Causes

  1. Retinal detachment
  2. Vitreous haemorrhage
  3. Retinal vein occlusion
  4. Retinal artery occlusion
  5. Wet age related macular degeneration
  6. Anterior ischemic optic neuropathy
  7. Optic neuritis
  8. Cerebrovascular accident

Retinal detachment

  • sudden painless loss of vision
  • preceded by flashing lights (photopia), floaters, visual field defects
  • macula involved = Central vision loss
  • macula NOT involved = peripheral field loss and visual acuity maybe normal
  • Relative Afferent Pupillary Defect – (affected eye pupil dilates in response to light)

Ophthalmoscope examination

  • abnormal red reflex
  • detached retina –grey and wrinkled
  • normal examination does not exclude diagnosis

Management

  • laser to retinal hole/ retinal surgery +/- vitrectomy

Vitreous haemorrhage

  • sudden painless loss of vision (extent of loss depends on degree of haemorrhage)
    • large haemorrhage = TOTAL visual loss
    • small haemorrhage = presents as floaters and normal/slight reduced visual acuity
  • sudden appearance of black spots/ cobwebs/ haze in vision

Ophthalmoscope examination

  • decreased red reflex
  • RBC in anterior vitreous

Causes

Management

  • Refer to ophthalmologist and determine cause
  • Mange complications – e.g. glaucoma due to RBC occluding trabecular meshwork

Vascular occlusion

Central Vein Occlusion

  • sudden painless loss of vision
  • if severe = RAPD

Ophthalmoscope examination

  • hyperaemic retina with engorged vines
  • multiple haemorrhages
  • cotton wool spots
  • ‘stormy sunset’

Causes

Management

Central retinal artery occlusion

  • sudden painless loss of vision à Unilateral
  • RAPD
  • Visual acuity markedly reduced

Ophthalmoscope examination

  • Pale retina with cherry red spot (macula is spared as receives branches from posterior ciliary artery)

Cause

  • very high intraocular pressure
  • Arterial embolus from diseased carotid, valvular heart disease, AF
  • Temporal Arteritis à high  ESR!
  • Vasculitis (polyarteritis nodosa)
  • Artherosclerotic process (diabetes, HT)

Management

  • Check – BP, Pulse – AF?, Carotids – bruits? , Heart – murmur?

Wet Age-related macular degeneration

  • occurs in the elderly
  • sudden distortion à straight lines seem curved and central blank patch of vision or,
  • sudden blurring of vision
  • decrease visual acuity with CENTRAL SCOTOMA

Ophthalmoscope examination

  • drusen
  • subretinal haemorrhages
  • hard exudates
  • macular oedema
  • All occur at macula as new abnormal vessels under it leak fluid and bleed.

Acute optic neuropathy

  • rapid progressive loss of vision
  • maybe decreased colour vision
  • decreased visual acuity
  • RAPD
  • symptoms of underlying disease (MS, nerve ischemia, artherosclerosis)

Ophthalmoscope examination

  • normal/ swollen optic disc

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