 70yo woman presents with sudden onset loss of vision in her right eye half hour ago  No improvement since  No previous ophthalmic history  What are your DDx?

 Retinal vessels  Central/ branch retinal artery occlusion  Central/ branch retinal vein occlusion  Vitreous  Vitreous haemorrhage (diabetic complications)  Retinal detachment  Macula  ARMD – ‘wet’ ARMD  Optic nerve  Anterior ischemic optic neuropathy: arteritic, non-artertic  Optic neuritis  Cerebral cortex  Stroke: homonymous hemianopia  Transient vision loss – amaurosis fugax

What else would you like to know about the patient?

 Hx  Sudden onset while she was gardening  Painless, no associated redness  Hx of transient blurring of vision 2 weeks ago but recovered  Medhx – IHD, diabetes (on meds)  Ex  Visual acuity <6/60 right eye, 6/9 left eye  RAPD  Fundus exam

 Pale oedematous retina  Thin attenuated vessels  Cherry red spot  Embolus may be seen  Optic disc not pale or swollen After 6 weeks:  Cherry red spot recedes  Optic disc pallor becomes evident

 Ix  CDV RFs – lipids, fasting BSL  ESR, CRP (r/o GCA)  Carotid US  Echocardiogram  ± Thrombophilia screen  Mx  Urgent referral to ophthal  Ocular massage  Lower IOP (diamox 500mg stat ± ant chamber paracentesis)  Long term aspirin?

 Similar hx  65 yo p/w sudden and painless loss of vision in left eye  Hx of DM and HTN  Similar ex  6/60 left eye, 6/9 right eye  RAPD  Fundus exam

 Intraretinal flame-shaped haemorrhages (visible in all four quadrants)  Optic disc swelling  Dilated, tortuous veins  Cotton wool spots

 Mx  Check BP  Screen for diabetes, hyperlipidemia  Thrombophilic screen in younger pts  2 major complications  Macular edema  Neovascularisation of iris and retina

 Hx  70yo lady p/w sudden onset loss of vision in her right eye  Generalised muscle pain and weakness (but untreated for past 8 months)  Been feeling poor for the past 4 weeks with a flu and fever that she hasn’t been able to shake  Moderate severe headaches during the time  Unable to chew food properly because ‘it hurts’, lost 5kgs  Pmedhx: T2DM, smoker  Visual acuity  Hand movements in right eye, 6/6 left eye  RAPD in right eye

 Fundoscopy  Pale, swollen optic disc  Some haemorrhages, cotton wool spots  Mx  ESR (urgent!), CRP, plt count  Temporal artery biopsy  High dose systemic steroids (but always check for RFs that may C/I or complicate Rx with steroids)

 Hx  69yo man who p/w painless loss of vision  Recent hx of increased number of visual floaters and flashes  “Dark shadow” in the visual field of left eye  High myopia since 15yo, T2DM  Ex  Loss of red reflex  RAPD

 Separation of sensory retina from the retinal pigment epithelium  Risk factors  High myopes  Ocular trauma  DM  Previous eye surgery eg cataract removal  Visual acuity will be affected only if central macula is affected  Examination  Abnormal red reflex  RAPD  ‘Tobacco dust’  Detached retina (grey area)  Urgent opinion from ophthalmologist- surgery?

Questions?