wikidoc - User contributions [en]

Gynecomastia causes

2016-02-09T19:32:12Z

Jyostna Chouturi: /* Causes by Organ System */

__NOTOC__
{{Gynecomastia}}
{{CMG}}

==Overview==
===Causes by Organ System===

{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Alcohol]], [[Anabolic]], [[Bicalutamide]], [[Chemotherapeutic]], [[Chlorpromazine]], [[Cimetidine]], [[Clomiphene]], [[Diazepam]], [[Digoxin]], [[Efavirenz]], [[Estrogen]]s, [[Etravirine]], [[Etomidate]], [[Febuxostat]], [[Finasteride]], [[Fluoxymesterone]], [[Haloperidol]], [[Heroin]], [[Histrelin]], [[Human chorionic gonadotropin]] ([[HCG]]), [[Iloperidone]], [[Isoniazid]], [[Ketoconazole]], [[Leuprolide]], [[Loxapine]], [[Marijuana]], [[Megestrol]], [[Methadone]], [[Methyldopa]], [[Metoclopramide]], [[Metronidazole]], [[Mitotane]], [[Nifedipine]], [[Nizatidine]], [[Oxandrolone]], [[Olanzapine]], [[Omeprazole]], [[Oxymetholone]], [[Penicillamine]], [[Phenothiazine]], [[Pramipexole]], [[Sertraline]], [[Sorafenib]], [[Spironolactone]], [[Steroid]], [[Tamoxifen]], [[Tiagabine]], [[Tricyclic antidepressants]], [[Trifluoperazine]], [[Verapamil]], [[Melatonin]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

==Causes==
In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>

* [[Acromegaly]]
* [[Adrenal Cancer]]
* [[Androgen-insensitivity Syndrome]]
* [[Breast Cancer]]
* [[Carcinoid]]
* [[Chromophobe adenoma]]
* [[Chronic Liver Disease]]
* [[Chronic Renal Insufficiency|Chronic renal insufficiency]]
* [[Cirrhosis]]
* [[Congenital anorchia]]
* [[Extragonadal germ cell tumors]]
* Familial gynecomastia
* [[Five alpha-reductase deficiency Syndrome]]
* [[Hemochromatosis]]
* [[Hepatitis]]
* [[Hepatocellular carcinoma]]
* [[Hypogonadism]]
* [[Hypopituitarism]]
* [[Hypothyroidism]]
* Idiopathic
* [[Kallman Syndrome]]
* [[Kidney Carcinoma]]
* [[Klinefelter Syndrome]]
* [[Liver cancer]]
* Local irradiation
* [[Lung cancer]]
* Medications/drugs:
*:* [[Alcohol]]
*:* [[Anabolic]]
*:* [[Bicalutamide]]
*:* [[Chemotherapeutic]]s
*:* [[Chlorpromazine]]
*:* [[Cimetidine]]
*:* [[Clomiphene]]
*:* [[Diazepam]]
*:* [[Digoxin]]
*:* [[Efavirenz]]
*:* [[Estrogen]]s
*:* [[Etravirine]]
*:* [[Etomidate]]
*:* [[Febuxostat]]
*:* [[Finasteride]]
*:* [[Fluoxymesterone]],
*:* [[Haloperidol]]
*:* [[Heroin]]
*:* [[Histrelin]]
*:* [[Human chorionic gonadotropin]] ([[HCG]])
*:* [[Iloperidone]]
*:* [[Isoniazid]]
*:* [[Ketoconazole]]
*:* [[Leuprolide]]
*:* [[Loxapine]]
*:* [[Marijuana]]
*:* [[Megestrol]]
*:* [[Methadone]]
*:* [[Methyldopa]]
*:* [[Metoclopramide]]
*:* [[Metronidazole]]
*:* [[Mitotane]]
*:* [[Nifedipine]]
*:* [[Nizatidine]]
*:* [[Oxandrolone]]
*:* [[Olanzapine]]
*:* [[Omeprazole]]
*:*[[Oxymetholone]]
*:* [[Penicillamine]]
*:* [[Phenothiazine]]
*:* [[Pramipexole]]
*:* [[Sertraline]]
*:*[[Sorafenib]]
*:* [[Spironolactone]]
*:* [[Steroid]]s
*:* [[Tamoxifen]]
*:*[[Tiagabine]]
*:* [[Tricyclic antidepressants]]
*:* [[Trifluoperazine]]
*:* [[Verapamil]]
*:* [[Melatonin]]
* Persistent postpubertal/elderly gynecomastia
* Physiologic gynecomastia of puberty
* Re-feeding after starvation
* [[Stomach cancer]]
* [[Testicular cancer]]
* Testicular trauma
* [[Thyroid Disease]]
* [[Torsion of testes]]
* Viral [[orchitis]]

According to underlying pathophysiology, the causes of gynecomastia are:
=== Decreased Testosterone ===
* [[Androgen-insensitivity syndrome]]
* [[Congenital anorchia]]
* [[Five alpha-reductase deficiency]]
* [[Hypopituitarism]]
* [[Kallman Syndrome]]
* [[Klinefelter Syndrome]]
* [[Renal Failure]]
* Testicular trauma
* Torsion of the testes
* Viral [[orchitis]]

=== Increased Estrogens ===
* [[Adrenal cancer]]
* Chronic liver disease
* [[Extragonadal germ cell tumors]]
* Familial gynecomastia
* [[Hyperthyroidism]]
* [[Kidney carcinoma]]
* [[Liver cancer]]
* [[Lung carcinoma]]
* Malnutrition
* Other gastrointestinal (GI) tract carcinoma
* [[Stomach cancer]]
* [[Testicular cancer]]

===Physiologic causes===
* Benign gynecomastia of adolescence
* Drugs
* Familial gynecomastia
* Gynecomastia in the newborn
* Gynecomastia of aging

===References===
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category:Endocrinology]]

Gynecomastia causes

2016-02-09T19:29:26Z

Jyostna Chouturi: /* Causes by Organ System */

__NOTOC__
{{Gynecomastia}}
{{CMG}}

==Overview==
===Causes by Organ System===

{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Alcoh]], [[Anabolic]], [[Bicalutamide]], [[Chemotherapeutic]], [[Chlorpromazine]], [[Cimetidine]], [[Clomiphene]], [[Diazepam]], [[Digoxin]], [[Efavirenz]], [[Estrogen]]s, [[Etravirine]], [[Etomidate]], [[Febuxostat]], [[Finasteride]], [[Fluoxymesterone]], [[Haloperidol]], [[Heroin]], [[Histrelin]], [[Human chorionic gonadotropin]] ([[HCG]]), [[Iloperidone]], [[Isoniazid]], [[Ketoconazole]], [[Leuprolide]], [[Loxapine]], [[Marijuana]], [[Megestrol]], [[Methadone]], [[Methyldopa]], [[Metoclopramide]], [[Metronidazole]], [[Mitotane]], [[Nifedipine]], [[Nizatidine]], [[Oxandrolone]], [[Olanzapine]], [[Omeprazole]], [[Oxymetholone]], [[Penicillamine]], [[Phenothiazine]], [[Pramipexole]], [[Sertraline]], [[Sorafenib]], [[Spironolactone]], [[Steroid]], [[Tamoxifen]], [[Tiagabine]], [[Tricyclic antidepressants]], [[Trifluoperazine]], [[Verapamil]], [[Melatonin]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

==Causes==
In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>

* [[Acromegaly]]
* [[Adrenal Cancer]]
* [[Androgen-insensitivity Syndrome]]
* [[Breast Cancer]]
* [[Carcinoid]]
* [[Chromophobe adenoma]]
* [[Chronic Liver Disease]]
* [[Chronic Renal Insufficiency|Chronic renal insufficiency]]
* [[Cirrhosis]]
* [[Congenital anorchia]]
* [[Extragonadal germ cell tumors]]
* Familial gynecomastia
* [[Five alpha-reductase deficiency Syndrome]]
* [[Hemochromatosis]]
* [[Hepatitis]]
* [[Hepatocellular carcinoma]]
* [[Hypogonadism]]
* [[Hypopituitarism]]
* [[Hypothyroidism]]
* Idiopathic
* [[Kallman Syndrome]]
* [[Kidney Carcinoma]]
* [[Klinefelter Syndrome]]
* [[Liver cancer]]
* Local irradiation
* [[Lung cancer]]
* Medications/drugs:
*:* [[Alcohol]]
*:* [[Anabolic]]
*:* [[Bicalutamide]]
*:* [[Chemotherapeutic]]s
*:* [[Chlorpromazine]]
*:* [[Cimetidine]]
*:* [[Clomiphene]]
*:* [[Diazepam]]
*:* [[Digoxin]]
*:* [[Efavirenz]]
*:* [[Estrogen]]s
*:* [[Etravirine]]
*:* [[Etomidate]]
*:* [[Febuxostat]]
*:* [[Finasteride]]
*:* [[Fluoxymesterone]],
*:* [[Haloperidol]]
*:* [[Heroin]]
*:* [[Histrelin]]
*:* [[Human chorionic gonadotropin]] ([[HCG]])
*:* [[Iloperidone]]
*:* [[Isoniazid]]
*:* [[Ketoconazole]]
*:* [[Leuprolide]]
*:* [[Loxapine]]
*:* [[Marijuana]]
*:* [[Megestrol]]
*:* [[Methadone]]
*:* [[Methyldopa]]
*:* [[Metoclopramide]]
*:* [[Metronidazole]]
*:* [[Mitotane]]
*:* [[Nifedipine]]
*:* [[Nizatidine]]
*:* [[Oxandrolone]]
*:* [[Olanzapine]]
*:* [[Omeprazole]]
*:*[[Oxymetholone]]
*:* [[Penicillamine]]
*:* [[Phenothiazine]]
*:* [[Pramipexole]]
*:* [[Sertraline]]
*:*[[Sorafenib]]
*:* [[Spironolactone]]
*:* [[Steroid]]s
*:* [[Tamoxifen]]
*:*[[Tiagabine]]
*:* [[Tricyclic antidepressants]]
*:* [[Trifluoperazine]]
*:* [[Verapamil]]
*:* [[Melatonin]]
* Persistent postpubertal/elderly gynecomastia
* Physiologic gynecomastia of puberty
* Re-feeding after starvation
* [[Stomach cancer]]
* [[Testicular cancer]]
* Testicular trauma
* [[Thyroid Disease]]
* [[Torsion of testes]]
* Viral [[orchitis]]

According to underlying pathophysiology, the causes of gynecomastia are:
=== Decreased Testosterone ===
* [[Androgen-insensitivity syndrome]]
* [[Congenital anorchia]]
* [[Five alpha-reductase deficiency]]
* [[Hypopituitarism]]
* [[Kallman Syndrome]]
* [[Klinefelter Syndrome]]
* [[Renal Failure]]
* Testicular trauma
* Torsion of the testes
* Viral [[orchitis]]

=== Increased Estrogens ===
* [[Adrenal cancer]]
* Chronic liver disease
* [[Extragonadal germ cell tumors]]
* Familial gynecomastia
* [[Hyperthyroidism]]
* [[Kidney carcinoma]]
* [[Liver cancer]]
* [[Lung carcinoma]]
* Malnutrition
* Other gastrointestinal (GI) tract carcinoma
* [[Stomach cancer]]
* [[Testicular cancer]]

===Physiologic causes===
* Benign gynecomastia of adolescence
* Drugs
* Familial gynecomastia
* Gynecomastia in the newborn
* Gynecomastia of aging

===References===
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category:Endocrinology]]

Gynecomastia causes

2016-02-09T19:18:57Z

Jyostna Chouturi: /* Causes by Organ System */

__NOTOC__
{{Gynecomastia}}
{{CMG}}

==Overview==
===Causes by Organ System===

{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

==Causes==
In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>

* [[Acromegaly]]
* [[Adrenal Cancer]]
* [[Androgen-insensitivity Syndrome]]
* [[Breast Cancer]]
* [[Carcinoid]]
* [[Chromophobe adenoma]]
* [[Chronic Liver Disease]]
* [[Chronic Renal Insufficiency|Chronic renal insufficiency]]
* [[Cirrhosis]]
* [[Congenital anorchia]]
* [[Extragonadal germ cell tumors]]
* Familial gynecomastia
* [[Five alpha-reductase deficiency Syndrome]]
* [[Hemochromatosis]]
* [[Hepatitis]]
* [[Hepatocellular carcinoma]]
* [[Hypogonadism]]
* [[Hypopituitarism]]
* [[Hypothyroidism]]
* Idiopathic
* [[Kallman Syndrome]]
* [[Kidney Carcinoma]]
* [[Klinefelter Syndrome]]
* [[Liver cancer]]
* Local irradiation
* [[Lung cancer]]
* Medications/drugs:
*:* [[Alcohol]]
*:* [[Anabolic]]
*:* [[Bicalutamide]]
*:* [[Chemotherapeutic]]s
*:* [[Chlorpromazine]]
*:* [[Cimetidine]]
*:* [[Clomiphene]]
*:* [[Diazepam]]
*:* [[Digoxin]]
*:* [[Efavirenz]]
*:* [[Estrogen]]s
*:* [[Etravirine]]
*:* [[Etomidate]]
*:* [[Febuxostat]]
*:* [[Finasteride]]
*:* [[Fluoxymesterone]],
*:* [[Haloperidol]]
*:* [[Heroin]]
*:* [[Histrelin]]
*:* [[Human chorionic gonadotropin]] ([[HCG]])
*:* [[Iloperidone]]
*:* [[Isoniazid]]
*:* [[Ketoconazole]]
*:* [[Leuprolide]]
*:* [[Loxapine]]
*:* [[Marijuana]]
*:* [[Megestrol]]
*:* [[Methadone]]
*:* [[Methyldopa]]
*:* [[Metoclopramide]]
*:* [[Metronidazole]]
*:* [[Mitotane]]
*:* [[Nifedipine]]
*:* [[Nizatidine]]
*:* [[Oxandrolone]]
*:* [[Olanzapine]]
*:* [[Omeprazole]]
*:*[[Oxymetholone]]
*:* [[Penicillamine]]
*:* [[Phenothiazine]]
*:* [[Pramipexole]]
*:* [[Sertraline]]
*:*[[Sorafenib]]
*:* [[Spironolactone]]
*:* [[Steroid]]s
*:* [[Tamoxifen]]
*:*[[Tiagabine]]
*:* [[Tricyclic antidepressants]]
*:* [[Trifluoperazine]]
*:* [[Verapamil]]
*:* [[Melatonin]]
* Persistent postpubertal/elderly gynecomastia
* Physiologic gynecomastia of puberty
* Re-feeding after starvation
* [[Stomach cancer]]
* [[Testicular cancer]]
* Testicular trauma
* [[Thyroid Disease]]
* [[Torsion of testes]]
* Viral [[orchitis]]

According to underlying pathophysiology, the causes of gynecomastia are:
=== Decreased Testosterone ===
* [[Androgen-insensitivity syndrome]]
* [[Congenital anorchia]]
* [[Five alpha-reductase deficiency]]
* [[Hypopituitarism]]
* [[Kallman Syndrome]]
* [[Klinefelter Syndrome]]
* [[Renal Failure]]
* Testicular trauma
* Torsion of the testes
* Viral [[orchitis]]

=== Increased Estrogens ===
* [[Adrenal cancer]]
* Chronic liver disease
* [[Extragonadal germ cell tumors]]
* Familial gynecomastia
* [[Hyperthyroidism]]
* [[Kidney carcinoma]]
* [[Liver cancer]]
* [[Lung carcinoma]]
* Malnutrition
* Other gastrointestinal (GI) tract carcinoma
* [[Stomach cancer]]
* [[Testicular cancer]]

===Physiologic causes===
* Benign gynecomastia of adolescence
* Drugs
* Familial gynecomastia
* Gynecomastia in the newborn
* Gynecomastia of aging

===References===
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category:Endocrinology]]

Gynecomastia causes

2016-02-09T19:18:11Z

Jyostna Chouturi:

__NOTOC__
{{Gynecomastia}}
{{CMG}}

==Overview==
===Causes by Organ System===
* To obtain the coding for the table seen below, click [[Differential diagnosis by organ system table|here]]. You need to copy the table content from the edit box, and paste it into the edit box.
* You can then list the causes by organ system. List the causes, separated by a comma under the appropriate category where it says "No underlying causes". Erase "No underlying causes" if you are listing causes in that category.
* For an example of the causes by organ system table in a causes microchapter, click [[Jaundice causes#Causes by Organ System|here]].

