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Ophthalmology > Visual loss > Flashcards

Visual loss Flashcards

1
Q

What are the causes of sudden visual loss?

A 
Vascular (central retinal artery/ vein occlusion) 
Vitreous haemorrhage
Retinal detachment
ARMD - wet 
Closed angle glaucoma
Optic neuritis
Stroke
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2
Q

What is the arterial supply to the eye?

A

All arises from the ophthalmic artery
Posterior ciliary artery supplies the optic nerve head
Central retinal artery supplies the retina

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3
Q

What are the symptoms of central retinal artery occlusion (CRAO)?

A

Sudden visual loss

Painless

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4
Q

What are the signs of CRAO?

A

RAPD
Pale, edematous retina
Thread like retinal vessels
Cannot see top letter on snellen chart

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5
Q

What are the common causes for CRAO?

A

Carotid artery disease

Emboli from heart due to vegetations on heart valve

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6
Q

What will branch retinal artery occlusion cause?

A

A section of the retina will be pale and ischaemic

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7
Q

What are the symptoms of amaurosis fugax?

A

Transient painless visual loss
“Like a curtain coming down”
Lasts 5 mons

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8
Q

What should be done if someone presents with a history of amaurosis fugax?

A

Urgent referral to stroke clinic as it can be a pre-warning to a stroke

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9
Q

What is central retinal vein occlusion (CRVO) associated with?

A

Endothelial damage e.g. diabetes
Abnormal blood flow e.g. hypertension
Hypercoagulable state e.g. cancer

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10
Q

What are the symptoms of CRVO?

A

Sudden visual loss if there is ischaemia

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11
Q

What are the signs of CRVO?

A

Retinal haemorrhages
Dilated tortuous vessel
Disc swelling and macular swelling
Cotton wool spots (small infarcts of the nerve fiber layer)

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12
Q

What can cause ischaemic optic neuropathy?

A

Occluded posterior ciliary artery

Giant cell arteritis

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13
Q

What causes ION in GCA?

A

Posterior ciliary arteries become inflamed with multinucleated giant cells causing a gross thickening of artery wall resulting in visual loss due to ischaemia of the optic nerve head

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14
Q

What are the symptoms of ION?

A

Sudden severe visual loss

Irreversible blindness

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15
Q

What is the sign of ION?

A

Swollen optic nerve

Pale disc

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16
Q

What are the symptoms of GCA?

A 
Temporal headache
Jaw claudication 
Scalp tenderness
Amaurosis fugax
Malaise
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17
Q

What is vitreous haemorrhage?

A

Bleeding from abnormal neovascularization bleeds into vitreous causing floaters

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18
Q

When will neovascularization occur in the retina?

A

Retinal ischaemia in diabetes or retinal vein occlusion sends out VEGF resulting in abnormal, fragile blood vessels to form which are susceptible to bleeding

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19
Q

What are the symptoms of vitreous haemorrhage?

A

Loss of vision

Floaters

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20
Q

What are the signs of vitreous haemorrhage?

A

Loss of red reflex

Haemorrhage on fundoscopy

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21
Q

What are the symptoms of retinal detachment?

A

Painless loss of vision

Sudden onset of flashes/ floaters

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22
Q

What are the signs of retinal detachment?

A

RAPD

Tear on ophthalmoscopy

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23
Q

What is wet ARMD?

A

New blood vessels grow under the retina resulting in leakage causing a build up of fluid/ blood and eventual scarring

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24
Q

What are the symptoms of wet ARMD?

A

Rapid central vision loss

Distortion (metamorphopsia)

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25
Q

What are the signs of wet ARMD?

A

Pale macula
Exudates at the periphery of macula
Small haemorrhages

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26
Q

What is glaucoma?

A

Progressive optic neuropathy mostly due to high IOP
2 different types
End result is optic nerve damage and visual loss

27
Q

What causes closed angle glaucoma?

A

Aqueous humour has increased resistance through iridocorneal angle which results in an increase pressure pusing iris forward obstructing the trabecular meshwork

28
Q

What are the symptoms of acute closed angle glaucoma?

A 
Painful
Red eye
Sudden visual loss
Headache
Nausea and vomiting
29
Q

What are the signs of acute closed angle glaucoma?

A

Red eye
Cloudy cornea
Dilated pupil

30
Q

When will gradual visual loss present early and late?

A

Presents early if reduction in visual acuity

Presents late if decreased visual field

31
Q

What are the causes of gradual visual loss?

A 
Cataract
ARMD - dry 
Refractive error
Glaucoma
Diabetic retinopathy
32
Q

What is cataracts?

