Sally Webber
TRANSIENT VISUAL LOSS
 What’s the most important feature?
TRANSIENT VISUAL LOSS
 Monocular or binocular?
 Duration
 Characteristics
 Examination findings
TRANSIENT VISUAL LOSS
 Monocular or binocular?
TRANSIENT VISUAL LOSS
 Monocular or binocular?
Difficult as patients may report uniocular
symptoms for migraine
Or pati...
TRANSIENT VISUAL LOSS
 Duration?
TRANSIENT VISUAL LOSS
 Visual obscurations
 Amaurosis Fugax
 Prolonged visual loss
TRANSIENT VISUAL LOSS
 Visual obscurations:
last seconds to minutes
Causes?
TRANSIENT VISUAL LOSS
 Visual obscurations: seconds to minutes
Causes?
Lots!
VISUAL OBSCURATIONS
 Causes
Optic neuritis with Uhthoff’s phenomonen
Retinal migraine
Papilloedema
Intermittant angle...
VISUAL OBSCURATIONS
Surface problems
○ Watery, dry, sticky
Vitreous floaters
Varifocals/bifocals/contact lenses
No obv...
Diagnosis mainly needs
Careful history
and on examination?
Examination tip
 Usual ocular examination
 Including
IOP
Visual field
Careful check of the disc (dilate if possible)
TRANSIENT VISUAL LOSS
 Amaurosis Fugax
Duration?
Symptoms?
Amaurosis Fugax
Lasts one to five minutes
Amaurosis Fugax
Symptoms
○ Over 50 years
○ Complete loss all or part of Visual field
○ ‘Like a curtain’
○ Normal vision i...
Amaurosis Fugax
• Examination
• Vision, anterior segment and IOP
• Visual field
• Dilate pupils, look at disc, follow all ...
Amaurosis Fugax
Ask about risk factors?
Amaurosis Fugax
Ask about risk factors
○ Over 50 years
○ Hypertension
○ Diabetes
○ Heart trouble, heart attack, angina
○ ...
Amaurosis Fugax
Management?
Amaurosis Fugax
Management
○ Refer to GP
Ask for Assessment for STROKE RISK FACTORS or
referral to the RUH STROKE CLINIC...
PROLONGED MONOCULAR
VISUAL LOSS
 Fifteen to sixty minutes
 Causes
Hypertension and blood disorders
‘Retinal migraine’
PROLONGED VISUAL LOSS
 Fifteen to sixty minutes
 Causes
Hypertension and blood disorders
‘Retinal migraine’
○ Rare, sp...
TRANSIENT BINOCULAR VISUAL LOSS
 Migraine
 Bilateral disease, optic nerve/angle
closure
 Brain tumour or Arteriovenous
...
MIGRAINE
MIGRAINE
 Expanding
scintillating scotoma
 10-30 mins
 Scotoma
 surrounded by
Zig-zags
Flashes
Sparkles
Waves/wate...
RETINAL ARTERY OCCLUSION
Embolus causing permenant occlusion
RETINAL ARTERY OCCLUSION
Embolus causing permenant occlusion
Complete visual loss/dense scotoma
Pale retina
Embolus may be...
TREATMENT OF CENTRAL RETINAL
ARTERY OCCLUSION?
TREATMENT OF CENTRAL RETINAL
ARTERY OCCLUSION
 Waiting
 Dilation of the artery
Sub-Lingual vasodialtors
Re-breathing e...
TREATMENT OF CENTRAL RETINAL
ARTERY OCCLUSION
 Increasing arterial perfusion pressure by
reduction of intra ocular pressu...
THROMBOLISIS
 Anti-platelet therapy
 Steroids
 Reducing red blood cells rigidity
 Pentoxifylline has been tried
Transient visual loss
Careful history
Visual fields
Check the discs
Remember the stoke clinic
Thank you
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Sally Webber presentation on TIA

  1. 1. Sally Webber
  2. 2. TRANSIENT VISUAL LOSS  What’s the most important feature?
  3. 3. TRANSIENT VISUAL LOSS  Monocular or binocular?  Duration  Characteristics  Examination findings
  4. 4. TRANSIENT VISUAL LOSS  Monocular or binocular?