{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

==Causes==
In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>

* [[Acromegaly]]
* [[Adrenal Cancer]]
* [[Androgen-insensitivity Syndrome]]
* [[Breast Cancer]]
* [[Carcinoid]]
* [[Chromophobe adenoma]]
* [[Chronic Liver Disease]]
* [[Chronic Renal Insufficiency|Chronic renal insufficiency]]
* [[Cirrhosis]]
* [[Congenital anorchia]]
* [[Extragonadal germ cell tumors]]
* Familial gynecomastia
* [[Five alpha-reductase deficiency Syndrome]]
* [[Hemochromatosis]]
* [[Hepatitis]]
* [[Hepatocellular carcinoma]]
* [[Hypogonadism]]
* [[Hypopituitarism]]
* [[Hypothyroidism]]
* Idiopathic
* [[Kallman Syndrome]]
* [[Kidney Carcinoma]]
* [[Klinefelter Syndrome]]
* [[Liver cancer]]
* Local irradiation
* [[Lung cancer]]
* Medications/drugs:
*:* [[Alcohol]]
*:* [[Anabolic]]
*:* [[Bicalutamide]]
*:* [[Chemotherapeutic]]s
*:* [[Chlorpromazine]]
*:* [[Cimetidine]]
*:* [[Clomiphene]]
*:* [[Diazepam]]
*:* [[Digoxin]]
*:* [[Efavirenz]]
*:* [[Estrogen]]s
*:* [[Etravirine]]
*:* [[Etomidate]]
*:* [[Febuxostat]]
*:* [[Finasteride]]
*:* [[Fluoxymesterone]],
*:* [[Haloperidol]]
*:* [[Heroin]]
*:* [[Histrelin]]
*:* [[Human chorionic gonadotropin]] ([[HCG]])
*:* [[Iloperidone]]
*:* [[Isoniazid]]
*:* [[Ketoconazole]]
*:* [[Leuprolide]]
*:* [[Loxapine]]
*:* [[Marijuana]]
*:* [[Megestrol]]
*:* [[Methadone]]
*:* [[Methyldopa]]
*:* [[Metoclopramide]]
*:* [[Metronidazole]]
*:* [[Mitotane]]
*:* [[Nifedipine]]
*:* [[Nizatidine]]
*:* [[Oxandrolone]]
*:* [[Olanzapine]]
*:* [[Omeprazole]]
*:*[[Oxymetholone]]
*:* [[Penicillamine]]
*:* [[Phenothiazine]]
*:* [[Pramipexole]]
*:* [[Sertraline]]
*:*[[Sorafenib]]
*:* [[Spironolactone]]
*:* [[Steroid]]s
*:* [[Tamoxifen]]
*:*[[Tiagabine]]
*:* [[Tricyclic antidepressants]]
*:* [[Trifluoperazine]]
*:* [[Verapamil]]
*:* [[Melatonin]]
* Persistent postpubertal/elderly gynecomastia
* Physiologic gynecomastia of puberty
* Re-feeding after starvation
* [[Stomach cancer]]
* [[Testicular cancer]]
* Testicular trauma
* [[Thyroid Disease]]
* [[Torsion of testes]]
* Viral [[orchitis]]

According to underlying pathophysiology, the causes of gynecomastia are:
=== Decreased Testosterone ===
* [[Androgen-insensitivity syndrome]]
* [[Congenital anorchia]]
* [[Five alpha-reductase deficiency]]
* [[Hypopituitarism]]
* [[Kallman Syndrome]]
* [[Klinefelter Syndrome]]
* [[Renal Failure]]
* Testicular trauma
* Torsion of the testes
* Viral [[orchitis]]

=== Increased Estrogens ===
* [[Adrenal cancer]]
* Chronic liver disease
* [[Extragonadal germ cell tumors]]
* Familial gynecomastia
* [[Hyperthyroidism]]
* [[Kidney carcinoma]]
* [[Liver cancer]]
* [[Lung carcinoma]]
* Malnutrition
* Other gastrointestinal (GI) tract carcinoma
* [[Stomach cancer]]
* [[Testicular cancer]]

===Physiologic causes===
* Benign gynecomastia of adolescence
* Drugs
* Familial gynecomastia
* Gynecomastia in the newborn
* Gynecomastia of aging

===References===
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category:Endocrinology]]

Gynecomastia causes

2016-02-09T19:17:21Z

Jyostna Chouturi:

__NOTOC__
{{Gynecomastia}}
{{CMG}}

==Overview==
==Causes==
In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>

===Causes by Organ System===
* To obtain the coding for the table seen below, click [[Differential diagnosis by organ system table|here]]. You need to copy the table content from the edit box, and paste it into the edit box.
* You can then list the causes by organ system. List the causes, separated by a comma under the appropriate category where it says "No underlying causes". Erase "No underlying causes" if you are listing causes in that category.
* For an example of the causes by organ system table in a causes microchapter, click [[Jaundice causes#Causes by Organ System|here]].

{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

* [[Acromegaly]]
* [[Adrenal Cancer]]
* [[Androgen-insensitivity Syndrome]]
* [[Breast Cancer]]
* [[Carcinoid]]
* [[Chromophobe adenoma]]
* [[Chronic Liver Disease]]
* [[Chronic Renal Insufficiency|Chronic renal insufficiency]]
* [[Cirrhosis]]
* [[Congenital anorchia]]
* [[Extragonadal germ cell tumors]]
* Familial gynecomastia
* [[Five alpha-reductase deficiency Syndrome]]
* [[Hemochromatosis]]
* [[Hepatitis]]
* [[Hepatocellular carcinoma]]
* [[Hypogonadism]]
* [[Hypopituitarism]]
* [[Hypothyroidism]]
* Idiopathic
* [[Kallman Syndrome]]
* [[Kidney Carcinoma]]
* [[Klinefelter Syndrome]]
* [[Liver cancer]]
* Local irradiation
* [[Lung cancer]]
* Medications/drugs:
*:* [[Alcohol]]
*:* [[Anabolic]]
*:* [[Bicalutamide]]
*:* [[Chemotherapeutic]]s
*:* [[Chlorpromazine]]
*:* [[Cimetidine]]
*:* [[Clomiphene]]
*:* [[Diazepam]]
*:* [[Digoxin]]
*:* [[Efavirenz]]
*:* [[Estrogen]]s
*:* [[Etravirine]]
*:* [[Etomidate]]
*:* [[Febuxostat]]
*:* [[Finasteride]]
*:* [[Fluoxymesterone]],
*:* [[Haloperidol]]
*:* [[Heroin]]
*:* [[Histrelin]]
*:* [[Human chorionic gonadotropin]] ([[HCG]])
*:* [[Iloperidone]]
*:* [[Isoniazid]]
*:* [[Ketoconazole]]
*:* [[Leuprolide]]
*:* [[Loxapine]]
*:* [[Marijuana]]
*:* [[Megestrol]]
*:* [[Methadone]]
*:* [[Methyldopa]]
*:* [[Metoclopramide]]
*:* [[Metronidazole]]
*:* [[Mitotane]]
*:* [[Nifedipine]]
*:* [[Nizatidine]]
*:* [[Oxandrolone]]
*:* [[Olanzapine]]
*:* [[Omeprazole]]
*:*[[Oxymetholone]]
*:* [[Penicillamine]]
*:* [[Phenothiazine]]
*:* [[Pramipexole]]
*:* [[Sertraline]]
*:*[[Sorafenib]]
*:* [[Spironolactone]]
*:* [[Steroid]]s
*:* [[Tamoxifen]]
*:*[[Tiagabine]]
*:* [[Tricyclic antidepressants]]
*:* [[Trifluoperazine]]
*:* [[Verapamil]]
*:* [[Melatonin]]
* Persistent postpubertal/elderly gynecomastia
* Physiologic gynecomastia of puberty
* Re-feeding after starvation
* [[Stomach cancer]]
* [[Testicular cancer]]
* Testicular trauma
* [[Thyroid Disease]]
* [[Torsion of testes]]
* Viral [[orchitis]]

According to underlying pathophysiology, the causes of gynecomastia are:
=== Decreased Testosterone ===
* [[Androgen-insensitivity syndrome]]
* [[Congenital anorchia]]
* [[Five alpha-reductase deficiency]]
* [[Hypopituitarism]]
* [[Kallman Syndrome]]
* [[Klinefelter Syndrome]]
* [[Renal Failure]]
* Testicular trauma
* Torsion of the testes
* Viral [[orchitis]]

=== Increased Estrogens ===
* [[Adrenal cancer]]
* Chronic liver disease
* [[Extragonadal germ cell tumors]]
* Familial gynecomastia
* [[Hyperthyroidism]]
* [[Kidney carcinoma]]
* [[Liver cancer]]
* [[Lung carcinoma]]
* Malnutrition
* Other gastrointestinal (GI) tract carcinoma
* [[Stomach cancer]]
* [[Testicular cancer]]

===Physiologic causes===
* Benign gynecomastia of adolescence
* Drugs
* Familial gynecomastia
* Gynecomastia in the newborn
* Gynecomastia of aging

===References===
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category:Endocrinology]]

Vision loss

2016-02-02T15:40:22Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Congenital rubella syndrome]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Infantile neuroaxonal dystrophy]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Lethal congenital contracture syndrome]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome]]
*[[Leukodystrophy]]
*[[Linear IgA bullous dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Oculocerebrorenal syndrome]]
*[[Macular degeneration]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol|Methanol poisoning]]
*[[Microphthalmia]]
*[[Microvascular disease]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Morning glory disc anomaly]]
*[[Mucosa-associated lymphoid tissue]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis and panuveitis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neurodegeneration with brain iron accumulation]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, and retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Pachydermoperiostosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Von Hippel-Lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[X-linked intellectual disability]]
*[[X-linked congenital stationary night blindness]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T14:42:41Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Congenital rubella syndrome]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Infantile neuroaxonal dystrophy]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Lethal congenital contracture syndrome]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome]]
*[[Leukodystrophy]]
*[[Linear IgA bullous dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Oculocerebrorenal syndrome]]
*[[Macular degeneration]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol|Methanol poisoning]]
*[[Microphthalmia]]
*[[Microvascular disease]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Morning glory disc anomaly]]
*[[Mucosa-associated lymphoid tissue]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis and panuveitis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neurodegeneration with brain iron accumulation]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, and retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Pachydermoperiostosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[X-linked intellectual disability]]
*[[X-linked congenital stationary night blindness]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T05:28:34Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Congenital rubella syndrome]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Infantile neuroaxonal dystrophy]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Lethal congenital contracture syndrome]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome]]
*[[Leukodystrophy]]
*[[Linear IgA bullous dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Oculocerebrorenal syndrome]]
*[[Macular degeneration]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol|Methanol poisoning]]
*[[Microphthalmia]]
*[[Microvascular disease]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Morning glory disc anomaly]]
*[[Mucosa-associated lymphoid tissue]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis and panuveitis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neurodegeneration with brain iron accumulation]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, and retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[X-linked intellectual disability]]
*[[X-linked congenital stationary night blindness]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T05:23:58Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Congenital rubella syndrome]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Infantile neuroaxonal dystrophy]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Lethal congenital contracture syndrome]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome]]
*[[Leukodystrophy]]
*[[Linear IgA bullous dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Oculocerebrorenal syndrome]]
*[[Macular degeneration]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol|Methanol poisoning]]
*[[Microphthalmia]]
*[[Microvascular disease]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Morning glory disc anomaly]]
*[[Mucosa-associated lymphoid tissue]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis and panuveitis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neurodegeneration with brain iron accumulation]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[X-linked intellectual disability]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T05:21:24Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Congenital rubella syndrome]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Infantile neuroaxonal dystrophy]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Lethal congenital contracture syndrome]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome]]
*[[Linear IgA bullous dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Oculocerebrorenal syndrome]]
*[[Macular degeneration]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol|Methanol poisoning]]
*[[Microphthalmia]]
*[[Microvascular disease]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Morning glory disc anomaly]]
*[[Mucosa-associated lymphoid tissue]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis and panuveitis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neurodegeneration with brain iron accumulation]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[X-linked intellectual disability]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T05:17:36Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Congenital rubella syndrome]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Infantile neuroaxonal dystrophy]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Lethal congenital contracture syndrome]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome]]
*[[Linear IgA bullous dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Oculocerebrorenal syndrome]]
*[[Macular degeneration]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol|Methanol poisoning]]
*[[Microphthalmia]]
*[[Microvascular disease]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Morning glory disc anomaly]]
*[[Mucosa-associated lymphoid tissue]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis and panuveitis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neurodegeneration with brain iron accumulation]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[X-linked intellectual disability]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Neurodegeneration with brain iron accumulation

2016-02-02T05:16:48Z

Jyostna Chouturi: Created page with "__NOTOC__ {{CMG}} {{AE}} {{JC}} ==Overview== '''Neurodegeneration with brain iron accumulation''' (NBIA) is a group of inherited neurological disorders in which iron accum..."

__NOTOC__
{{CMG}} {{AE}} {{JC}}
==Overview==
'''Neurodegeneration with brain iron accumulation''' (NBIA) is a group of inherited [[neurological disorder]]s in which iron accumulates in the [[basal ganglia]], resulting in progressive [[dystonia]], [[Parkinsonism]], [[spasticity]], [[optic atrophy]] or [[retinopathy|retinal degeneration]] and [[neuropsychiatric]] abnormalities. NBIA have been associated with genes in synapse and lipid metabolism related pathways.<ref>{{cite journal|last1=Bettencourt|first1=C|last2=Forabosco|first2=P|last3=Wiethoff|first3=S|last4=Heidari|first4=M|last5=Johnstone|first5=DM|last6=Botía|first6=JA|last7=Collingwood|first7=JF|last8=Hardy|first8=J|last9=Milward|first9=EA|last10=Ryten|first10=M|last11=Houlden|first11=H|last12=UK Brain Expression Consortium|first12=(UKBEC)|title=Gene co-expression networks shed light into diseases of brain iron accumulation.|journal=Neurobiology of disease|date=17 December 2015|doi=10.1016/j.nbd.2015.12.004|pmid=26707700}}</ref>

The group includes the following disorders:
*[[Pantothenate kinase-associated neurodegeneration]] (PKAN) also known as neurodegeneration with brain iron accumulation 1 (NBIA1)
*PLAN ([[PLA2G6]]-associated neurodegeneration)
*MPAN (Mitochondrial membrane protein-associated neurodegeneration)
*BPAN (Beta-propeller protein-associated neurodegeneration)
*FAHN (Fatty acid hydroxylase-associated neurodegeneration)
*[[Kufor–Rakeb syndrome]]
*[[Neuroferritinopathy]]
*[[Aceruloplasminemia]]
*[[Woodhouse–Sakati syndrome]]
*CoPAN (CoA synthase protein-associated neurodegeneration)
*Idiopathic NBIA
*[[Neurodegeneration with brain iron accumulation 2B]] (NBIA2B)
*[[Neurodegeneration with brain iron accumulation 3]] (NBIA3)

==References==
{{reflist}}
*[http://www.ninds.nih.gov/disorders/nbia/nbia.htm Neurodegeneration with Brain Iron Accumulation Information Page] at [[National Institute of Neurological Disorders and Stroke]]

[[Category:Neurological disorders]]
[[Category:Extrapyramidal and movement disorders]]
[[Category:Vitamin, coenzyme, and cofactor metabolism disorders]]
[[Category:Neuroscience]]

{{Neuroscience-stub}}

Vision loss

2016-02-02T05:10:47Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Congenital rubella syndrome]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Infantile neuroaxonal dystrophy]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Lethal congenital contracture syndrome]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome]]
*[[Linear IgA bullous dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Oculocerebrorenal syndrome]]
*[[Macular degeneration]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol|Methanol poisoning]]
*[[Microphthalmia]]
*[[Microvascular disease]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Morning glory disc anomaly]]
*[[Mucosa-associated lymphoid tissue]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis and panuveitis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[X-linked intellectual disability]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T05:08:11Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Congenital rubella syndrome]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Lethal congenital contracture syndrome]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome]]
*[[Linear IgA bullous dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Oculocerebrorenal syndrome]]
*[[Macular degeneration]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol|Methanol poisoning]]
*[[Microphthalmia]]
*[[Microvascular disease]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Morning glory disc anomaly]]
*[[Mucosa-associated lymphoid tissue]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis and panuveitis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[X-linked intellectual disability]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T05:04:30Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Congenital rubella syndrome]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Lethal congenital contracture syndrome]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome]]
*[[Linear IgA bullous dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Oculocerebrorenal syndrome]]
*[[Macular degeneration]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol|Methanol poisoning]]
*[[Microphthalmia]]
*[[Microvascular disease]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Morning glory disc anomaly]]
*[[Mucosa-associated lymphoid tissue]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis and panuveitis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[X-linked intellectual disability]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Multifocal choroiditis and panuveitis

2016-02-02T05:03:34Z

Jyostna Chouturi: Created page with "__NOTOC__ {{CMG}} {{AE}} {{JC}} ==Overview== '''Multifocal choroiditis and panuveitis''' (MCP) is an idiopathic inflammatory disorder of unknown etiology affecting the choro..."

__NOTOC__
{{CMG}} {{AE}} {{JC}}

==Overview==
'''Multifocal choroiditis and panuveitis''' (MCP) is an idiopathic inflammatory disorder of unknown etiology affecting the choroid, retina, and vitreous of the eye that presents asymmetrically, most often in young [[myopia|myopic]] women with [[photopsias]], enlargement of the physiologic blind spot and decreased vision.{{fact|date=June 2015}}

The first description of the disease was written in 1973.<ref name=EMedicine1190935>{{EMedicine|article|1190935|Multifocal Choroidopathy Syndromes}}</ref>

==Symptoms==
Blurry vision, mild pain in the eye balls , as well as small yellow, grey , and white spots may begin to appear on the retina.<ref name=EMedicine1190935/>

==References==
{{reflist}}

==Further reading==
*{{cite book |first1=Myron |last1=Yanoff |first2=Jay S. |last2=Duker |title=Ophthalmology |year=2009 |publisher=Mosby Elsevier |isbn=978-0-323-04332-8 |edition=3rd}}

[[Category:Disorders of choroid and retina]]

Vision loss

2016-02-02T04:56:44Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Congenital rubella syndrome]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Lethal congenital contracture syndrome]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome]]
*[[Linear IgA bullous dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Oculocerebrorenal syndrome]]
*[[Macular degeneration]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol|Methanol poisoning]]
*[[Microphthalmia]]
*[[Microvascular disease]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Morning glory disc anomaly]]
*[[Mucosa-associated lymphoid tissue]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[X-linked intellectual disability]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Morning glory disc anomaly

2016-02-02T04:55:12Z

Jyostna Chouturi: Created page with "__NOTOC__ {{CMG}} {{AE}}{{JC}} ==Overview== The '''morning glory disc anomaly''' (MGDA) is a congenital deformity resulting from failure of the optic nerve to completely..."

