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Download - Acute and Chronic visual loss (1 hour) DR. SHEHAH
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Acute and Chronic visual loss By Dr. ABDULMAJID ALSHEHAH Ophthalmology consultant Anterior Segment and Uveitis consultant DDx of acute vision loss Painful (usually) • Corneal Abrasion • Corneal ulcer • acute angle closure glaucoma • Acute uveitis (sometimes painless) • Endophthalmitis Painless (usually) • • • • • • hyphema Vitreous hemorrhage. Retinal Artery Occlusion Retinal Vein Occlusion Retinal Detachment Optic Neuritis (can be associated with ocular pain on eye movement) Acute visual loss • In medicine, an acute disease is a disease with a rapid onset and/or a short course. • minutes up to few weeks History taking for a patient with loss of vision • • • • • For how long? One or both eyes History of eye trauma History of eye surgery Associated symptoms (pain). • Medical illnesses (DM) Examining a patient with loss of vision • VA • Confrontation VF testing • Pupillary reactions • Ophthalmoscopy (red reflex+fundus). • Penlight exam. • Tonometry. corneal epithelial defect (CED) or corneal abrasion Corneal ulcer or microbial keratitis • History of (trauma, CL wear) • Need urgent referral to ophthalmologist • Need samples for microbiology • Might need hospitalization • Treated with frequent application of topical broad spectrum antibiotics. • If neglected can lead to corneal perforation and endophthalmitis acute angle closure glaucoma • C/O acute vision loss, pain, headache, vomiting • • • • • Corneal edema Mid-dilated non-reactive pupil Ciliary injection High IOP (around 50s) Optic disc swelling • Systemic IOP lowering medications • YAG laser peripheral iridotomy ASAP Acute uveitis • Most commonly idiopathic • • can be associated with pain and high IOP Characterized by: ciliary injection, keratic precipitates (KPs), iris nodules, synechia, vitritis, vasculitis, chorioretinitis and/or papillitis. • Any type of uveitis (anterior, intermediate and posterior) can cause acute loss of vision but usually posterior (toxoplasmosis retinitis) • • Rule out infection and malignancy Treatment is usually with Local or systemic immunosuppression Endophthalmitis • Painful loss of vision • Usually Recent intraocular surgery. • Usually unilateral (except septicemia) • Need urgent referral to ophthalmologist. • Need vitreous samples for microbiology • Need intravitreal antibiotic injections • Might need retina surgery. Hyphema • History of trauma (usually) • Medical illness (DM, HTN) • Painless loss of vision • Rubiosis (NVI) due to CRVO or PDR • High IOP • Treat the cause • Steroids and cycloplegic topical drops. • Might need surgery (AC washout) Vitreous hemorrhage • History of trauma • Medical illness (DM, HTN) • Painless loss of vision • Rubiosis (NVI) due to CRVO or PDR • Retinal Hrg, NVD, NVE • Treat the cause • Might need surgery (PPV) Retinal Artery Occlusion • BRAO • CRAO Retinal Vein Occlusion • BRVO • CRVO Retinal Detachment • Typical black curtain complaint Optic Neuritis • RAPD • Color vision • VF Chronic visual loss Chronic visual loss • DDX 1- amblyopia 2- corneal opacities 3- cataract 4- glaucoma 5- retinal vascular diseases 6- macular degeneration (rare in KSA) 7- chronic uveitis 8- neglected or persistent cause of acute visual loss Corneal opacities • Corneal scars (Trachoma, old trauma, old infection, advanced keratoconus) • Corneal dystrophies (macular stromal corneal dystrophy, congenital hereditary corneal dystrophy CHED, Fuchs corneal dystrophy) • Corneal degenerations (band keratopathy, CDK) Treatment of corneal opacities • Refraction • Laser (if superficial opacity) • Corneal transplant Qustions
