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Questions Answered: 300

Final Score 76%

229
71

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Ophthalmology

Question 208 of 300

A 49 year old woman presents to the Emergency Department complaining of sudden onset floaters and dark streaks in her vision. She has a past medical history of insulin dependant diabetes. On slit lamp examination you are able to see red blood cells in the anterior chamber. What is the most likely diagnosis?

Answer:

Clinical features of vitreous haemorrhage:
  • Early/mild haemorrhage
    • New floaters
  • Moderate haemorrhage
    • Dark streaks
  • Dense haemorrhage
    • Fall in visual acuity

Vitreous Haemorrhage

Ophthalmology

Last Updated: 12th February 2021

Vitreous haemorrhage is the extravasation of blood into one of the several potential spaces formed within and around the vitreous body.

Causes

  • Abnormal vessels
    • Diabetic retinopathy
    • Neovascularisation from branch or central retinal vein occlusion
    • Sickle cell retinopathy
  • Rupture of normal vessels
    • Retinal tear or detachment
    • Posterior vitreous detachment
    • Trauma
  • Blood from adjacent source
    • Macroaneurysm
    • Age-related macular degeneration

Clinical features

  • Early/mild haemorrhage
    • New floaters
  • Moderate haemorrhage
    • Dark streaks
  • Dense haemorrhage
    • Fall in visual acuity

Management

  • Urgent referral to ophthalmology
  • Treatment is directed at the underlying cause

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l
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