__NOTOC__
{{CMG}} {{AE}}{{JC}}

==Overview==
The '''morning glory disc anomaly''' (MGDA) is a congenital deformity resulting from failure of the [[optic nerve]] to completely form in utero.<ref>{{cite journal|last=Magrath|first=GN|author2=Cheeseman EW |author3=Sarrica RA |title=Morning Glory Disc Anomaly|journal=Pediatric Neurology|year=2013|volume=49|issue=6|page=517|doi=10.1016/j.pediatrneurol.2013.05.015}}</ref> The term was coined in 1970 by Kindler, noting a resemblance of the malformed optic nerve to the [[morning glory]] flower.<ref>{{cite journal|last=Kindler|title=Morning glory syndrome: unusual congenital optic disk anomaly|journal=Am J Ophthalmol|year=1970|volume=69|pages=376–84}}</ref> The condition is usually unilateral.<ref name=Barnard>{{cite web|last=Barnard|first=Simon|title=An Introduction to Diseases of the Optic nerve|url=http://www.academy.org.uk/lectures/barnard3.htm|accessdate=30 May 2014}}</ref>

On [[Ophthalmoscopy|fundoscopic]] examination, there are three principal findings comprising the anomaly:<ref>{{cite journal|last=Auber|first=AE|author2=O’Hara M|title=,Morning glory syndrome. MR imaging|journal=Clin Imaging|year=1999|volume=23|pages=152–158|doi=10.1016/s0899-7071(99)00118-7}}</ref>
#an enlarged, funnel-shaped excavation in optic disc
#an annulus or ring of [[Media:Three Internal chambers of the Eye.png|chorioretinal]] pigmentary changes surrounding the optic disc excavation
#a central glial tuft overlying the optic disc

==Associated conditions==
Although the finding itself is rare, MGDA can be associated with midline cranial defects and abnormal [[carotid artery|carotid]] circulation, such as carotid [[stenosis]]/aplasia or progressive vascular obstruction with collateralization (also known as [[Moya moya]]).<ref name="Quah">{{cite journal|last=Quah|first=BL|author2=Hamilton J |author3=Blaser S |title=Morning glory disc anomaly, midline cranial defects and abnormal carotid circulation: an association worth looking for|journal=Pediatr Radiol|year=2005|volume=35|pages=525–528 |doi=10.1007/s00247-004-1345-y|display-authors=etal}}</ref> The vascular defects may lead to ischemia, stroke, or seizures and so a finding of MGDA should be further investigated radiographic imaging.

==Complications==
Serous retinal detachment can occur in the affected eye.<ref name="Quah" />

'''See also'''
* [[Coloboma of optic nerve]]
* [http://eyewiki.aao.org/Morning_Glory_anomaly Eye wiki: Morning glory anomaly]

==References==
{{reflist}}

[[Category:Optic nerve]]
[[Category:Disorders of optic nerve and visual pathways]]

Vision loss

2016-02-02T04:52:45Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Congenital rubella syndrome]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Lethal congenital contracture syndrome]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome]]
*[[Linear IgA bullous dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Oculocerebrorenal syndrome]]
*[[Macular degeneration]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol|Methanol poisoning]]
*[[Microphthalmia]]
*[[Microvascular disease]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucosa-associated lymphoid tissue]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[X-linked intellectual disability]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T04:49:42Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Congenital rubella syndrome]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Lethal congenital contracture syndrome]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome]]
*[[Linear IgA bullous dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Oculocerebrorenal syndrome]]
*[[Macular degeneration]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol|Methanol poisoning]]
*[[Microphthalmia]]
*[[Microvascular complications of diabetes]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucosa-associated lymphoid tissue]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[X-linked intellectual disability]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T04:46:14Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Lethal congenital contracture syndrome]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome]]
*[[Linear IgA bullous dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Oculocerebrorenal syndrome]]
*[[Macular degeneration]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol|Methanol poisoning]]
*[[Microcephaly, microphthalmos]]
*[[Microphthalmia]]
*[[Microvascular complications of diabetes]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucosa-associated lymphoid tissue]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[X-linked intellectual disability]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Methanol

2016-02-02T04:45:26Z

Jyostna Chouturi:

__NOTOC__
{{CMG}} {{AE}} {{JC}}

{{Chembox new
| Name = Methanol
| ImageFileL1 = Methanol-2D.png
| ImageSizeL1 = 120px
| ImageNameL1 = Methanol
| ImageFileR1 = Methanol-3D-balls.png
| ImageSizeR1 = 120px
| ImageNameR1 = Methanol
| ImageFile2 = Methanol-3D-vdW.png
| ImageSize2 = 150px
| ImageName2 = Methanol
| IUPACName = methanol
| OtherNames = hydroxymethane<br/>methyl alcohol<br/>methyl hydrate</br>wood alcohol<br/>carbinol
| Section1 = {{Chembox Identifiers
| SMILES = CO
| CASNo = 67-56-1
| RTECS = PC1400000
}}
| Section2 = {{Chembox Properties
| Formula = CH<sub>3</sub>OH
| MolarMass = 32.04 g/mol
| Appearance = colorless liquid
| Density = 0.7918 g/cm³, liquid
| Solubility = Fully [[miscible]]
| MeltingPt = –97 °C (176 K)
| BoilingPt = 64.7 °C (337.8 K)
| pKa = ~ 15.5
| Viscosity = 0.59 [[Pascal-second|mPa·s]] at 20 °C
| Dipole = 1.69 [[Debye|D]] (gas)
}}
| Section7 = {{Chembox Hazards
| FlashPt = 11 °C
| EUClass = Flammable ('''F''')<br/>Toxic ('''T''')
| NFPA-H = 3
| NFPA-F = 3
| NFPA-R = 1
| RPhrases = {{R11}},
| SPhrases = {{S1/2}}, {{S7}}, {{S16}}, {{S36/37}}, {{S45}}
}}
| Section8 = {{Chembox Related
| Function = [[alkanol]]s
| OtherFunctn = [[ethanol]]<br/>[[butanol]]
| OtherCpds = [[chloromethane]]<br/>[[methoxymethane]]}}
}}

==Overview==
'''Methanol''', also known as '''methyl alcohol''', '''carbinol''', '''wood alcohol''', '''wood naphtha''' or '''wood spirits''', is a [[chemical compound]] with [[chemical formula]] [[carbon|C]][[hydrogen|H]]<sub>3</sub>[[Hydroxide|OH]] (often abbreviated MeOH). It is the simplest [[alcohol]], and is a light, [[Volatility (chemistry)|volatile]], [[colour]]less, [[flammable]], [[poison]]ous liquid with a distinctive odor that is somewhat milder and sweeter than [[ethanol]] ([[ethyl alcohol]]). At room temperature it is a [[Solvent#Polarity.2C_solubility.2C_and_miscibility|polar liquid]] and is used as an [[antifreeze (coolant)|antifreeze]], [[solvent]], [[fuel]], and as a [[denatured alcohol|denaturant]] for [[ethyl alcohol]]. It is also used for producing [[biodiesel]] via [[transesterification]] reaction.

Methanol is produced naturally in the [[anaerobic organism|anaerobic]] [[metabolism]] of many varieties of bacteria. As a result, there is a small fraction of methanol vapor in the atmosphere. Over the course of several days, atmospheric methanol is [[oxidized]] by oxygen with the help of sunlight to carbon dioxide and water.

Methanol burns in air forming [[carbon dioxide]] and [[water]]:

:2 CH<sub>3</sub>OH + 3 O<sub>2</sub> → 2 CO<sub>2</sub> + 4 H<sub>2</sub>O

A methanol flame is almost colorless, causing an additional safety hazard around open methanol flames.

Because of its poisonous properties, methanol is frequently used as a denaturant additive for ethanol manufactured for industrial uses— this addition of a [[poison]] economically exempts industrial ethanol from the rather significant 'liquor' taxes that would otherwise be levied as it is the essence of all potable alcoholic beverages. Methanol is often called wood alcohol because it was once produced chiefly as a byproduct of the destructive distillation of wood. It is now produced synthetically by a multi-step process: [[natural gas]] and steam are reformed in a furnace to produce hydrogen and carbon monoxide; then, hydrogen and carbon monoxide gases react under pressure in the presence of a catalyst.

An entire [[methanol economy]], based on methanol as a primary energy-storage medium and fuel, has been seriously proposed.

==History==

In their [[embalming]] process, the [[ancient Egyptians]] used a mixture of substances, including methanol, which they obtained from the [[pyrolysis]] of wood. Pure methanol, however, was first isolated in 1661 by [[Robert Boyle]], who called it ''spirit of box'', because he produced it via the distillation of [[boxwood]]. It later became known as ''pyroxylic spirit''. In 1834, the [[France|French]] chemists [[Jean-Baptiste Dumas]] and [[Eugene Peligot]] determined its elemental composition. They also introduced the word ''methylene'' to organic chemistry, forming it from [[Greek language|Greek]] ''methy'' = "[[wine]]" + ''hȳlē'' = [[wood]] (patch of trees). Its intended origin was "[[alcohol]] made from [[wood]] (substance)," but it has Greek language errors. The term "methyl" was derived in about 1840 by [[back-formation]] from ''methylene'', and was then applied to describe "methyl alcohol." This was shortened to "methanol" in 1892 by the International Conference on Chemical Nomenclature. The [[suffix (linguistics)|suffix]] [[-yl]] used in [[organic chemistry]] to form names of [[Radical (chemistry)|radical]]s, was extracted from the word "methyl."

In 1923, the [[Germany|German]] chemists Matthias and Pier, working for [[BASF]] developed a means to convert [[syngas|''synthesis gas'']] (a mixture of [[carbon oxide]]s and [[hydrogen]]) into methanol. A patent was filed Jan 12 1926 (reference no. 1,569,775). This process used a [[chromium and manganese oxid]] [[catalyst]], and required extremely vigorous conditions—pressures ranging from 50 to 220 [[atmosphere (unit)|atm]]), and temperatures up to 450 °[[Celsius|C]]. Modern methanol production has been made more efficient through use of catalysts (commonly [[copper]]) capable of operating at lower pressures.

The use of methanol as a motor fuel received attention during the oil crises of the 1970s due to its availability and low cost. Problems occurred early in the development of gasoline-methanol blends. As a result of its low price, some gasoline marketers over-blended. Others used improper blending and handling techniques.

In 2006 astronomers using the [[MERLIN]] array of radio telescopes at [[Jodrell Bank|Jodrell Bank Observatory]] discovered a large cloud of methanol in space, 300 billion miles across.

==Production==
Today, synthesis gas is most commonly produced from the [[methane]] component in [[natural gas]] rather than from coal. Three processes are commercially practiced. At moderate pressures of 1 to 2 [[MPa]] (10–20 atm) and high temperatures (around 850 °C), methane [[chemical reaction|reacts]] with [[steam]] on a nickel catalyst to produce [[syngas]] according to the [[chemical equation]]:

:[[methane|CH<sub>4</sub>]] + [[water|H<sub>2</sub>O]] → [[carbon monoxide|CO]] + 3 [[hydrogen|H<sub>2</sub>]]

This reaction, commonly called steam-methane reforming or SMR, is [[endothermic]] and the heat transfer limitations place limits on the size of and pressure in the catalytic reactors used. Methane can also undergo partial oxidation with molecular oxygen to produce syngas, as the following equation shows:

:2 [[methane|CH<sub>4</sub>]] + [[oxygen|O<sub>2</sub>]] → 2 [[carbon monoxide|CO]] + 4 [[hydrogen|H<sub>2</sub>]]

this reaction is [[exothermic]] and the heat given off can be used ''in-situ'' to drive the steam-methane reforming reaction. When the two processes are combined, it is referred to as autothermal reforming. The ratio of CO and H<sub>2</sub> can be adjusted to some extent by the water-gas shift reaction,

:[[carbon monoxide|CO]] + [[water|H<sub>2</sub>O]] → [[carbon dioxide|CO<sub>2</sub>]] + [[hydrogen|H<sub>2</sub>]],

to provide the appropriate stoichiometry for methanol synthesis.

The carbon monoxide and hydrogen then react on a second catalyst to produce methanol. Today, the most widely used catalyst is a mixture of [[copper]], [[zinc oxide]], and [[alumina]] first used by [[Imperial Chemical Industries|ICI]] in 1966. At 5–10 MPa (50–100 atm) and 250 °C, it can catalyze the production of methanol from carbon monoxide and hydrogen with high selectivity

:[[carbon monoxide|CO]] + 2 [[hydrogen|H<sub>2</sub>]] → CH<sub>3</sub>OH

It is worth noting that the production of synthesis gas from methane produces 3 [[Mole (unit)|mole]]s of hydrogen for every mole of carbon monoxide, while the methanol synthesis consumes only 2 moles of hydrogen for every mole of carbon monoxide. One way of dealing with the excess hydrogen is to inject [[carbon dioxide]] into the methanol synthesis reactor, where it, too, reacts to form methanol according to the [[chemical equation]]

:[[carbon dioxide|CO<sub>2</sub>]] + 3 [[hydrogen|H<sub>2</sub>]] → CH<sub>3</sub>OH + [[water|H<sub>2</sub>O]]

Although natural gas is the most economical and widely used feedstock for methanol production, other feedstocks can be used. Where natural gas is unavailable, light [[petroleum]] products can be used in its place.
==Occurrence==

===Human metabolite===
{{main|Alcohol#Toxicity}}

Methanol is poisonous to the central nervous system and may cause blindness, coma, and death. However, in small amounts, methanol is a natural endogenous compound found in normal, healthy human individuals. A study found a mean of 4.5 [[parts per million|ppm]] in the exhaled breath of subjects.<ref>{{Cite journal
| pmid = 16705261
| year = 2006
| author1 = Turner
| first1 = C
| title = A longitudinal study of methanol in the exhaled breath of 30 healthy volunteers using selected ion flow tube mass spectrometry, SIFT-MS
| journal = Physiological Measurement
| volume = 27
| issue = 7
| pages = 637–48
| last2 = Spanel
| first2 = P
| last3 = Smith
| first3 = D
| doi = 10.1088/0967-3334/27/7/007
}}</ref> The mean endogenous methanol production in humans of 0.45 g/d may be metabolized from pectin found in fruit; one [[kilogram]] of apple produces up to 1.4 g methanol.<ref>{{Cite journal
| pmid = 9267548
| year = 1997
| author1 = Lindinger
| first1 = W
| title = Endogenous production of methanol after the consumption of fruit
| journal = Alcoholism, clinical and experimental research
| volume = 21
| issue = 5
| pages = 939–43
| last2 = Taucher
| first2 = J
| last3 = Jordan
| first3 = A
| last4 = Hansel
| first4 = A
| last5 = Vogel
| first5 = W
| doi=10.1111/j.1530-0277.1997.tb03862.x
}}</ref>

==Toxicity==

Methanol has a high toxicity in humans. If as little as 10 mL of pure methanol is ingested, for example, it can break down into [[formic acid]], which can cause permanent blindness by destruction of the [[optic nerve]], and 30 mL is potentially fatal,<ref name="Vale">{{cite journal |author=Vale A |title=Methanol |journal=Medicine |volume=35 |issue=12 |pages=633–4 |year=2007|doi=10.1016/j.mpmed.2007.09.014}}</ref> although the median lethal dose is typically 100 mL (3.4 fl oz) (i.e. 1–2 mL/kg body weight of pure methanol<ref>{{cite web|title=Methanol Poisoning Overview|url=http://www.antizol.com/mpoisono.htm|publisher=Antizol|archiveurl=http://web.archive.org/web/20111005043548/http://www.antizol.com/mpoisono.htm|archivedate=5 October 2011}}</ref>). [[Reference dose]] for methanol is 2 mg/kg/day.<ref>[http://www.epa.gov/iris/subst/0305.htm Methanol (CASRN 67-56-1)]</ref> Toxic effects take hours to start, and effective antidotes can often prevent permanent damage.<ref name="Vale"/> Because of its similarities in both appearance and odor to [[ethanol]] (the alcohol in beverages), it is difficult to differentiate between the two (such is also the case with [[denatured alcohol]]). However, there are cases of methanol resistance, such as that of [[Michael Malloy|Mike Malloy]], who was the victim of a failed murder attempt by methanol in the early 1930s.<ref>Blum, Deborah (2011). ''The Poisoner's Handbook''. Penguin Books. p. 231. ISBN 014311882X.</ref>