  5. 5. TRANSIENT VISUAL LOSS  Monocular or binocular? Difficult as patients may report uniocular symptoms for migraine Or patients may notice only the temporal side of a homonomous visual field defect
  6. 6. TRANSIENT VISUAL LOSS  Duration?
  7. 7. TRANSIENT VISUAL LOSS  Visual obscurations  Amaurosis Fugax  Prolonged visual loss
  8. 8. TRANSIENT VISUAL LOSS  Visual obscurations: last seconds to minutes Causes?
  9. 9. TRANSIENT VISUAL LOSS  Visual obscurations: seconds to minutes Causes? Lots!
  10. 10. VISUAL OBSCURATIONS  Causes Optic neuritis with Uhthoff’s phenomonen Retinal migraine Papilloedema Intermittant angle closure glaucoma Pituitary tumour
  11. 11. VISUAL OBSCURATIONS Surface problems ○ Watery, dry, sticky Vitreous floaters Varifocals/bifocals/contact lenses No obvious cause
  12. 12. Diagnosis mainly needs Careful history and on examination?
  13. 13. Examination tip  Usual ocular examination  Including IOP Visual field Careful check of the disc (dilate if possible)
  14. 14. TRANSIENT VISUAL LOSS  Amaurosis Fugax Duration? Symptoms?
  15. 15. Amaurosis Fugax Lasts one to five minutes
  16. 16. Amaurosis Fugax Symptoms ○ Over 50 years ○ Complete loss all or part of Visual field ○ ‘Like a curtain’ ○ Normal vision in other eye ○ No systemic/neurological symptoms
  17. 17. Amaurosis Fugax • Examination • Vision, anterior segment and IOP • Visual field • Dilate pupils, look at disc, follow all retinal arterioles to look for emboli
  18. 18. Amaurosis Fugax Ask about risk factors?
  19. 19. Amaurosis Fugax Ask about risk factors ○ Over 50 years ○ Hypertension ○ Diabetes ○ Heart trouble, heart attack, angina ○ Stroke, TIA
  20. 20. Amaurosis Fugax Management?
  21. 21. Amaurosis Fugax Management ○ Refer to GP Ask for Assessment for STROKE RISK FACTORS or referral to the RUH STROKE CLINIC ○ Refer to Eye department to confirm diagnosis
  22. 22. PROLONGED MONOCULAR VISUAL LOSS  Fifteen to sixty minutes  Causes Hypertension and blood disorders ‘Retinal migraine’
  23. 23. PROLONGED VISUAL LOSS  Fifteen to sixty minutes  Causes Hypertension and blood disorders ‘Retinal migraine’ ○ Rare, spasm of choroidal circulation ○ Young adults ○ Patchy/fading visual loss in one eye ○ No positive visual phenomena ○ No other neuro symptoms/signs
  24. 24. TRANSIENT BINOCULAR VISUAL LOSS  Migraine  Bilateral disease, optic nerve/angle closure  Brain tumour or Arteriovenous malfomation  Vertibrobasilar TIA or insufficency
  25. 25. MIGRAINE
  26. 26. MIGRAINE  Expanding scintillating scotoma  10-30 mins  Scotoma  surrounded by Zig-zags Flashes Sparkles Waves/watery NORMAL EXAMINATION
  27. 27. RETINAL ARTERY OCCLUSION Embolus causing permenant occlusion
  28. 28. RETINAL ARTERY OCCLUSION Embolus causing permenant occlusion Complete visual loss/dense scotoma Pale retina Embolus may be visible Cherry red spot
  29. 29. TREATMENT OF CENTRAL RETINAL ARTERY OCCLUSION?
  30. 30. TREATMENT OF CENTRAL RETINAL ARTERY OCCLUSION  Waiting  Dilation of the artery Sub-Lingual vasodialtors Re-breathing expired carbon dioxide  Removal of physical obstruction Eye massage
  31. 31. TREATMENT OF CENTRAL RETINAL ARTERY OCCLUSION  Increasing arterial perfusion pressure by reduction of intra ocular pressure Anterior chamber paracentesis Intravenous Diamox Intravenous Maritol
  32. 32. THROMBOLISIS  Anti-platelet therapy  Steroids  Reducing red blood cells rigidity  Pentoxifylline has been tried
  33. 33. Transient visual loss Careful history Visual fields Check the discs Remember the stoke clinic
  34. 34. Thank you
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