List ten causes of sudden visual loss
- Acute closed angle gluacoma
- Retinal Detachment
- Wet macular degeneration
- Temporal arteritis
- Vitreous Haemmorhage
- Central Retinal Artery Occlusion
- Central Retinal Vein Occlusion
- Optic neuritis
- Amourosis Fugax
- Ischaemic optic neuropathy
List four causes of gradual visual loss
- Cataracts
- Open angle gluacoma
- Dry macular degeneration
- Diabetic Retinopathy
List six causes of cataracts
- Age
- Congenital
- Traumatic
- Metabolic (diabetic)
- Drug induced
- Intrauterine infection (rubella, CMV, toxoplasmosis)
List three types of cataracts
- Nuclear sclerotic
- Cortical
- Posterior subcapsular
What are the important things to ask about a patient presenting with visual loss?
- Sudden/Gradual
- Painful/Painless
- Extent (Total/Partial)
- Associated symptoms
- Past ocular history -myopia etc
- Past medical history - diabetes/hypertension
What is the treatment for cataracts in the developed world?
Phaco - emulsification with intra ocular lens implantation
What is dry ARMD?
Wear and tear of the retinal pigment epithelium
In what type of visual loss do you see drusen on opthalmoscopy?
Dry macular degeneration
What is wet ARMD?
The eye grows new blood vessels within the macula to repair dry ARMD damage. The vessels then leak fluid or bleed into the retinal tissue causing a sudden devastating drop in central vision with associated metamorphopsia
What investigation would you do for wet armd?
Ocular coherance tomography
What treatment could you give for wet armd?
Anti VEGf injections
Monoclonal antibodies that inhibit the growth of abnormal blood vessels
Sudden, profound visual loss (<6/60)
Relative afferent pupillary defect (RAPD)
Pale swollen retina with cherry red spot at macula
Central retinal artery occlusion
What is the treatment for a CRAO?
Treatment is only effective if patient seen within 24 hrs. Occular massage Paper bag breathing IV Diamox Anterior chamber paracentesis
Moderate to severe visual loss RAPD Retinal flame haemorrhages (stormy sunset) Tortuous vessels Swollen disc Cotton wool spots
Central retinal vein occlusion
Persisting flashing lights
Burst of new floaters
Dark shadow in peripheral vision, increasing in size
Retinal detachment
Who is more likely to get a retinal detachment?
Myopics (short sighted)
If you fins a retinal tear what treatment can be given to reduce the chance of detachment?
Laser
What are the options for treatment of a retinal detachment?
Scleral buckle
Vitrectomy/Laser therapy/Gas bubble
Variable loss of vision, usually over few days
Washed out colours
Dull ache on eye movements
Optic neuritis
What is the most common cause of optic neuritis?
Demyelination..MS