Methanol is [[toxic]] by two mechanisms. First, methanol (whether it enters the body by [[ingestion]], [[inhalation]], or [[absorption (chemistry)|absorption]] through the skin) can be fatal due to its [[CNS depressant]] properties in the same manner as [[Alcohol intoxication#Acute alcohol poisoning|ethanol poisoning]]. Second, in a process of [[toxication]], it is [[metabolism|metabolized]] to [[formic acid]] (which is present as the formate ion) via [[formaldehyde]] in a process initiated by the [[enzyme]] [[alcohol dehydrogenase]] in the [[liver]].<ref name="Schep">{{cite journal |author=Schep LJ, Slaughter RJ, Vale JA, Beasley DM |title=A seaman with blindness and confusion |journal=[[BMJ]]|volume=339 |pages=b3929 |date=2009|url=http://www.bmj.com/cgi/content/full/339/sep30_1/b3929|doi=10.1136/bmj.b3929|pmid=19793790}}</ref> Methanol is converted to formaldehyde via alcohol dehydrogenase (ADH) and formaldehyde is converted to formic acid (formate) via [[aldehyde dehydrogenase]] (ALDH). The conversion to formate via ALDH proceeds completely, with no detectable formaldehyde remaining.<ref name=noCHOH>{{Cite journal |author=McMartin KE, Martin-Amat G, Noker PE, Tephly TR |title=Lack of a role for formaldehyde in methanol poisoning in the monkey |journal=Biochem. Pharmacol. |volume=28 |issue=5 |pages=645–9 |year=1979 |pmid=109089 |doi= 10.1016/0006-2952(79)90149-7}}</ref> Formate is toxic because it inhibits mitochondrial [[cytochrome c oxidase]], causing the symptoms of [[hypoxia (medical)|hypoxia]] at the cellular level, and also causing [[metabolic acidosis]], among a variety of other metabolic disturbances.<ref>{{Cite journal |author=Liesivuori J, Savolainen H |title=Methanol and formic acid toxicity: biochemical mechanisms |journal=Pharmacol. Toxicol. |volume=69 |issue=3 |pages=157–63 |date=September 1991 |pmid=1665561 |doi= 10.1111/j.1600-0773.1991.tb01290.x}}</ref>

Methanol poisoning can be treated with [[fomepizole]], or if unavailable, ethanol.<ref name="Schep"/><ref>{{cite journal |author=Casavant MJ |title=Fomepizole in the treatment of poisoning |journal=Pediatrics |volume=107 |issue=1 |pages=170–171 |date=Jan 2001 |pmid=11134450 |url=http://pediatrics.aappublications.org/cgi/content/full/107/1/170 |doi=10.1542/peds.107.1.170}}</ref><ref name="Brent">{{cite journal |author=Brent J |title=Fomepizole for ethylene glycol and methanol poisoning |journal=N Engl J Med |volume=360 |issue=21 |pages=2216–23 |date=May 2009 |pmid=19458366 |doi=10.1056/NEJMct0806112}}</ref> Both drugs act to reduce the action of [[alcohol dehydrogenase]] on methanol by means of [[competitive inhibition]], so it is excreted by the [[kidney]]s rather than being transformed into toxic metabolites.<ref name="Schep"/> Further treatment may include giving [[sodium bicarbonate]] for metabolic acidosis, and [[hemodialysis]] or [[hemodiafiltration]] can be used to remove methanol and formate from the blood.<ref name="Schep"/> [[Folinic acid]] or [[folic acid]] is also administered to enhance the metabolism of formate.<ref name="Schep"/>

The initial symptoms of methanol intoxication include [[central nervous system]] [[depressant|depression]], headache, dizziness, nausea, lack of coordination, and confusion. Sufficiently large doses can cause unconsciousness and death. The initial symptoms of methanol exposure are usually less severe than the symptoms resulting from the ingestion of a similar quantity of ethanol.<ref name=ershdb /> Once the initial symptoms have passed, a second set of symptoms arises, 10 to as many as 30 hours after the initial exposure to methanol, including blurring or complete loss of vision, [[acidosis]] and putaminal hemorrhages, an uncommon but serious complication.<ref name="Schep"/><ref>{{cite journal |author=Permpalung N, Cheungpasitporn W, Chongnarungsin D, Hodgdon TM|title=Bilateral putaminal hemorrhages: serious complication of methanol intoxication|journal=N Am J Med Sci|volume=5 |issue=10 |pages=623–4 |date=Oct 2013 |pmid=24350079 |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3842708/|doi=10.4103/1947-2714.120804 |pmc=3842708}}</ref> These symptoms result from the accumulation of toxic levels of [[formate]] in the blood, and may progress to death by [[respiratory failure]]. Physical examination may show [[tachypnea]], and ophthalmologic examination may show dilated pupils with [[hyperemia]] of the optic disc and retinal [[edema]].

Ethanol is sometimes [[denatured alcohol|denatured]] (adulterated), and made poisonous, by the addition of methanol. The result is known as methylated spirit, "meths" (British use) or "metho" (Australian slang). These are not to be confused with "meth", a common abbreviation for [[methamphetamine]], and an abbreviation for [[methadone]] in Britain.

Small amounts of methanol are produced by the metabolism of food and are generally harmless, being metabolized quickly and completely.

==Applications==
Methanol is a common laboratory solvent. It is especially useful for [[HPLC]] and [[UV/VIS spectroscopy]] due to its low UV cutoff.

===Feedstock===
The largest use of methanol by far, is in making other chemicals. About 40% of methanol is converted to [[formaldehyde]], and from there into products as diverse as [[plastic]]s, [[plywood]], [[paint]]s, [[explosive]]s, and [[permanent press]] [[textile]]s.

Also in the early 1970s, a [[Methanol to gasoline]] process was developed by [[Mobil]] for producing gasoline ready for use in vehicles. One such industrial facility was built in [[New Zealand]] in the 1980s. In the 1990s, large amounts of methanol were used in the [[United States]] to produce the gasoline additive [[methyl tert-butyl ether]] (MTBE), though leakage has led to many states banning it. In addition to direct use as a fuel, methanol (or less commonly, [[ethanol]]) is used as a component in the [[transesterification]] of [[triglycerides]] to yield a form of [[biodiesel]].

Other chemical derivatives of methanol include [[dimethyl ether]], which has replaced [[chlorofluorocarbon]]s as an [[aerosol spray#Propellant|aerosol spray propellant]], and [[acetic acid]].

===Automotive fuel===
{{main|Methanol fuel}}
Methanol is used on a limited basis to fuel [[internal combustion engine]]s, mainly by virtue of the fact that it is not nearly as [[flammable]] as [[gasoline]]. Pure methanol is required by rule to be used in [[Champcars]], [[USAC]] sprint cars (as well as midgets, modifieds, etc.), and other dirt track series such as [[World of Outlaws]]. Methanol is also used in [[radio controlled model]] [[Model aircraft|airplanes]] (required in the "[[Glow plug (model engine)|glow-plug]]" engines that primarily power them), cars and trucks. [[Drag racing|Drag racers]] and mud racers also use methanol as their primary fuel source. Methanol is required with a supercharged engine in a [[Top Alcohol Dragster]] and, until the end of the 2006 season, all vehicles in the [[Indianapolis 500]] had to run methanol. [[Mud racer]]s have mixed methanol with gasoline and nitrous oxide to produce more power than gasoline and nitrous oxide alone.

One of the drawbacks of methanol as a fuel is its [[corrosion|corrosivity]] to some metals, including [[aluminium]]. Methanol, although a weak acid, attacks the oxide coating that normally protects the aluminium from corrosion:

:6 CH<sub>3</sub>OH + Al<sub>2</sub>O<sub>3</sub> → 2 Al(OCH<sub>3</sub>)<sub>3</sub> + 3 H<sub>2</sub>O

The resulting [[methoxide]] salts are soluble in methanol, resulting in clean aluminum surface, which is readily oxidised by some dissolved [[oxygen]]. Also the methanol can act as an oxidizer:

:6 CH<sub>3</sub>OH + 2 Al → 2 Al(OCH<sub>3</sub>)<sub>3</sub> + 3 H<sub>2</sub>

This reciprocal process effectively fuels corrosion until either the metal is eaten away or the concentration of CH<sub>3</sub>OH is negligible.

When produced from wood or other organic materials, the resulting organic methanol ([[bioalcohol]]) has been suggested as renewable alternative to petroleum-based [[hydrocarbon]]s. However, one cannot use pure methanol in modern petroleum cars without modification, due to potential damage to metal piping and rubber seals.

===Other applications===
Methanol is a traditional denaturant for ethanol, thus giving the term ''[[methylated spirit]]''.

Methanol is also used as a [[solvent]], and as an [[antifreeze (coolant)|antifreeze]] in [[Pipeline transport|pipelines]] and [[windshield washer fluid]].

In some [[wastewater treatment plant]]s, a small amount of methanol is added to [[wastewater]] to provide a food source of carbon for the [[denitrifying bacteria]], which convert [[nitrate]]s to [[nitrogen]].

During [[World War II]], methanol was used as a fuel in several German military rocket designs, under name '''M-Stoff''', and in a mixture as [[C-Stoff]].

Methanol is used as a denaturing agent in [[polyacrylamide gel electrophoresis]].

[[Direct-methanol fuel cell]]s are unique in their low temperature, atmospheric pressure operation, allowing them to be miniaturized to an unprecedented degree. This, combined with the relatively easy and safe storage and handling of methanol may open the possibility of fuel cell-powered [[consumer electronics]], such as for laptop computers.<ref>{{cite web|url=http://www.compukiss.com/populartopics/tech_gadgetshtm/article887.htm|title=Methanol Laptop Fuel|author=Sandy Berger|publisher=Compu·Kiss|date=September 30, 2006|accessdate=2007-05-22}}</ref>

==Health and safety==
Methanol is [[toxic]] by two mechanisms. Firstly, methanol (whether it enters the body by [[ingestion]], [[inhalation]], or [[absorption (chemistry)|absorption]] through the [[skin]]) can be fatal due to its [[CNS depressant]] properties in the same manner as [[ethanol]] poisoning. Secondly, it is [[toxic]] by its breakdown ([[toxication]]) by the [[enzyme]] [[alcohol dehydrogenase]] in the [[liver]] by forming [[formic acid]] and [[formaldehyde]] which cause permanent [[blindness]] by destruction of the [[optic nerve]].<ref>{{cite web|url=http://www.newton.dep.anl.gov/askasci/chem03/chem03561.htm|title=Methanol and Blindness|publisher=Ask A Scientist, Chemistry Archive|accessdaymonth=22 May|accessyear=2007}}</ref> Fetal tissue will not tolerate methanol. Dangerous doses will build up if a person is regularly exposed to vapors or handles liquid without skin protection. If methanol has been ingested, a doctor should be contacted immediately. The usual fatal dose is 100–125 mL (4 fl oz). Toxic effects take hours to start, and effective antidotes can often prevent permanent damage. This is treated using [[ethanol]] or [[fomepizole]].<ref>{{cite online journal|url=http://pediatrics.aappublications.org/cgi/content/full/107/1/170|title=Fomepizole in the Treatment of Poisoning|journal=Pediatrics|date=January 2001|issue=No. 1|volume=107|accessdaymonth=22 May|accessyear=2007}}</ref> Either of these drugs acts to slow down the action of [[alcohol dehydrogenase]] on methanol by means of [[competitive inhibition]], so that it is excreted by the [[kidney]]s rather than being transformed into toxic metabolites.

The initial symptoms of methanol intoxication are those of [[central nervous system]] [[depressant|depression]]: headache, dizziness, nausea, lack of coordination, confusion, drowsiness, and with sufficiently large doses, unconsciousness and death. The initial symptoms of methanol exposure are usually less severe than the symptoms resulting from the ingestion of a similar quantity of [[ethyl alcohol]].

Once the initial symptoms have passed, a second set of symptoms arises 10–30 hours after the initial exposure to methanol: blurring or complete loss of vision, together with [[acidosis]]. These symptoms result from the accumulation of toxic levels of [[formate]] in the bloodstream, and may progress to death by [[respiratory failure]]. The [[ester]] derivatives of methanol do not share this toxicity.

Ethanol is sometimes denatured (adulterated), and thus made undrinkable, by the addition of methanol. The result is known as [[methylated spirit]] or "meths" (UK use). (The latter should not be confused with ''meth'', a common abbreviation for [[methamphetamine]].)

Pure methanol has been used in [[open wheel car|open wheel auto racing]] since the mid-1960s. Unlike petroleum fires, methanol fires can be [[active fire protection|extinguished]] with plain water. A methanol-based fire burns invisibly, unlike gasoline, which burns with visible smoke. If a fire occurs on the track, there is no smoke to obstruct the view of fast approaching drivers, but this can also delay visual detection of the fire and the initiation of fire suppression actions. The decision to permanently switch to methanol in American [[American Championship Car Racing|IndyCar]] racing was a result of the devastating crash and explosion at the [[1964 Indianapolis 500]] which killed drivers [[Eddie Sachs]] and [[Dave MacDonald]].<ref>{{Citation
| last = McDonald
| first = Norris
| title = Green no longer bad luck at Indy
| newspaper = Toronto Star
| url = http://www.thestar.com/comment/columnists/article/205088 }}</ref>

One concern with the addition of methanol to automotive fuels is highlighted by recent groundwater impacts from the fuel additive [[methyl tert-butyl ether]] (MTBE). Leaking underground gasoline storage tanks created MTBE plumes in groundwater that eventually contaminated well water. Methanol's high solubility in water raises concerns that similar well water contamination could arise from the widespread use of methanol as an automotive fuel.

==See also==
* [[Liquid fuel]]s
* [[Methanol fuel]]
* [[List of Stoffs]]
* [[Methanol (data page)]]
* [[Methanol economy]]
* [[Aspartame]]
* [[Methanol to gasoline]]

==References==
<references/>

==Additional Resource==
*[[Robert Boyle]], ''[[The Sceptical Chymist]]'' (1661) – contains account of distillation of wood alcohol.

==External links==
*{{ICSC|0057|00}}
*[http://www.racecarbook.com Race Car Book] RaceCarBook.com, includes technical articles and methanol racing book information.
*[http://methanol.org The Methanol Institute] Industry trade group, lots of information on methanol's use in fuel cells and as an alternative fuel.
*[http://www.setamericafree.org/Rnichols.pdf The methanol story: a sustainable fuel for the future] article by Ford Motor's Roberta Nichols, the mother of the flexible fuel vehicle, discussing Gasoline-Ethanol-Methanol flexibility in the Journal of Scientific & Industrial Research
* [http://www.npi.gov.au/database/substance-info/profiles/54.html National Pollutant Inventory - Methanol Fact Sheet]
*[http://www.bluerhinos.co.uk/molview/indv.php?id=1 Molview from bluerhinos.co.uk] See Methanol in 3D
*[http://www.labnews.co.uk/new_labnews/article.php?artid=1017&categoryid=2&scheme=2 Methanol Discovered in Space]

{{Alcohols}}

[[Category:Alcohols]]
[[Category:Biofuels]]
[[Category:Hazardous air pollutants]]
[[Category:Alcohol solvents]]
[[Category:anatomical preservation]]

[[af:Metanol]]
[[ar:ميثانول]]
[[bs:Metanol]]
[[bg:Метанол]]
[[ca:Metanol]]
[[cs:Methanol]]
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[[de:Methanol]]
[[et:Metanool]]
[[es:Metanol]]
[[eo:Metanolo]]
[[eu:Metanol]]
[[fa:متانول]]
[[fr:Méthanol]]
[[ko:메탄올]]
[[hr:Metanol]]
[[id:Metanol]]
[[it:Metanolo]]
[[he:מתנול]]
[[la:Methanol]]
[[lv:Metanols]]
[[lb:Methanol]]
[[lt:Metanolis]]
[[hu:Metanol]]
[[nl:Methanol]]
[[ja:メタノール]]
[[no:Metanol]]
[[nn:Metanol]]
[[pl:Alkohol metylowy]]
[[pt:Metanol]]
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[[ru:Метанол]]
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[[zh:甲醇]]

{{jb1}}
{{WH}}
{{WikiDoc Sources}}

Vision loss

2016-02-02T04:36:15Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Lethal congenital contracture syndrome]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome]]
*[[Linear IgA bullous dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Oculocerebrorenal syndrome]]
*[[Macular degeneration]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol poisoning]]
*[[Microcephaly, microphthalmos]]
*[[Microphthalmia]]
*[[Microvascular complications of diabetes]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucosa-associated lymphoid tissue]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[X-linked intellectual disability]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T04:18:52Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Lethal congenital contracture syndrome]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome]]
*[[Linear IgA bullous dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Oculocerebrorenal syndrome]]
*[[Macular degeneration]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Abetalipoproteinemia|Mental retardation, hypocupremia, hypobetalipoproteinemia]]
*[[Mental retardation unusual facies ampola type]]
*[[Mental retardation, x-linked, wittwer type]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol poisoning]]
*[[Microcephaly, microphthalmos]]
*[[Microphthalmia]]
*[[Microvascular complications of diabetes]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucosa-associated lymphoid tissue]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T04:15:00Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Lethal congenital contracture syndrome]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome]]
*[[Linear IgA bullous dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Oculocerebrorenal syndrome]]
*[[Macular degeneration]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mental retardation, hypocupremia, hypobetalipoproteinemia]]
*[[Mental retardation unusual facies ampola type]]
*[[Mental retardation, x-linked, wittwer type]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol poisoning]]
*[[Microcephaly, microphthalmos]]
*[[Microphthalmia]]
*[[Microvascular complications of diabetes]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucosa-associated lymphoid tissue]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T04:14:15Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Lethal congenital contracture syndrome]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome]]
*[[Linear IgA bullous dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Oculocerebrorenal syndrome]]
*[[Macular degeneration]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marsden syndrome]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mental retardation, hypocupremia, hypobetalipoproteinemia]]
*[[Mental retardation unusual facies ampola type]]
*[[Mental retardation, x-linked, wittwer type]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol poisoning]]
*[[Microcephaly, microphthalmos]]
*[[Microphthalmia]]
*[[Microvascular complications of diabetes]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucosa-associated lymphoid tissue]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T03:10:44Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Lethal congenital contracture syndrome]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome]]
*[[Linear IgA bullous dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Oculocerebrorenal syndrome]]
*[[Macular degeneration]]
*[[Macular dystrophy, concentric annular]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marsden syndrome]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mental retardation, hypocupremia, hypobetalipoproteinemia]]
*[[Mental retardation unusual facies ampola type]]
*[[Mental retardation, x-linked, wittwer type]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol poisoning]]
*[[Microcephaly, microphthalmos]]
*[[Microphthalmia]]
*[[Microvascular complications of diabetes]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucosa-associated lymphoid tissue]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T03:07:29Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Lethal congenital contracture syndrome]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome]]
*[[Linear IgA bullous dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Oculocerebrorenal syndrome]]
*[[Lymphoma, mucosa-associated lymphoid tissue]]
*[[Macular degeneration]]
*[[Macular dystrophy, concentric annular]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marsden syndrome]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mental retardation, hypocupremia, hypobetalipoproteinemia]]
*[[Mental retardation unusual facies ampola type]]
*[[Mental retardation, x-linked, wittwer type]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol poisoning]]
*[[Microcephaly, microphthalmos]]
*[[Microphthalmia]]
*[[Microvascular complications of diabetes]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T03:03:39Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Lethal congenital contracture syndrome]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome]]
*[[Linear IgA bullous dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Lowe oculocerebrorenal syndrome]]
*[[Lymphoma, mucosa-associated lymphoid tissue]]
*[[Macular degeneration]]
*[[Macular dystrophy, concentric annular]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marsden syndrome]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mental retardation, hypocupremia, hypobetalipoproteinemia]]
*[[Mental retardation unusual facies ampola type]]
*[[Mental retardation, x-linked, wittwer type]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol poisoning]]
*[[Microcephaly, microphthalmos]]
*[[Microphthalmia]]
*[[Microvascular complications of diabetes]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T03:01:09Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Lethal congenital contracture syndrome]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome]]
*[[Linear igA dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Lowe oculocerebrorenal syndrome]]
*[[Lymphoma, mucosa-associated lymphoid tissue]]
*[[Macular degeneration]]
*[[Macular dystrophy, concentric annular]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marsden syndrome]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mental retardation, hypocupremia, hypobetalipoproteinemia]]
*[[Mental retardation unusual facies ampola type]]
*[[Mental retardation, x-linked, wittwer type]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol poisoning]]
*[[Microcephaly, microphthalmos]]
*[[Microphthalmia]]
*[[Microvascular complications of diabetes]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Lethal congenital contracture syndrome

2016-02-02T02:59:30Z

Jyostna Chouturi: Created page with "__NOTOC__ {{CMG}} {{AE}} {{JC}} ==Overview== '''Lethal congenital contracture syndrome 1''' (LCCS1), also called '''Multiple contracture syndrome, Finnish type''',<ref name..."