A

Cloudiness of the lens - abnormal changes in lens proteins (crystalline) results in their chemical and structure alteration, leading to loss of transparency

33
Q

What can cause cataracts?

A 
Age related
Congenital (intrauterine infection) 
Traumatic
Metabolic (diabetes)
Drug-induced (steroids)
34
Q

What are the different types of cataract?

A

Nuclear
Posterior subcapsular
Christmas tree
Congenital

35
Q

What are the symptoms of cataracts?

A

Gradual decline in vision (hazy/blurred) that cannot be fixed with glasses
Glare

36
Q

What is the management of cataracts?

A

Surgical removal with intraocular lens implant if symptomatic

37
Q

What causes dry ARMD?

A

Build up of drusen under the retina which will stop nutrients from diffusing from the choroid to the retina
The retina will become atrophic and thin

38
Q

What are the symptoms of dry ARMD?

A

Gradual decline in vision

Central vision missing - scotoma

39
Q

What are the signs of dry ARMD?

A

Drusen - waste products below the RPE

Atrophic patches of retina - scotoma

40
Q

What is myopia?

A

Short sighted

41
Q

What is hypermetropia?

A

Long sighted

42
Q

What is astigmatism?

A

Irregular corneal curvature

43
Q

What is presbyopia?

A

Loss of accommodation with aging (pupil dilation, medial convergence and parasympathetic fattening of lens)

44
Q

What are the symptoms of open angle glaucoma?

A

NONE

Optician may discover

45
Q

What are the signs of open angle glaucoma?

A

Cupped disc
Visual field defect
May/ may not have high IOP

46
Q

What is a swollen disc?

A

Any disc swelling secondary to any cause

47
Q

What is papilloedema?

A

Swollen optic disc secondary to raised ICP

48
Q

What is the golden rule with bilateral optic disc swelling?

A

All patients with bilateral optic disc swelling should be suspected of having raised ICP due to SOL until proven otherwise
RAISED ICP IS A MEDICAL EMERGENCY

49
Q

What is included in the optic nerve examination?

A 
Ophthalmoscopy
Visual acuity - snellen chart 
Pupil exam  - direct, consensual and RAPD 
Visual field assessment
Colour vision - ishihara test
50
Q

Where is the CSF fluid in papilloedema?

A

Subarachnoid space of the meninges

51
Q

What are the three components of ICP?

A

Brain 80%
Blood 10%
CSF 10%

52
Q

What is the monro-kellie hypothesis?

A

An increase in one variable of ICP will result in a decrease of one/both other variables as the cranium is rigid and cannot expand

53
Q

What will occur with an increase in CSF fluid?

A

Blood vessels compressed causing global brain ischaemia

Swelling with herniation through foramen magnum, brainstem compression and death

54
Q

CASE:
70yr old male, blurred vision, headaches, VA 6/6 R and L
Bilateral swollen discs

A

Meningioma

55
Q 
CASE: 
55yr old
Smoker 
Obese
C/o blurred vision for 1 week
Bilateral grossly swollen discs
A

ALWAYS CHECK BP
He has a BP of 240/140 mmHg
Malignant hypertension

56
Q

What are the functions of CSF?

A 
Maintains stable extracellular environment for the brain
Buoyancy
Mechanical protection
Waste removal
Nutrition
57
Q

What can cause a rise in ICP?

A

Obstruction to CSF circulation
Overproduction of CSF
Inadequate absorption

58
Q 
CASE: 
25 y/o female
6 mnth headaches
BMI 40
VA 6/6 R&L
Bilateral disc swelling
Normal BP 
Normal head MRI
A

Lumbar puncture showed raised CSF opening pressure

Idiopathic intracranial hypertension

59
Q

What causes idiopathic intracranial hypertension?

A

Stenosis of transverse cerebral sinuses
Increased abdo pressure, increased cardiac pressure resulting in obstructed venous return from cranium
Microemboli in sagittal sinus

60
Q

What happens if the disc swelling becomes chronic?

A

Atrophic and pale disc
Loss of visual function
Blindness

61
Q

What are the causes of RAPD?

A 
Optic neuritis
Ischaemic optic disease 
Severe glaucoma resulting in trauma to the optic nerve
Direct optic nerve damage
Retinal detachment 
Severe macular degeneration 
Retinal infection
62
Q

Symptoms of horners sydrome

A

Ptosis - loss of innervation to superior tarsal muscle
Miosis - loss of symp output to ciliary muscles
Anhidrosis

63
Q

What can cause horner’s syndrome?

A

Carotid artery dissection
Pancoast tumour
Brachial plexus injury
Cavernous sinus thrombosis

Ophthalmology (14 decks)

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