Evaluation of vision loss

Question 1

Loss of vision?

Answer 1

Loss of central vision or loss of part of the visual field

Question 2

When does loss of vision occur?

Answer 2

When there is pathology along the visual pathway

Question 3

A scotoma (blind spot) is one eye is associated with?

Answer 3

A retinal or optic nerve lesion in that eye

Question 4

Where do optic nerve disease typically cause scotomas?

Answer 4

Centrally

Question 5

Chiasmal compression causes?

Answer 5

Bitemporal visual field defect

Question 6

Damage to the visual pathways behind the chiasm produce?

Answer 6

homonymous hemianopsi (defect affects the same side of the patient’s visual field in both eyes)

Question 7

If a patient has a congruous homonymous hemianopsia, where is the lesion?

Answer 7

Occipital Cortex, more congruous the closer to the Occipital cortex

Question 8

Characteristics of optic neuritis?

Answer 8

Occurs in young or middle age adults
Sudden loss of vision in one eye
May have pain on motion of eye
Afferent pupillary defect present
Central visual field defect
Color desaturation in affected eye (mostly red)
Disc normal or swollen

Question 9

What does the optic disc look like in retrobulbar optic neuritis?

Answer 9

Normal

Question 10

What does the optic disc look like in papillitis?

Answer 10

Swollen

Question 11

How does vision loss proceed in optic neuritis?

Answer 11

over 10-14 days

Question 12

Improvement of vision in optic neuritis occurs over what time period?

Answer 12

3 or more weeks

Question 13

Optic neuritis is associated with what?

Answer 13

Multiple sclerosis

Question 14

Most common cause of compression of optic chiasm?

Answer 14

Pituitary adenoma

Question 15

What is papilledema?

Answer 15

Bilateral swelling of the optic discs secondary to increased intracranial pressure

Question 16

What does papilledema indicate?

Answer 16

SERIOUS Neurological problem

Question 17

Most common causes of papilledema?

Answer 17

Brain tumor

Pseudotumor cerebri

Question 18

Characteristics of papilledema?

Answer 18

Visual acuity normal
Visual field full with enlarged blind spot
No pain on eye movement
No afferent pupillary defect
HA, nausea, and vomiting common
\+/- CN VI nerve palsy

Question 19

Signs of papilledema?

Answer 19

Both discs elevated and hyperemic
Disc margins blurred, indistinct
Small vessels at margin obscured
Retinal vessels tortuous, dilated
Hemorrhages and exudates
Spontaneous venous pulsations ABSENT

Question 20

Characteristics of ischemic optic neuropathy?

Answer 20

Acute loss of vision in older patient
Usually only one eye
Afferent pupil defect present
Disc is swollen and PALE
Ischemia of disc (small artery occlusion)
Altitudinal hemianopsia common
Must R/O temporal arteritis

Question 21

Characteristics of optic atrophy?

Answer 21

Suggested by pale color of disc
Usually poor vision and visual field defect
May be caused by lesion in retina, optic nerve, chiasm, or optic tract
Multiple causes

Question 22

Characteristics of chronic open angle glaucoma?

Answer 22

Ocular disease usually associated with increased intraocular pressure
Optic nerve is damaged
Enlargement of optic cup and eventual pallor (atrophy)
Early visual field loss (asymptomatic)
Loss of central vision (LATE)