__NOTOC__

{{CMG}} {{AE}} {{JC}}

==Overview==
'''Lethal congenital contracture syndrome 1''' (LCCS1), also called '''Multiple contracture syndrome, Finnish type''',<ref name=omim>{{OMIM|255310}}</ref> is an [[autosome|autosomal]] [[dominance (genetics)|recessive]] [[genetic disorder]] characterized by total immobility of a fetus, detectable at around the 13th week of pregnancy. LCCS1 invariably leads to prenatal death before the 32nd gestational week. LCCS1 is one of 40 [[Finnish heritage disease]]s. It was first described in 1985 and since then, approximately 70 cases have been diagnosed.<ref name="norio">{{cite journal
| author = Norio R
| title = The Finnish disease heritage III: the individual diseases
| journal = Hum. Genet.
| volume = 112
| pages = 486–487
| year = 2003
| pmid = 12627297
| issue = 5–6
| doi = 10.1007/s00439-002-0877-1}}</ref>

==Characteristics==

LCCS1 is characterized by total lack of the movements of the [[fetus]], and is detectable at 13th week of [[pregnancy]]. It is accompanied by oedema, small chin, small lungs, crooked joints and occasional skin webs of the neck and elbows. The fetus has characteristic pattern of malpositions recognizable even in severely macerated fetuses with club feet and hyperextension of the knees but the elbows and wrists showing flexion contractures.<ref name="herva1985">{{cite journal
| author = Herva R, Leisti J, Kirkinen P, Seppänen U
| title = A lethal autosomal recessive syndrome of multiple congenital contractures
| journal = Am. J. Med. Genet.
| volume = 20
| pages = 431–439
| year = 1985
| pmid = 3993672
|doi=10.1002/ajmg.1320200303
| issue = 3}}</ref>

Neuropathological analysis shows lack of anterior horn motoneurons and severe atrophy of the ventral spinal cord. The skeletal muscles are severely hypoplastic.<ref name="herva1998">{{cite journal
| author = Herva R, Conradi N, Kalimo H, Leisti J, Sourander P
| title = A lethal autosomal recessive syndrome of multiple congenital contractures. Neuropathological analysis of five fetal cases
| journal = Am. J. Med. Genet.
| volume = 29
| pages = 67–76
| year = 1988
| doi = 10.1002/ajmg.1320290109
| pmid = 3344776
| issue = 1
}}</ref>

==Cause==

The defective gene associated with LCCS1 is mRNA export mediator [[GLE1L|GLE1]] at [[chromosome]] [[chromosome 9|9q34]]. In more than 40 families the fetus has been homozygous for A->G substitution (c.432-10A>G) located in intron 3 of GLE1 creating an illegitimate splice acceptor site resulting in nine extra nucleotides in the GLE1 cDNA (GLE1 FinMajor mutation). In one family the fetus has been compound heterozygous for GLE1 FinMajor and R→H substitution in exon 12.<ref name="nousiainen">{{cite journal
| author = Nousiainen HO, Kestilä M, Pakkasjärvi N, Honkala H, Kuure S, Tallila J, Vuopala K, Ignatius J, Herva R, Peltonen L
| title = Mutations in mRNA export mediator GLE1 result in a fetal motoneuron disease
| journal = Nature Genetics
| volume = 40
| issue = 2
| pages = 155–157
| year = 2008
| pmid = 18204449
| doi = 10.1038/ng.2007.65
| pmc = 2684619}}</ref>

A slightly milder phenotype with survival beyond 32nd gestational week also characterized by foetal akinesia, arthrogryposis and anterior horn cell loss ([[Lethal arthrogryposis with anterior horn cell disease]], LAAHD) was also shown to be allelic to LCCS1 and result from mutations in GLE1.

== Genetics ==

[[Image:Autorecessive.svg|thumb|right|Lethal congenital contracture syndrome has an autosomal recessive pattern of [[heredity|inheritance]].]]

LCCS1 is inherited in an autosomal recessive manner.<ref name="herva1998"/> This means the defective gene responsible for the disorder (GLE1) is located on an [[autosome]] (chromosome 9), and two copies of the defective gene (one inherited from each parent) are required in order to be born with the disorder. The parents of an individual with an autosomal recessive disorder both [[genetic carrier|carry]] one copy of the defective gene, but usually do not experience any signs or symptoms of the disorder.

===Population genetics===

LCCS1 belongs to Finnish heritage of diseases and cases have been confirmed until now (2009) only in Finland. The prevalence is 1 in 25000 births.<ref name="pakkasjarvi">{{cite journal
| author = Pakkasjärvi N, Ritvanen A, Herva R, Peltonen L, Kestilä M, Ignatius J
| title = Lethal congenital contracture syndrome (LCC) and other lethal arthrogryposes in Finland – an epidemiological study
| journal = Am. J. Med. Genet.
| volume = 140A
| pages = 1834–1839
| year = 2006
| doi = 10.1002/ajmg.a.31381
| pmid = 16892327
| issue = 17}}</ref> The carrier frequency is 1% in whole Finland and 2% in North-Eastern part of Finland where the birthplaces of ancestors of affected individual show clustering.

===Mapping===

Mäkelä-Bengs et al. (1997,1998) performed a genome-wide screening and linkage analysis and assigned the LCCS locus to a defined region of 9q34.<ref name="makela">{{cite journal
| author = Mäkelä-Bengs P, Järvinen N, Vuopala K, Suomalainen A, Palotie A, Peltonen L
| title = The assignment the lethal congenital contracture syndrome (LCCS) locus to chromosome 9q33-34
| journal = Am. J. Hum. Genet.
| volume = 61
| issue = suppl
| pages = A30
| year = 1997}}</ref>

==References==
{{reflist|2}}

==See also==
*[[Lethal arthrogryposis with anterior horn cell disease]]

[[Category:Rare diseases]]
[[Category:Autosomal recessive disorders]]
[[Category:Syndromes]]

Vision loss

2016-02-02T02:53:37Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Leber hereditary optic neuropathy]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome (lccs)]]
*[[Linear igA dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Lowe oculocerebrorenal syndrome]]
*[[Lymphoma, mucosa-associated lymphoid tissue]]
*[[Macular degeneration]]
*[[Macular dystrophy, concentric annular]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marsden syndrome]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mental retardation, hypocupremia, hypobetalipoproteinemia]]
*[[Mental retardation unusual facies ampola type]]
*[[Mental retardation, x-linked, wittwer type]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol poisoning]]
*[[Microcephaly, microphthalmos]]
*[[Microphthalmia]]
*[[Microvascular complications of diabetes]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T02:45:30Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Leber hereditary optic neuropathy]]
*[[Leg absence, deformity, cataract]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome (lccs)]]
*[[Linear igA dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Lowe oculocerebrorenal syndrome]]
*[[Lymphoma, mucosa-associated lymphoid tissue]]
*[[Macular degeneration]]
*[[Macular dystrophy, concentric annular]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marsden syndrome]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mental retardation, hypocupremia, hypobetalipoproteinemia]]
*[[Mental retardation unusual facies ampola type]]
*[[Mental retardation, x-linked, wittwer type]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol poisoning]]
*[[Microcephaly, microphthalmos]]
*[[Microphthalmia]]
*[[Microvascular complications of diabetes]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T02:44:38Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lattice corneal dystrophy type 1]]
*[[Lawrence-Moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Leber hereditary optic neuropathy]]
*[[Leg absence, deformity, cataract]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome (lccs)]]
*[[Linear igA dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Lowe oculocerebrorenal syndrome]]
*[[Lymphoma, mucosa-associated lymphoid tissue]]
*[[Macular degeneration]]
*[[Macular dystrophy, concentric annular]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marsden syndrome]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mental retardation, hypocupremia, hypobetalipoproteinemia]]
*[[Mental retardation unusual facies ampola type]]
*[[Mental retardation, x-linked, wittwer type]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol poisoning]]
*[[Microcephaly, microphthalmos]]
*[[Microphthalmia]]
*[[Microvascular complications of diabetes]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T02:35:18Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Langerhans cell histiocytosis]]
*[[Lattice corneal dystrophy type 1]]
*[[Laurence-moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Leber hereditary optic neuropathy]]
*[[Leg absence, deformity, cataract]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome (lccs)]]
*[[Linear igA dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Lowe oculocerebrorenal syndrome]]
*[[Lymphoma, mucosa-associated lymphoid tissue]]
*[[Macular degeneration]]
*[[Macular dystrophy, concentric annular]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marsden syndrome]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mental retardation, hypocupremia, hypobetalipoproteinemia]]
*[[Mental retardation unusual facies ampola type]]
*[[Mental retardation, x-linked, wittwer type]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol poisoning]]
*[[Microcephaly, microphthalmos]]
*[[Microphthalmia]]
*[[Microvascular complications of diabetes]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T02:32:42Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Krause syndrome]]
*[[Langerhans cell histiocytosis]]
*[[Lattice corneal dystrophy type 1]]
*[[Laurence-moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Leber hereditary optic neuropathy]]
*[[Leg absence, deformity, cataract]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome (lccs)]]
*[[Linear igA dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Lowe oculocerebrorenal syndrome]]
*[[Lymphoma, mucosa-associated lymphoid tissue]]
*[[Macular degeneration]]
*[[Macular dystrophy, concentric annular]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marsden syndrome]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mental retardation, hypocupremia, hypobetalipoproteinemia]]
*[[Mental retardation unusual facies ampola type]]
*[[Mental retardation, x-linked, wittwer type]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol poisoning]]
*[[Microcephaly, microphthalmos]]
*[[Microphthalmia]]
*[[Microvascular complications of diabetes]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T02:32:02Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Krause syndrome]]
*[[Langerhans cell histiocytosis]]
*[[Lattice corneal dystrophy type 1]]
*[[Laurence-moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Leber hereditary optic neuropathy]]
*[[Leg absence, deformity, cataract]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome (lccs)]]
*[[Linear igA dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Lowe oculocerebrorenal syndrome]]
*[[Lymphoma, mucosa-associated lymphoid tissue]]
*[[Macular degeneration]]
*[[Macular dystrophy, concentric annular]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marsden syndrome]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mental retardation, hypocupremia, hypobetalipoproteinemia]]
*[[Mental retardation unusual facies ampola type]]
*[[Mental retardation, x-linked, wittwer type]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol poisoning]]
*[[Microcephaly, microphthalmos]]
*[[Microphthalmia]]
*[[Microvascular complications of diabetes]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Pantothenate kinase-associated neurodegeneration]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T02:30:07Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Juvenile macular degeneration and hypotrichosis]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Krause syndrome]]
*[[Langerhans cell histiocytosis]]
*[[Lattice corneal dystrophy type 1]]
*[[Laurence-moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Leber hereditary optic neuropathy]]
*[[Leg absence, deformity, cataract]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome (lccs)]]
*[[Linear igA dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Lowe oculocerebrorenal syndrome]]
*[[Lymphoma, mucosa-associated lymphoid tissue]]
*[[Macular degeneration]]
*[[Macular dystrophy, concentric annular]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marsden syndrome]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mental retardation, hypocupremia, hypobetalipoproteinemia]]
*[[Mental retardation unusual facies ampola type]]
*[[Mental retardation, x-linked, wittwer type]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol poisoning]]
*[[Microcephaly, microphthalmos]]
*[[Microphthalmia]]
*[[Microvascular complications of diabetes]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Pantothenate kinase-associated neurodegeneration]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T02:21:27Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Pantothenate kinase-associated neurodegeneration|Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Juvenile macular degeneration and hypotrichosis]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Krause syndrome]]
*[[Langerhans cell histiocytosis]]
*[[Lattice corneal dystrophy type 1]]
*[[Laurence-moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Leber hereditary optic neuropathy]]
*[[Leg absence, deformity, cataract]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome (lccs)]]
*[[Linear igA dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Lowe oculocerebrorenal syndrome]]
*[[Lymphoma, mucosa-associated lymphoid tissue]]
*[[Macular degeneration]]
*[[Macular dystrophy, concentric annular]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marsden syndrome]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mental retardation, hypocupremia, hypobetalipoproteinemia]]
*[[Mental retardation unusual facies ampola type]]
*[[Mental retardation, x-linked, wittwer type]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol poisoning]]
*[[Microcephaly, microphthalmos]]
*[[Microphthalmia]]
*[[Microvascular complications of diabetes]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Pantothenate kinase-associated neurodegeneration]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt's disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Pantothenate kinase-associated neurodegeneration

2016-02-02T02:20:49Z

Jyostna Chouturi:

__NOTOC__
{{CMG}} {{AE}} {{JC}}

{{SK}}: Hallervorden–Spatz syndrome
==Overview==
'''Pantothenate kinase-associated neurodegeneration''' (PKAN), also known as '''[[neurodegeneration with brain iron accumulation]] 1''' (NBIA1) and formerly called '''Hallervorden–Spatz syndrome''' (use of this eponym is somewhat discouraged due to [[Julius Hallervorden|Hallervorden]] and [[Hugo Spatz|Spatz]]'s affiliation with the Nazi regime and the ethically questionable manner in which they acted<ref>{{cite journal |last= Bazelon |first=Emily |date= Nov 6, 2013 |title= The Nazi Anatomists |url= http://www.slate.com/articles/life/history/2013/11/nazi_anatomy_history_the_origins_of_conservatives_anti_abortion_claims_that.html |journal= Slate Magazine |location= Web-based |publisher= The Washington Post Company |accessdate= Nov 7, 2013}}</ref><ref>{{whonamedit|doctor|535}}</ref><ref>{{whonamedit|doctor|1063}}</ref>), is a [[degenerative disease]] of the [[brain]] that can lead to [[parkinsonism]], dystonia, dementia, and ultimately death. Neurodegeneration in PKAN is accompanied by an excess of [[iron]] that progressively builds up in the brain.

==Signs and symptoms==
Symptoms typically begin in childhood and are progressive, often resulting in death by early adulthood. Symptoms of PKAN begin before middle childhood, and most often are noticed before ten years of age. Symptoms include:
*[[dystonia]] (repetitive uncontrollable muscle contractions that may cause jerking or twisting of certain muscle groups)
*[[dysphagia]] & [[dysarthria]] due to muscle groups involved in speech being involved
*rigidity/stiffness of limbs
*[[tremor]]
*writhing movements
*[[dementia]]
*[[spasticity]]
*[[Rigidity (neurology)]]
*[[weakness]]
*[[seizure]]s (rare)
*[[toe walking]]
*[[retinitis pigmentosa]], another degenerative disease that affects the individual’s [[retina]], often causing alteration of retinal color and progressive deterioration of the retina at first causing [[night blindness]] and later resulting in a complete loss of vision.

25% of individuals experience an uncharacteristic form of PKAN that develops post-10 years of age and follows a slower, more gradual pace of deterioration than those pre-10 years of age. These individuals face significant speech deficits as well as psychiatric and behavioral disturbances.

Being a progressive, degenerative nerve illness, PKAN leads to early immobility and often death by early adulthood. Death occurs prematurely due to infections such as pneumonia, and the disease in itself is technically not life limiting.

