Ophthalmology KFP 2.4 – Peter has painless unilateral vision loss

by | Jan 20, 2018

Peter 35 presents to your practice with sudden onset visual change in his right eye only. He described a sudden onset flashes in this eye and the appearance of a “curtain descending” in that eye. He has a history of poorly controlled diabetes adnd family history of myopia. Fundoscopy looks as below.

What are the most likely differentials on the basis of the symptoms described?

  1. Retinal detachment
  2. Posterior vitreous detachment
  3. Vitreous Haemorrhage

What are the differentials of floaters?

  1. Vitreous syneresis
  2. Vitreous haemorrhage
  3. Posterior vitreous detachment
  4. Retinal detachment
  5. Vitritis
  6. Tear film debris

What are the differentials of flashes, of ophthalmic origin?

  1. Posterior vitreous detachment
  2. Retinal tear/hole
  3. Retinal detachment
  4. Optic neuritis

What are the differentials of flashes, of non-ophthalmic origin?

  1. Migraine
  2. Postural hypotension
  3. Occipital tumours
  4. Vertebrobasilar transient ischaemic attacks

What are the features on history of retinal detachment?

  1. Sudden onset of floaters or flashes or black spots
  2. Blurred vision in one eye becoming worse
  3. Curtain came down over the eye
  4. Partial or total loss of visual field
  5. VA can be preserved if macula not affected

What are the 3 categories of retinal detachment?

  1. Rhegmatogenous
  2. Tractional
  3. Exudative

What are the associations of Rhegmatogenous Retinal Detachment

  1. Age
  2. Myopia
  3. Cataract surgery
  4. Trauma
  5. Degenerative retinal lesions
  6. Marfan’s syndrome

What are the associations of Tractional Retinal Detachment?

  1. Proliferative diabetic retinopathy
  2. Proliferative vitreoretinopathy
  3. Retinopathy of prematurity
  4. Penetrating eye injury
  5. Sickle cell retinopathy
  6. Retinal vein occlusion

What are the risk factors for developing retinal detachment?

Advancing age
Myopia (near sightedness)
Trauma
Cataract surgery
Previous retinal detachment surgery
HIV retinopathy
Smoking
Thin retina
Choroid tumours
Diabetic retinopathy

What are the Key features on examination of retinal detachment?

Fundoscopy shows detached retinal fold
Large grey shadow in vitreous cavity
Visual field loss
Visual acuity loss

What are the most important initial investigations?

  1. Ocular USS
  2. Orbital CT
  3. Orbital MRI

What is the most important initial step in management of this condition?

  1. Referral to ophthalmologist

[wpforms id=”7496″ title=”false” description=”false”]