Optic tract:

  • Macula

    • central scotoma

  • Anterior to optic chiasm

    • uniocular visual loss

  • within the optic chism

    • bitemporal hemianopia

  • posterior to optic chiasm

    • Optic tract

    • Lateral geniculate body

    • optic radiation

    • occipital cortex

      • homonymous hemianopia

        • most common cause =

          • elderly = stroke

            • CT = best investigation

retinal vein occlusion

  • branch vs. central

  • images

  • sudden loss of vision

  • scattered retinal haemorrhages and tortuous retinal veins

    • in region of occluded vein

  • associated with hypertension

  • refer within 2 weeks

  • usually has a benign course

  • improve spont. within 2 months

  • consider laser if not improved within 3mo

  • rare causes;

    • rheumatological

      • behcet’s syndrome

      • antiphospholipid syndrome

      • protein c deficiency

    • inflammatory

      • sarcoidosis

      • Wegener’s granulomatosis

  • subretinal haemorrhages

  • drusen deposits

    • tiny yellow/white accumulations of extracellular material

    • noraml >40yo to have a few drusen deposits

Central retinal artery occlusion

  • diffuse pallor

    • retinal ischaemia

  • occlusion usually related to embolus

    • carotid arteirs or from ehart valves

  • fovea appears red

    • this part of retina is thin

    • intact choroidal circulation shines through fovea

      • “cherry red spot”

  • refer within 24hours of symptoms

    • possible to prevent permanent ischaemica of retina by dislodging the embolus

    • then to stroke clinic

      • doppler

      • echocardiogram

  • GCA may also present with retinal artery occlusion

retinal artery detachemnt

  • inner sensory retina detaches from underlying pigmented epithelium

  • symptoms

    • floaters

    • flashers

    • Loss of vision

    • also shadow or curtain

  • tear or hole

    • secondary to posterior vitreous detachment or an ocular trauma

  • associated with

    • congenital malformations

    • trauma

    • vascular disease

    • choroidal tumours

    • high myopia

    • vitrous disease/degeneration

Optic nuritis

  • inflammation of optic nerve may be idiopathic

  • comonly associatedwith multiple sclerosis

    • risk of developing MS after episode of isolated optic neuritis = 30% at 5yrs

    • 15-20% with MS present with ON

    • 38-58% have ON at some point in MS course

  • refer opthalmologist within 1wk

  • intravenous steroids

    • reduce recurrence of disease

  • oral prednisolone ineffective

  • neuromyelitis optica

    • iv steroid indicated

  • impaired colour vision

    • red

  • pain on eye movement

posterior vitreous attachment

  • vitreous gel that fills middle of eye

    • contracts and separates from retina

  • liquefaction of vitrous jelly

  • normally occurs as people get older

  • floaters and flashers

  • can lead to retirnal tear

  • ?associated with loss of vision

Giant cell arteritis

  • diagnosis can be difficult

  • 28% will have skip lesions

  • American College of Rheumatology’s 1990 classification

    • =≥3 = sens 94% and 91% spec

      • >50yo

      • localised headache of new onset

      • ESR ≥ 50mm in first hour

      • tenderness in palpation over temporal artery

      • abnormal temporal artery biopsy

        • granulomatous infiltration

        • disruption of internal elastic lamina

        • proliferation of intima

        • occulsion of the lumen

  • ask about:

    • headahce

    • weight loss

    • shoulder pain

    • jaw claudicaiton

    • recent episodes of transient loss of vision

  • consider USS