==Genetics==
PKAN is an [[autosomal]] [[recessive]] disorder. The parents of an afflicted child must both be [[heterozygous]] carriers for the disease and therefore must carry one [[mutant]] [[allele]]. As it is an autosomal disorder, those [[heterozygous]] for the disorder may not display any atypical characteristics that are considered suggestive of the disorder, however there have been reported cases of [[compound heterozygosity]] in which heterozygous individuals do develop the classic form of the disease.<ref name="Zhou2001" /><ref>{{cite journal |author=Bei-sha, Tang|title=Novel compound heterozygous mutations in the PANK2 gene in a Chinese patient with atypical pantothenate kinase-associated neurodegeneration |journal=Movement Disorders |volume=20 |issue=7 |pages=819–21 |year=2005 |pmid=15747360 |doi=10.1002/mds.20408 |pmc=2105744|display-authors=etal}}</ref>

The disorder is caused by a mutant [[PANK2]] gene located at the [[chromosome|chromosomal]] [[Locus (genetics)|locus]]: 20p13-p12.3. [[PANK2]] is responsible in coding for the protein [[Pantothenate kinase]] 2, which in turn is responsible for stifling the accumulation of [[N-pantothenoyl-cysteine]] and [[pantetheine]]. It is believed that when this accumulation is not suppressed, the result is direct cell [[toxicity]] or cell toxicity as a result of free radical damage due to the lack of suppression.

PANK2 encodes a 1.85Kb transcript which is derived from seven exons covering a total distance of approximately 3.5Mb of genomic DNA. The PANK2 gene also encodes a 50.5-kDa[[protein]] that is a functional pantothenate [[kinase]], an essential regulatory [[enzyme]] in [[coenzyme A]] (CoA) biosynthesis, and catalyzing the phosphorylation of pantothenate ([[Vitamin B5|vitamin B<sub>5</sub>]]), N-pantothenoyl-cysteine, and pantetheine (OMIM).

Mutant PANK2 gene coded proteins are often caused by null or [[missense mutation]]s most notably a 7bp deletion in the PANK2 [[gene]] coding sequence.

This disorder has been reported in specific communities based on intra-community marriages where both parents of the child are carrying the same mutation. One of the communities reported is Agrawal (Agarwal) Community mainly based in Northern Part of India.The known mutation in Agarwal community is pathogenic mutation 1c.215_216insA in PANK2 gene. This is also coded as chr20:3870292-3870293insA by some labs. It results in a frameshift and premature truncation of the protein 47 amino acids downstream to codon 183 (p.Arg183GlufsTer47; ENST00000316562).
<ref>http://www.scribd.com/doc/95164360/PANK2-Agarwal</ref>
<ref>http://www.britannica.com/bps/additionalcontent/18/27764296/Founder-mutation-in-the-PANK-gene-of-Agrawal-children-with-Neurodegeneration-with-Brain-Iron-accumulation-NBIA</ref>

==Diagnosis==
[[File:Pkan-basal-ganglia-MRI.JPG|200Px|centre]]
A neurological examination would show evidence of muscle rigidity; weakness; and abnormal postures, movements, and tremors. If other family members are also affected, this may help determine the diagnosis. Genetic tests can confirm an abnormal gene causing the disease. However, this test is not yet widely available. Other movement disorders and diseases must be ruled out. Individuals exhibiting any of the above listed symptoms are often tested using [[MRI]] (Magnetic Resonance Imaging) for a number of neuro-related disorders. As PKAN is a disease prominently evident in the brain, MRIs are very useful in making a sound diagnosis. An MRI usually shows iron deposits in the [[basal ganglia]]. Development of diagnostic criteria continues in the hope of further separating PKAN from other forms of neurodegenerative diseases featuring NBIA.

===Neuropathology===
Microscopic features of PKAN include:
*Iron granules
*[[Spheroid bodies]]
*[[Lewy bodies]] within neurons

==Treatment==
There have been no major breakthroughs in the treatment of PKAN, with most [[Pharmacology|pharmacologic]] treatments focusing on the easing or temporary relieving of PKAN’s symptoms. Iron [[chelating]] agents have been used somewhat successfully in retarding the disorder, but they have not been a significant success.

Many believe taking certain vitamins may be beneficial, including [[pantothenate]], [[Coenzyme Q]], and other [[anti-oxidants]].{{Citation needed|date=March 2007}}

Current research focuses on the future use of high dose [[pantothenate]], the PANK2 enzyme substrate, in possibly alleviating symptoms as well as the further development of iron chelating agents that may be better aimed at reaching the central nervous system and working to better remove excess iron from the individual’s system.

Complications may result from the medication used to treat symptoms. Immobility from the disease can also lead to [[skin breakdown]], respiratory infections, and blood clots, among others.

==Prognosis==
Survival rates for those diagnosed with typical PKAN is 11.18 years with a standard deviation of 7.8 years.

==Epidemiology==
[[Prevalence]] data regarding this disorder remains incomplete, however it is estimated that anywhere between 1 in 1,000,000 to 3 in 1,000,000 individuals will be afflicted with this disorder (based upon observed cases in a population), but once again this is only an estimate as the disease is so rare it is difficult to statistically and accurately ascertain.

==History==
PKAN was first described by Hallervorden and Spatz (1922). Their discovery was brought about by a diagnosis of a family of 12 in which five sisters exhibited progressively increasing dementia and dysarthria. [[Autopsy|Autopsies]] revealed brown discolorations in different areas of the brain (particularly of interest were the globus pallidus and substantia nigra regions). Further investigation and description was brought about by Meyer (1958) who diagnosed 30 separate cases of PKAN. Meyer(1958) was followed by Elejalde et al. (1978) who described 5 affected family members and hypothesized that the disorder originated in central [[Europe]], backing up his hypothesis with clinical and genetic analysis. Further investigation and insights were provided by Malmstrom-Groth and Kristensson (1982)<ref>{{cite journal |author=Malmström-Groth AG, Kristensson K |title=Neuroaxonal dystrophy in childhood. Report of two second cousins with PKAN, and a case of Seitelberger's disease |journal=Acta paediatrica Scandinavica |volume=71 |issue=6 |pages=1045–9 |year=1982|pmid=7158329 |doi=10.1111/j.1651-2227.1982.tb09574.x}}</ref> and Jankovic et al. (1985).<ref>{{cite journal |author=Jankovic J, Kirkpatrick JB, Blomquist KA, Langlais PJ, Bird ED|title=Late-onset Hallervorden-Spatz disease presenting as familial parkinsonism |journal=Neurology |volume=35 |issue=2 |pages=227–34 |date=February 1985 |pmid=3969211 |doi= 10.1159/000153550|url=}}</ref>

Diagnosis of PKAN hit a milestone with the availability of MRIs, as well as the in-depth descriptions of those MRIs provided by Littrup and Gebarski (1985),<ref>{{cite journal|author=Jankovic J, Kirkpatrick JB, Blomquist KA, Langlais PJ, Bird ED |title=Late-onset Hallervorden-Spatz disease presenting as familial parkinsonism |journal=Neurology |volume=35|issue=2 |pages=227–34 |year=1985 |pmid=3969211 |doi=10.1159/000153550}}</ref> Tanfani et al. (1987),<ref>{{cite journal |author=Tanfani G, Mascalchi M, Dal Pozzo GC, Taverni N, Saia A, Trevisan C |title=MR imaging in a case of Hallervorden-Spatz disease |journal=Journal of computer assisted tomography |volume=11 |issue=6 |pages=1057–8 |year=1987|pmid=3680689 |doi=10.1097/00004728-198711000-00027}}</ref> Sethi et al. (1988),<ref>{{cite journal |author=Sethi KD, Adams RJ, Loring DW, el Gammal T |title=Hallervorden-Spatz syndrome: clinical and magnetic resonance imaging correlations |journal=Ann. Neurol. |volume=24 |issue=5 |pages=692–4 |year=1988 |pmid=3202617 |doi=10.1002/ana.410240519}}</ref> Angelini et al. (1992),<ref>{{cite journal |author=Angelini L, Nardocci N, Rumi V, Zorzi C, Strada L, Savoiardo M |title=Hallervorden-Spatz disease: clinical and MRI study of 11 cases diagnosed in life |journal=J. Neurol. |volume=239 |issue=8 |pages=417–25 |year=1992 |pmid=1447570 |doi=10.1007/BF00856805}}</ref> Casteels et al. (1994),<ref>{{cite journal |vauthors=Casteels I, Spileers W, Swinnen T, etal |title=Optic atrophy as the presenting sign in Hallervorden-Spatz syndrome |journal=Neuropediatrics |volume=25 |issue=5|pages=265–7 |year=1994 |pmid=7885538 |doi=10.1055/s-2008-1073034}}</ref> and Malandrini et al. (1995).<ref>{{cite journal |author=Malandrini A, Bonuccelli U, Parrotta E, Ceravolo R, Berti G, Guazzi GC |title=Myopathic involvement in two cases of Hallervorden-Spatz disease |journal=Brain Dev. |volume=17 |issue=4 |pages=286–90 |year=1995 |pmid=7503394|doi=10.1016/0387-7604(95)00039-E}}</ref> The gene was localized to chromosome 20p by Taylor et al. (1996) <ref name="Taylor1996">{{cite journal |author= Taylor TD, Litt M, Kramer P, Pandolfo M, Angelini L, Nardocci N, Davis S, Pineda M, Hattori H, Flett PJ, Cilio MR, Bertini E, Hayflick SJ |title=Homozygosity mapping of Hallervorden-Spatz syndrome to chromosome 20p12.3-p13 |journal=Nat. Genet. |volume=14 |issue=4 |pages=479–81 |year=1996 |pmid=8944032 |doi=10.1038/ng1296-479}}</ref> who suggested that this disorder should be referred to as neurodegeneration with brain iron accumulation (NBIA1) to avoid the objectionable eponym of Hallervorden-Spatz. The disease was named 'pantothenate kinase-associated neurodegeneration' or PKAN by Zhou et al. (2001)<ref name="Zhou2001">{{cite journal |author=Zhou B, Westaway SK, Levinson B, Johnson MA, Gitschier J, Hayflick SJ |title=A novel pantothenate kinase gene (PANK2) is defective in Hallervorden-Spatz syndrome |journal=Nat. Genet. |volume=28 |issue=4 |pages=345–9 |year=2001 |pmid=11479594|doi=10.1038/ng572}}</ref> who suggested the name to avoid misinterpretation and to better reflect the true nature of the disorder. Most recently Pellecchia et al. (2005) published a report of 16 patients afflicted with PKAN, confirmed by genetic analysis.<ref>{{cite journal |vauthors=Pellecchia MT, Valente EM, Cif L, etal |title=The diverse phenotype and genotype of pantothenate kinase-associated neurodegeneration |journal=Neurology |volume=64 |issue=10 |pages=1810–2 |year=2005 |pmid=15911822|doi=10.1212/01.WNL.0000161843.52641.EC}}</ref>

==References==
{{Reflist|2}}


==External links==
* {{Chorus|02041}}
* {{WhoNamedIt|synd|1082}}
* {{NINDS|nbia}}
* [http://nbiadisorders.org/ NBIA Disorders Association]

{{Diseases of the nervous system}}
{{Metabolic disorders of vitamins, coenzymes, and cofactors}}

{{DEFAULTSORT:Pantothenate Kinase-Associated Neurodegeneration}}
[[Category:Extrapyramidal and movement disorders]]
[[Category:Vitamin, coenzyme, and cofactor metabolism disorders]]

Pantothenate kinase-associated neurodegeneration

2016-02-02T02:20:26Z

Jyostna Chouturi:

__NOTOC__
{{CMG}} {{AE}} {{JC}}
{{SK}}: Hallervorden–Spatz syndrome
==Overview==
'''Pantothenate kinase-associated neurodegeneration''' (PKAN), also known as '''[[neurodegeneration with brain iron accumulation]] 1''' (NBIA1) and formerly called '''Hallervorden–Spatz syndrome''' (use of this eponym is somewhat discouraged due to [[Julius Hallervorden|Hallervorden]] and [[Hugo Spatz|Spatz]]'s affiliation with the Nazi regime and the ethically questionable manner in which they acted<ref>{{cite journal |last= Bazelon |first=Emily |date= Nov 6, 2013 |title= The Nazi Anatomists |url= http://www.slate.com/articles/life/history/2013/11/nazi_anatomy_history_the_origins_of_conservatives_anti_abortion_claims_that.html |journal= Slate Magazine |location= Web-based |publisher= The Washington Post Company |accessdate= Nov 7, 2013}}</ref><ref>{{whonamedit|doctor|535}}</ref><ref>{{whonamedit|doctor|1063}}</ref>), is a [[degenerative disease]] of the [[brain]] that can lead to [[parkinsonism]], dystonia, dementia, and ultimately death. Neurodegeneration in PKAN is accompanied by an excess of [[iron]] that progressively builds up in the brain.

==Signs and symptoms==
Symptoms typically begin in childhood and are progressive, often resulting in death by early adulthood. Symptoms of PKAN begin before middle childhood, and most often are noticed before ten years of age. Symptoms include:
*[[dystonia]] (repetitive uncontrollable muscle contractions that may cause jerking or twisting of certain muscle groups)
*[[dysphagia]] & [[dysarthria]] due to muscle groups involved in speech being involved
*rigidity/stiffness of limbs
*[[tremor]]
*writhing movements
*[[dementia]]
*[[spasticity]]
*[[Rigidity (neurology)]]
*[[weakness]]
*[[seizure]]s (rare)
*[[toe walking]]
*[[retinitis pigmentosa]], another degenerative disease that affects the individual’s [[retina]], often causing alteration of retinal color and progressive deterioration of the retina at first causing [[night blindness]] and later resulting in a complete loss of vision.

25% of individuals experience an uncharacteristic form of PKAN that develops post-10 years of age and follows a slower, more gradual pace of deterioration than those pre-10 years of age. These individuals face significant speech deficits as well as psychiatric and behavioral disturbances.

Being a progressive, degenerative nerve illness, PKAN leads to early immobility and often death by early adulthood. Death occurs prematurely due to infections such as pneumonia, and the disease in itself is technically not life limiting.

==Genetics==
PKAN is an [[autosomal]] [[recessive]] disorder. The parents of an afflicted child must both be [[heterozygous]] carriers for the disease and therefore must carry one [[mutant]] [[allele]]. As it is an autosomal disorder, those [[heterozygous]] for the disorder may not display any atypical characteristics that are considered suggestive of the disorder, however there have been reported cases of [[compound heterozygosity]] in which heterozygous individuals do develop the classic form of the disease.<ref name="Zhou2001" /><ref>{{cite journal |author=Bei-sha, Tang|title=Novel compound heterozygous mutations in the PANK2 gene in a Chinese patient with atypical pantothenate kinase-associated neurodegeneration |journal=Movement Disorders |volume=20 |issue=7 |pages=819–21 |year=2005 |pmid=15747360 |doi=10.1002/mds.20408 |pmc=2105744|display-authors=etal}}</ref>

The disorder is caused by a mutant [[PANK2]] gene located at the [[chromosome|chromosomal]] [[Locus (genetics)|locus]]: 20p13-p12.3. [[PANK2]] is responsible in coding for the protein [[Pantothenate kinase]] 2, which in turn is responsible for stifling the accumulation of [[N-pantothenoyl-cysteine]] and [[pantetheine]]. It is believed that when this accumulation is not suppressed, the result is direct cell [[toxicity]] or cell toxicity as a result of free radical damage due to the lack of suppression.

PANK2 encodes a 1.85Kb transcript which is derived from seven exons covering a total distance of approximately 3.5Mb of genomic DNA. The PANK2 gene also encodes a 50.5-kDa[[protein]] that is a functional pantothenate [[kinase]], an essential regulatory [[enzyme]] in [[coenzyme A]] (CoA) biosynthesis, and catalyzing the phosphorylation of pantothenate ([[Vitamin B5|vitamin B<sub>5</sub>]]), N-pantothenoyl-cysteine, and pantetheine (OMIM).

Mutant PANK2 gene coded proteins are often caused by null or [[missense mutation]]s most notably a 7bp deletion in the PANK2 [[gene]] coding sequence.

This disorder has been reported in specific communities based on intra-community marriages where both parents of the child are carrying the same mutation. One of the communities reported is Agrawal (Agarwal) Community mainly based in Northern Part of India.The known mutation in Agarwal community is pathogenic mutation 1c.215_216insA in PANK2 gene. This is also coded as chr20:3870292-3870293insA by some labs. It results in a frameshift and premature truncation of the protein 47 amino acids downstream to codon 183 (p.Arg183GlufsTer47; ENST00000316562).
<ref>http://www.scribd.com/doc/95164360/PANK2-Agarwal</ref>
<ref>http://www.britannica.com/bps/additionalcontent/18/27764296/Founder-mutation-in-the-PANK-gene-of-Agrawal-children-with-Neurodegeneration-with-Brain-Iron-accumulation-NBIA</ref>

==Diagnosis==
[[File:Pkan-basal-ganglia-MRI.JPG|200Px|centre]]
A neurological examination would show evidence of muscle rigidity; weakness; and abnormal postures, movements, and tremors. If other family members are also affected, this may help determine the diagnosis. Genetic tests can confirm an abnormal gene causing the disease. However, this test is not yet widely available. Other movement disorders and diseases must be ruled out. Individuals exhibiting any of the above listed symptoms are often tested using [[MRI]] (Magnetic Resonance Imaging) for a number of neuro-related disorders. As PKAN is a disease prominently evident in the brain, MRIs are very useful in making a sound diagnosis. An MRI usually shows iron deposits in the [[basal ganglia]]. Development of diagnostic criteria continues in the hope of further separating PKAN from other forms of neurodegenerative diseases featuring NBIA.

