New blood vessels grow under retina – leakage causes build up of fluid/blood and eventually scarring • Rapid central visual loss What is this?

Answer 31

Wet age related macular degeneration

Question 32

What is the difference of the macula on fundoscopy in wet and dry age related macular degenration?

Answer 32

Wet - can see bleeding and scrring over macula in right pic Dry - can see drusen spots around the macula on left pic

Question 33

What is the distortion known as in wet- age related macular degeneration?

Answer 33

Metamorphopsia

Question 34

What is the treatment for wet ARMD?

Answer 34

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