Transcript - Acute and Chronic visual loss (1 hour) DR. SHEHAH

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)
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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
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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
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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
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Most commonly idiopathic
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can be associated with pain and high IOP
Characterized by: ciliary injection, keratic
precipitates (KPs), iris nodules, synechia, vitritis,
vasculitis, chorioretinitis and/or papillitis.
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Any type of uveitis (anterior, intermediate and
posterior) can cause acute loss of vision but
usually posterior (toxoplasmosis retinitis)
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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