===Neuropathology===
Microscopic features of PKAN include:
*Iron granules
*[[Spheroid bodies]]
*[[Lewy bodies]] within neurons

==Treatment==
There have been no major breakthroughs in the treatment of PKAN, with most [[Pharmacology|pharmacologic]] treatments focusing on the easing or temporary relieving of PKAN’s symptoms. Iron [[chelating]] agents have been used somewhat successfully in retarding the disorder, but they have not been a significant success.

Many believe taking certain vitamins may be beneficial, including [[pantothenate]], [[Coenzyme Q]], and other [[anti-oxidants]].{{Citation needed|date=March 2007}}

Current research focuses on the future use of high dose [[pantothenate]], the PANK2 enzyme substrate, in possibly alleviating symptoms as well as the further development of iron chelating agents that may be better aimed at reaching the central nervous system and working to better remove excess iron from the individual’s system.

Complications may result from the medication used to treat symptoms. Immobility from the disease can also lead to [[skin breakdown]], respiratory infections, and blood clots, among others.

==Prognosis==
Survival rates for those diagnosed with typical PKAN is 11.18 years with a standard deviation of 7.8 years.

==Epidemiology==
[[Prevalence]] data regarding this disorder remains incomplete, however it is estimated that anywhere between 1 in 1,000,000 to 3 in 1,000,000 individuals will be afflicted with this disorder (based upon observed cases in a population), but once again this is only an estimate as the disease is so rare it is difficult to statistically and accurately ascertain.

==History==
PKAN was first described by Hallervorden and Spatz (1922). Their discovery was brought about by a diagnosis of a family of 12 in which five sisters exhibited progressively increasing dementia and dysarthria. [[Autopsy|Autopsies]] revealed brown discolorations in different areas of the brain (particularly of interest were the globus pallidus and substantia nigra regions). Further investigation and description was brought about by Meyer (1958) who diagnosed 30 separate cases of PKAN. Meyer(1958) was followed by Elejalde et al. (1978) who described 5 affected family members and hypothesized that the disorder originated in central [[Europe]], backing up his hypothesis with clinical and genetic analysis. Further investigation and insights were provided by Malmstrom-Groth and Kristensson (1982)<ref>{{cite journal |author=Malmström-Groth AG, Kristensson K |title=Neuroaxonal dystrophy in childhood. Report of two second cousins with PKAN, and a case of Seitelberger's disease |journal=Acta paediatrica Scandinavica |volume=71 |issue=6 |pages=1045–9 |year=1982|pmid=7158329 |doi=10.1111/j.1651-2227.1982.tb09574.x}}</ref> and Jankovic et al. (1985).<ref>{{cite journal |author=Jankovic J, Kirkpatrick JB, Blomquist KA, Langlais PJ, Bird ED|title=Late-onset Hallervorden-Spatz disease presenting as familial parkinsonism |journal=Neurology |volume=35 |issue=2 |pages=227–34 |date=February 1985 |pmid=3969211 |doi= 10.1159/000153550|url=}}</ref>

Diagnosis of PKAN hit a milestone with the availability of MRIs, as well as the in-depth descriptions of those MRIs provided by Littrup and Gebarski (1985),<ref>{{cite journal|author=Jankovic J, Kirkpatrick JB, Blomquist KA, Langlais PJ, Bird ED |title=Late-onset Hallervorden-Spatz disease presenting as familial parkinsonism |journal=Neurology |volume=35|issue=2 |pages=227–34 |year=1985 |pmid=3969211 |doi=10.1159/000153550}}</ref> Tanfani et al. (1987),<ref>{{cite journal |author=Tanfani G, Mascalchi M, Dal Pozzo GC, Taverni N, Saia A, Trevisan C |title=MR imaging in a case of Hallervorden-Spatz disease |journal=Journal of computer assisted tomography |volume=11 |issue=6 |pages=1057–8 |year=1987|pmid=3680689 |doi=10.1097/00004728-198711000-00027}}</ref> Sethi et al. (1988),<ref>{{cite journal |author=Sethi KD, Adams RJ, Loring DW, el Gammal T |title=Hallervorden-Spatz syndrome: clinical and magnetic resonance imaging correlations |journal=Ann. Neurol. |volume=24 |issue=5 |pages=692–4 |year=1988 |pmid=3202617 |doi=10.1002/ana.410240519}}</ref> Angelini et al. (1992),<ref>{{cite journal |author=Angelini L, Nardocci N, Rumi V, Zorzi C, Strada L, Savoiardo M |title=Hallervorden-Spatz disease: clinical and MRI study of 11 cases diagnosed in life |journal=J. Neurol. |volume=239 |issue=8 |pages=417–25 |year=1992 |pmid=1447570 |doi=10.1007/BF00856805}}</ref> Casteels et al. (1994),<ref>{{cite journal |vauthors=Casteels I, Spileers W, Swinnen T, etal |title=Optic atrophy as the presenting sign in Hallervorden-Spatz syndrome |journal=Neuropediatrics |volume=25 |issue=5|pages=265–7 |year=1994 |pmid=7885538 |doi=10.1055/s-2008-1073034}}</ref> and Malandrini et al. (1995).<ref>{{cite journal |author=Malandrini A, Bonuccelli U, Parrotta E, Ceravolo R, Berti G, Guazzi GC |title=Myopathic involvement in two cases of Hallervorden-Spatz disease |journal=Brain Dev. |volume=17 |issue=4 |pages=286–90 |year=1995 |pmid=7503394|doi=10.1016/0387-7604(95)00039-E}}</ref> The gene was localized to chromosome 20p by Taylor et al. (1996) <ref name="Taylor1996">{{cite journal |author= Taylor TD, Litt M, Kramer P, Pandolfo M, Angelini L, Nardocci N, Davis S, Pineda M, Hattori H, Flett PJ, Cilio MR, Bertini E, Hayflick SJ |title=Homozygosity mapping of Hallervorden-Spatz syndrome to chromosome 20p12.3-p13 |journal=Nat. Genet. |volume=14 |issue=4 |pages=479–81 |year=1996 |pmid=8944032 |doi=10.1038/ng1296-479}}</ref> who suggested that this disorder should be referred to as neurodegeneration with brain iron accumulation (NBIA1) to avoid the objectionable eponym of Hallervorden-Spatz. The disease was named 'pantothenate kinase-associated neurodegeneration' or PKAN by Zhou et al. (2001)<ref name="Zhou2001">{{cite journal |author=Zhou B, Westaway SK, Levinson B, Johnson MA, Gitschier J, Hayflick SJ |title=A novel pantothenate kinase gene (PANK2) is defective in Hallervorden-Spatz syndrome |journal=Nat. Genet. |volume=28 |issue=4 |pages=345–9 |year=2001 |pmid=11479594|doi=10.1038/ng572}}</ref> who suggested the name to avoid misinterpretation and to better reflect the true nature of the disorder. Most recently Pellecchia et al. (2005) published a report of 16 patients afflicted with PKAN, confirmed by genetic analysis.<ref>{{cite journal |vauthors=Pellecchia MT, Valente EM, Cif L, etal |title=The diverse phenotype and genotype of pantothenate kinase-associated neurodegeneration |journal=Neurology |volume=64 |issue=10 |pages=1810–2 |year=2005 |pmid=15911822|doi=10.1212/01.WNL.0000161843.52641.EC}}</ref>

==References==
{{Reflist|2}}


==External links==
* {{Chorus|02041}}
* {{WhoNamedIt|synd|1082}}
* {{NINDS|nbia}}
* [http://nbiadisorders.org/ NBIA Disorders Association]

{{Diseases of the nervous system}}
{{Metabolic disorders of vitamins, coenzymes, and cofactors}}

{{DEFAULTSORT:Pantothenate Kinase-Associated Neurodegeneration}}
[[Category:Extrapyramidal and movement disorders]]
[[Category:Vitamin, coenzyme, and cofactor metabolism disorders]]

Pantothenate kinase-associated neurodegeneration

2016-02-02T02:18:47Z

Jyostna Chouturi:

__NOTOC__
{{CMG}} {{AE}} {{JC}}
==Overview==
'''Pantothenate kinase-associated neurodegeneration''' (PKAN), also known as '''[[neurodegeneration with brain iron accumulation]] 1''' (NBIA1) and formerly called '''Hallervorden–Spatz syndrome''' (use of this eponym is somewhat discouraged due to [[Julius Hallervorden|Hallervorden]] and [[Hugo Spatz|Spatz]]'s affiliation with the Nazi regime and the ethically questionable manner in which they acted<ref>{{cite journal |last= Bazelon |first=Emily |date= Nov 6, 2013 |title= The Nazi Anatomists |url= http://www.slate.com/articles/life/history/2013/11/nazi_anatomy_history_the_origins_of_conservatives_anti_abortion_claims_that.html |journal= Slate Magazine |location= Web-based |publisher= The Washington Post Company |accessdate= Nov 7, 2013}}</ref><ref>{{whonamedit|doctor|535}}</ref><ref>{{whonamedit|doctor|1063}}</ref>), is a [[degenerative disease]] of the [[brain]] that can lead to [[parkinsonism]], dystonia, dementia, and ultimately death. Neurodegeneration in PKAN is accompanied by an excess of [[iron]] that progressively builds up in the brain.

==Signs and symptoms==
Symptoms typically begin in childhood and are progressive, often resulting in death by early adulthood. Symptoms of PKAN begin before middle childhood, and most often are noticed before ten years of age. Symptoms include:
*[[dystonia]] (repetitive uncontrollable muscle contractions that may cause jerking or twisting of certain muscle groups)
*[[dysphagia]] & [[dysarthria]] due to muscle groups involved in speech being involved
*rigidity/stiffness of limbs
*[[tremor]]
*writhing movements
*[[dementia]]
*[[spasticity]]
*[[Rigidity (neurology)]]
*[[weakness]]
*[[seizure]]s (rare)
*[[toe walking]]
*[[retinitis pigmentosa]], another degenerative disease that affects the individual’s [[retina]], often causing alteration of retinal color and progressive deterioration of the retina at first causing [[night blindness]] and later resulting in a complete loss of vision.

25% of individuals experience an uncharacteristic form of PKAN that develops post-10 years of age and follows a slower, more gradual pace of deterioration than those pre-10 years of age. These individuals face significant speech deficits as well as psychiatric and behavioral disturbances.

Being a progressive, degenerative nerve illness, PKAN leads to early immobility and often death by early adulthood. Death occurs prematurely due to infections such as pneumonia, and the disease in itself is technically not life limiting.

==Genetics==
PKAN is an [[autosomal]] [[recessive]] disorder. The parents of an afflicted child must both be [[heterozygous]] carriers for the disease and therefore must carry one [[mutant]] [[allele]]. As it is an autosomal disorder, those [[heterozygous]] for the disorder may not display any atypical characteristics that are considered suggestive of the disorder, however there have been reported cases of [[compound heterozygosity]] in which heterozygous individuals do develop the classic form of the disease.<ref name="Zhou2001" /><ref>{{cite journal |author=Bei-sha, Tang|title=Novel compound heterozygous mutations in the PANK2 gene in a Chinese patient with atypical pantothenate kinase-associated neurodegeneration |journal=Movement Disorders |volume=20 |issue=7 |pages=819–21 |year=2005 |pmid=15747360 |doi=10.1002/mds.20408 |pmc=2105744|display-authors=etal}}</ref>

The disorder is caused by a mutant [[PANK2]] gene located at the [[chromosome|chromosomal]] [[Locus (genetics)|locus]]: 20p13-p12.3. [[PANK2]] is responsible in coding for the protein [[Pantothenate kinase]] 2, which in turn is responsible for stifling the accumulation of [[N-pantothenoyl-cysteine]] and [[pantetheine]]. It is believed that when this accumulation is not suppressed, the result is direct cell [[toxicity]] or cell toxicity as a result of free radical damage due to the lack of suppression.

PANK2 encodes a 1.85Kb transcript which is derived from seven exons covering a total distance of approximately 3.5Mb of genomic DNA. The PANK2 gene also encodes a 50.5-kDa[[protein]] that is a functional pantothenate [[kinase]], an essential regulatory [[enzyme]] in [[coenzyme A]] (CoA) biosynthesis, and catalyzing the phosphorylation of pantothenate ([[Vitamin B5|vitamin B<sub>5</sub>]]), N-pantothenoyl-cysteine, and pantetheine (OMIM).

Mutant PANK2 gene coded proteins are often caused by null or [[missense mutation]]s most notably a 7bp deletion in the PANK2 [[gene]] coding sequence.

This disorder has been reported in specific communities based on intra-community marriages where both parents of the child are carrying the same mutation. One of the communities reported is Agrawal (Agarwal) Community mainly based in Northern Part of India.The known mutation in Agarwal community is pathogenic mutation 1c.215_216insA in PANK2 gene. This is also coded as chr20:3870292-3870293insA by some labs. It results in a frameshift and premature truncation of the protein 47 amino acids downstream to codon 183 (p.Arg183GlufsTer47; ENST00000316562).
<ref>http://www.scribd.com/doc/95164360/PANK2-Agarwal</ref>
<ref>http://www.britannica.com/bps/additionalcontent/18/27764296/Founder-mutation-in-the-PANK-gene-of-Agrawal-children-with-Neurodegeneration-with-Brain-Iron-accumulation-NBIA</ref>

==Diagnosis==
[[File:Pkan-basal-ganglia-MRI.JPG|200Px|centre]]
A neurological examination would show evidence of muscle rigidity; weakness; and abnormal postures, movements, and tremors. If other family members are also affected, this may help determine the diagnosis. Genetic tests can confirm an abnormal gene causing the disease. However, this test is not yet widely available. Other movement disorders and diseases must be ruled out. Individuals exhibiting any of the above listed symptoms are often tested using [[MRI]] (Magnetic Resonance Imaging) for a number of neuro-related disorders. As PKAN is a disease prominently evident in the brain, MRIs are very useful in making a sound diagnosis. An MRI usually shows iron deposits in the [[basal ganglia]]. Development of diagnostic criteria continues in the hope of further separating PKAN from other forms of neurodegenerative diseases featuring NBIA.

===Neuropathology===
Microscopic features of PKAN include:
*Iron granules
*[[Spheroid bodies]]
*[[Lewy bodies]] within neurons

==Treatment==
There have been no major breakthroughs in the treatment of PKAN, with most [[Pharmacology|pharmacologic]] treatments focusing on the easing or temporary relieving of PKAN’s symptoms. Iron [[chelating]] agents have been used somewhat successfully in retarding the disorder, but they have not been a significant success.

Many believe taking certain vitamins may be beneficial, including [[pantothenate]], [[Coenzyme Q]], and other [[anti-oxidants]].{{Citation needed|date=March 2007}}

Current research focuses on the future use of high dose [[pantothenate]], the PANK2 enzyme substrate, in possibly alleviating symptoms as well as the further development of iron chelating agents that may be better aimed at reaching the central nervous system and working to better remove excess iron from the individual’s system.

Complications may result from the medication used to treat symptoms. Immobility from the disease can also lead to [[skin breakdown]], respiratory infections, and blood clots, among others.

==Prognosis==
Survival rates for those diagnosed with typical PKAN is 11.18 years with a standard deviation of 7.8 years.

==Epidemiology==
[[Prevalence]] data regarding this disorder remains incomplete, however it is estimated that anywhere between 1 in 1,000,000 to 3 in 1,000,000 individuals will be afflicted with this disorder (based upon observed cases in a population), but once again this is only an estimate as the disease is so rare it is difficult to statistically and accurately ascertain.

==History==
PKAN was first described by Hallervorden and Spatz (1922). Their discovery was brought about by a diagnosis of a family of 12 in which five sisters exhibited progressively increasing dementia and dysarthria. [[Autopsy|Autopsies]] revealed brown discolorations in different areas of the brain (particularly of interest were the globus pallidus and substantia nigra regions). Further investigation and description was brought about by Meyer (1958) who diagnosed 30 separate cases of PKAN. Meyer(1958) was followed by Elejalde et al. (1978) who described 5 affected family members and hypothesized that the disorder originated in central [[Europe]], backing up his hypothesis with clinical and genetic analysis. Further investigation and insights were provided by Malmstrom-Groth and Kristensson (1982)<ref>{{cite journal |author=Malmström-Groth AG, Kristensson K |title=Neuroaxonal dystrophy in childhood. Report of two second cousins with PKAN, and a case of Seitelberger's disease |journal=Acta paediatrica Scandinavica |volume=71 |issue=6 |pages=1045–9 |year=1982|pmid=7158329 |doi=10.1111/j.1651-2227.1982.tb09574.x}}</ref> and Jankovic et al. (1985).<ref>{{cite journal |author=Jankovic J, Kirkpatrick JB, Blomquist KA, Langlais PJ, Bird ED|title=Late-onset Hallervorden-Spatz disease presenting as familial parkinsonism |journal=Neurology |volume=35 |issue=2 |pages=227–34 |date=February 1985 |pmid=3969211 |doi= 10.1159/000153550|url=}}</ref>

Diagnosis of PKAN hit a milestone with the availability of MRIs, as well as the in-depth descriptions of those MRIs provided by Littrup and Gebarski (1985),<ref>{{cite journal|author=Jankovic J, Kirkpatrick JB, Blomquist KA, Langlais PJ, Bird ED |title=Late-onset Hallervorden-Spatz disease presenting as familial parkinsonism |journal=Neurology |volume=35|issue=2 |pages=227–34 |year=1985 |pmid=3969211 |doi=10.1159/000153550}}</ref> Tanfani et al. (1987),<ref>{{cite journal |author=Tanfani G, Mascalchi M, Dal Pozzo GC, Taverni N, Saia A, Trevisan C |title=MR imaging in a case of Hallervorden-Spatz disease |journal=Journal of computer assisted tomography |volume=11 |issue=6 |pages=1057–8 |year=1987|pmid=3680689 |doi=10.1097/00004728-198711000-00027}}</ref> Sethi et al. (1988),<ref>{{cite journal |author=Sethi KD, Adams RJ, Loring DW, el Gammal T |title=Hallervorden-Spatz syndrome: clinical and magnetic resonance imaging correlations |journal=Ann. Neurol. |volume=24 |issue=5 |pages=692–4 |year=1988 |pmid=3202617 |doi=10.1002/ana.410240519}}</ref> Angelini et al. (1992),<ref>{{cite journal |author=Angelini L, Nardocci N, Rumi V, Zorzi C, Strada L, Savoiardo M |title=Hallervorden-Spatz disease: clinical and MRI study of 11 cases diagnosed in life |journal=J. Neurol. |volume=239 |issue=8 |pages=417–25 |year=1992 |pmid=1447570 |doi=10.1007/BF00856805}}</ref> Casteels et al. (1994),<ref>{{cite journal |vauthors=Casteels I, Spileers W, Swinnen T, etal |title=Optic atrophy as the presenting sign in Hallervorden-Spatz syndrome |journal=Neuropediatrics |volume=25 |issue=5|pages=265–7 |year=1994 |pmid=7885538 |doi=10.1055/s-2008-1073034}}</ref> and Malandrini et al. (1995).<ref>{{cite journal |author=Malandrini A, Bonuccelli U, Parrotta E, Ceravolo R, Berti G, Guazzi GC |title=Myopathic involvement in two cases of Hallervorden-Spatz disease |journal=Brain Dev. |volume=17 |issue=4 |pages=286–90 |year=1995 |pmid=7503394|doi=10.1016/0387-7604(95)00039-E}}</ref> The gene was localized to chromosome 20p by Taylor et al. (1996) <ref name="Taylor1996">{{cite journal |author= Taylor TD, Litt M, Kramer P, Pandolfo M, Angelini L, Nardocci N, Davis S, Pineda M, Hattori H, Flett PJ, Cilio MR, Bertini E, Hayflick SJ |title=Homozygosity mapping of Hallervorden-Spatz syndrome to chromosome 20p12.3-p13 |journal=Nat. Genet. |volume=14 |issue=4 |pages=479–81 |year=1996 |pmid=8944032 |doi=10.1038/ng1296-479}}</ref> who suggested that this disorder should be referred to as neurodegeneration with brain iron accumulation (NBIA1) to avoid the objectionable eponym of Hallervorden-Spatz. The disease was named 'pantothenate kinase-associated neurodegeneration' or PKAN by Zhou et al. (2001)<ref name="Zhou2001">{{cite journal |author=Zhou B, Westaway SK, Levinson B, Johnson MA, Gitschier J, Hayflick SJ |title=A novel pantothenate kinase gene (PANK2) is defective in Hallervorden-Spatz syndrome |journal=Nat. Genet. |volume=28 |issue=4 |pages=345–9 |year=2001 |pmid=11479594|doi=10.1038/ng572}}</ref> who suggested the name to avoid misinterpretation and to better reflect the true nature of the disorder. Most recently Pellecchia et al. (2005) published a report of 16 patients afflicted with PKAN, confirmed by genetic analysis.<ref>{{cite journal |vauthors=Pellecchia MT, Valente EM, Cif L, etal |title=The diverse phenotype and genotype of pantothenate kinase-associated neurodegeneration |journal=Neurology |volume=64 |issue=10 |pages=1810–2 |year=2005 |pmid=15911822|doi=10.1212/01.WNL.0000161843.52641.EC}}</ref>

==References==
{{Reflist|2}}


==External links==
* {{Chorus|02041}}
* {{WhoNamedIt|synd|1082}}
* {{NINDS|nbia}}
* [http://nbiadisorders.org/ NBIA Disorders Association]

{{Diseases of the nervous system}}
{{Metabolic disorders of vitamins, coenzymes, and cofactors}}

{{DEFAULTSORT:Pantothenate Kinase-Associated Neurodegeneration}}
[[Category:Extrapyramidal and movement disorders]]
[[Category:Vitamin, coenzyme, and cofactor metabolism disorders]]

Pantothenate kinase-associated neurodegeneration

2016-02-02T02:18:18Z

Jyostna Chouturi: /* Diagnosis */

__NOTOC__
{{CMG}} {{AE}} {{JC}}
==Overview==
'''Pantothenate kinase-associated neurodegeneration''' (PKAN), also known as '''[[neurodegeneration with brain iron accumulation]] 1''' (NBIA1) and formerly called '''Hallervorden–Spatz syndrome''' (use of this eponym is somewhat discouraged due to [[Julius Hallervorden|Hallervorden]] and [[Hugo Spatz|Spatz]]'s affiliation with the Nazi regime and the ethically questionable manner in which they acted<ref>{{cite journal |last= Bazelon |first=Emily |date= Nov 6, 2013 |title= The Nazi Anatomists |url= http://www.slate.com/articles/life/history/2013/11/nazi_anatomy_history_the_origins_of_conservatives_anti_abortion_claims_that.html |journal= Slate Magazine |location= Web-based |publisher= The Washington Post Company |accessdate= Nov 7, 2013}}</ref><ref>{{whonamedit|doctor|535}}</ref><ref>{{whonamedit|doctor|1063}}</ref>), is a [[degenerative disease]] of the [[brain]] that can lead to [[parkinsonism]], dystonia, dementia, and ultimately death. Neurodegeneration in PKAN is accompanied by an excess of [[iron]] that progressively builds up in the brain.

==Signs and symptoms==
Symptoms typically begin in childhood and are progressive, often resulting in death by early adulthood. Symptoms of PKAN begin before middle childhood, and most often are noticed before ten years of age. Symptoms include:
*[[dystonia]] (repetitive uncontrollable muscle contractions that may cause jerking or twisting of certain muscle groups)
*[[dysphagia]] & [[dysarthria]] due to muscle groups involved in speech being involved
*rigidity/stiffness of limbs
*[[tremor]]
*writhing movements
*[[dementia]]
*[[spasticity]]
*[[Rigidity (neurology)]]
*[[weakness]]
*[[seizure]]s (rare)
*[[toe walking]]
*[[retinitis pigmentosa]], another degenerative disease that affects the individual’s [[retina]], often causing alteration of retinal color and progressive deterioration of the retina at first causing [[night blindness]] and later resulting in a complete loss of vision.

25% of individuals experience an uncharacteristic form of PKAN that develops post-10 years of age and follows a slower, more gradual pace of deterioration than those pre-10 years of age. These individuals face significant speech deficits as well as psychiatric and behavioral disturbances.

Being a progressive, degenerative nerve illness, PKAN leads to early immobility and often death by early adulthood. Death occurs prematurely due to infections such as pneumonia, and the disease in itself is technically not life limiting.

==Genetics==
PKAN is an [[autosomal]] [[recessive]] disorder. The parents of an afflicted child must both be [[heterozygous]] carriers for the disease and therefore must carry one [[mutant]] [[allele]]. As it is an autosomal disorder, those [[heterozygous]] for the disorder may not display any atypical characteristics that are considered suggestive of the disorder, however there have been reported cases of [[compound heterozygosity]] in which heterozygous individuals do develop the classic form of the disease.<ref name="Zhou2001" /><ref>{{cite journal |author=Bei-sha, Tang|title=Novel compound heterozygous mutations in the PANK2 gene in a Chinese patient with atypical pantothenate kinase-associated neurodegeneration |journal=Movement Disorders |volume=20 |issue=7 |pages=819–21 |year=2005 |pmid=15747360 |doi=10.1002/mds.20408 |pmc=2105744|display-authors=etal}}</ref>

The disorder is caused by a mutant [[PANK2]] gene located at the [[chromosome|chromosomal]] [[Locus (genetics)|locus]]: 20p13-p12.3. [[PANK2]] is responsible in coding for the protein [[Pantothenate kinase]] 2, which in turn is responsible for stifling the accumulation of [[N-pantothenoyl-cysteine]] and [[pantetheine]]. It is believed that when this accumulation is not suppressed, the result is direct cell [[toxicity]] or cell toxicity as a result of free radical damage due to the lack of suppression.

PANK2 encodes a 1.85Kb transcript which is derived from seven exons covering a total distance of approximately 3.5Mb of genomic DNA. The PANK2 gene also encodes a 50.5-kDa[[protein]] that is a functional pantothenate [[kinase]], an essential regulatory [[enzyme]] in [[coenzyme A]] (CoA) biosynthesis, and catalyzing the phosphorylation of pantothenate ([[Vitamin B5|vitamin B<sub>5</sub>]]), N-pantothenoyl-cysteine, and pantetheine (OMIM).

Mutant PANK2 gene coded proteins are often caused by null or [[missense mutation]]s most notably a 7bp deletion in the PANK2 [[gene]] coding sequence.

This disorder has been reported in specific communities based on intra-community marriages where both parents of the child are carrying the same mutation. One of the communities reported is Agrawal (Agarwal) Community mainly based in Northern Part of India.The known mutation in Agarwal community is pathogenic mutation 1c.215_216insA in PANK2 gene. This is also coded as chr20:3870292-3870293insA by some labs. It results in a frameshift and premature truncation of the protein 47 amino acids downstream to codon 183 (p.Arg183GlufsTer47; ENST00000316562).
<ref>http://www.scribd.com/doc/95164360/PANK2-Agarwal</ref>
<ref>http://www.britannica.com/bps/additionalcontent/18/27764296/Founder-mutation-in-the-PANK-gene-of-Agrawal-children-with-Neurodegeneration-with-Brain-Iron-accumulation-NBIA</ref>

==Diagnosis==
[[File:Pkan-basal-ganglia-MRI.JPG|300Px|centre]]
A neurological examination would show evidence of muscle rigidity; weakness; and abnormal postures, movements, and tremors. If other family members are also affected, this may help determine the diagnosis. Genetic tests can confirm an abnormal gene causing the disease. However, this test is not yet widely available. Other movement disorders and diseases must be ruled out. Individuals exhibiting any of the above listed symptoms are often tested using [[MRI]] (Magnetic Resonance Imaging) for a number of neuro-related disorders. As PKAN is a disease prominently evident in the brain, MRIs are very useful in making a sound diagnosis. An MRI usually shows iron deposits in the [[basal ganglia]]. Development of diagnostic criteria continues in the hope of further separating PKAN from other forms of neurodegenerative diseases featuring NBIA.

===Neuropathology===
Microscopic features of PKAN include:
*Iron granules
*[[Spheroid bodies]]
*[[Lewy bodies]] within neurons

==Treatment==
There have been no major breakthroughs in the treatment of PKAN, with most [[Pharmacology|pharmacologic]] treatments focusing on the easing or temporary relieving of PKAN’s symptoms. Iron [[chelating]] agents have been used somewhat successfully in retarding the disorder, but they have not been a significant success.

Many believe taking certain vitamins may be beneficial, including [[pantothenate]], [[Coenzyme Q]], and other [[anti-oxidants]].{{Citation needed|date=March 2007}}

Current research focuses on the future use of high dose [[pantothenate]], the PANK2 enzyme substrate, in possibly alleviating symptoms as well as the further development of iron chelating agents that may be better aimed at reaching the central nervous system and working to better remove excess iron from the individual’s system.

Complications may result from the medication used to treat symptoms. Immobility from the disease can also lead to [[skin breakdown]], respiratory infections, and blood clots, among others.

==Prognosis==
Survival rates for those diagnosed with typical PKAN is 11.18 years with a standard deviation of 7.8 years.

==Epidemiology==
[[Prevalence]] data regarding this disorder remains incomplete, however it is estimated that anywhere between 1 in 1,000,000 to 3 in 1,000,000 individuals will be afflicted with this disorder (based upon observed cases in a population), but once again this is only an estimate as the disease is so rare it is difficult to statistically and accurately ascertain.

==History==
PKAN was first described by Hallervorden and Spatz (1922). Their discovery was brought about by a diagnosis of a family of 12 in which five sisters exhibited progressively increasing dementia and dysarthria. [[Autopsy|Autopsies]] revealed brown discolorations in different areas of the brain (particularly of interest were the globus pallidus and substantia nigra regions). Further investigation and description was brought about by Meyer (1958) who diagnosed 30 separate cases of PKAN. Meyer(1958) was followed by Elejalde et al. (1978) who described 5 affected family members and hypothesized that the disorder originated in central [[Europe]], backing up his hypothesis with clinical and genetic analysis. Further investigation and insights were provided by Malmstrom-Groth and Kristensson (1982)<ref>{{cite journal |author=Malmström-Groth AG, Kristensson K |title=Neuroaxonal dystrophy in childhood. Report of two second cousins with PKAN, and a case of Seitelberger's disease |journal=Acta paediatrica Scandinavica |volume=71 |issue=6 |pages=1045–9 |year=1982|pmid=7158329 |doi=10.1111/j.1651-2227.1982.tb09574.x}}</ref> and Jankovic et al. (1985).<ref>{{cite journal |author=Jankovic J, Kirkpatrick JB, Blomquist KA, Langlais PJ, Bird ED|title=Late-onset Hallervorden-Spatz disease presenting as familial parkinsonism |journal=Neurology |volume=35 |issue=2 |pages=227–34 |date=February 1985 |pmid=3969211 |doi= 10.1159/000153550|url=}}</ref>

Diagnosis of PKAN hit a milestone with the availability of MRIs, as well as the in-depth descriptions of those MRIs provided by Littrup and Gebarski (1985),<ref>{{cite journal|author=Jankovic J, Kirkpatrick JB, Blomquist KA, Langlais PJ, Bird ED |title=Late-onset Hallervorden-Spatz disease presenting as familial parkinsonism |journal=Neurology |volume=35|issue=2 |pages=227–34 |year=1985 |pmid=3969211 |doi=10.1159/000153550}}</ref> Tanfani et al. (1987),<ref>{{cite journal |author=Tanfani G, Mascalchi M, Dal Pozzo GC, Taverni N, Saia A, Trevisan C |title=MR imaging in a case of Hallervorden-Spatz disease |journal=Journal of computer assisted tomography |volume=11 |issue=6 |pages=1057–8 |year=1987|pmid=3680689 |doi=10.1097/00004728-198711000-00027}}</ref> Sethi et al. (1988),<ref>{{cite journal |author=Sethi KD, Adams RJ, Loring DW, el Gammal T |title=Hallervorden-Spatz syndrome: clinical and magnetic resonance imaging correlations |journal=Ann. Neurol. |volume=24 |issue=5 |pages=692–4 |year=1988 |pmid=3202617 |doi=10.1002/ana.410240519}}</ref> Angelini et al. (1992),<ref>{{cite journal |author=Angelini L, Nardocci N, Rumi V, Zorzi C, Strada L, Savoiardo M |title=Hallervorden-Spatz disease: clinical and MRI study of 11 cases diagnosed in life |journal=J. Neurol. |volume=239 |issue=8 |pages=417–25 |year=1992 |pmid=1447570 |doi=10.1007/BF00856805}}</ref> Casteels et al. (1994),<ref>{{cite journal |vauthors=Casteels I, Spileers W, Swinnen T, etal |title=Optic atrophy as the presenting sign in Hallervorden-Spatz syndrome |journal=Neuropediatrics |volume=25 |issue=5|pages=265–7 |year=1994 |pmid=7885538 |doi=10.1055/s-2008-1073034}}</ref> and Malandrini et al. (1995).<ref>{{cite journal |author=Malandrini A, Bonuccelli U, Parrotta E, Ceravolo R, Berti G, Guazzi GC |title=Myopathic involvement in two cases of Hallervorden-Spatz disease |journal=Brain Dev. |volume=17 |issue=4 |pages=286–90 |year=1995 |pmid=7503394|doi=10.1016/0387-7604(95)00039-E}}</ref> The gene was localized to chromosome 20p by Taylor et al. (1996) <ref name="Taylor1996">{{cite journal |author= Taylor TD, Litt M, Kramer P, Pandolfo M, Angelini L, Nardocci N, Davis S, Pineda M, Hattori H, Flett PJ, Cilio MR, Bertini E, Hayflick SJ |title=Homozygosity mapping of Hallervorden-Spatz syndrome to chromosome 20p12.3-p13 |journal=Nat. Genet. |volume=14 |issue=4 |pages=479–81 |year=1996 |pmid=8944032 |doi=10.1038/ng1296-479}}</ref> who suggested that this disorder should be referred to as neurodegeneration with brain iron accumulation (NBIA1) to avoid the objectionable eponym of Hallervorden-Spatz. The disease was named 'pantothenate kinase-associated neurodegeneration' or PKAN by Zhou et al. (2001)<ref name="Zhou2001">{{cite journal |author=Zhou B, Westaway SK, Levinson B, Johnson MA, Gitschier J, Hayflick SJ |title=A novel pantothenate kinase gene (PANK2) is defective in Hallervorden-Spatz syndrome |journal=Nat. Genet. |volume=28 |issue=4 |pages=345–9 |year=2001 |pmid=11479594|doi=10.1038/ng572}}</ref> who suggested the name to avoid misinterpretation and to better reflect the true nature of the disorder. Most recently Pellecchia et al. (2005) published a report of 16 patients afflicted with PKAN, confirmed by genetic analysis.<ref>{{cite journal |vauthors=Pellecchia MT, Valente EM, Cif L, etal |title=The diverse phenotype and genotype of pantothenate kinase-associated neurodegeneration |journal=Neurology |volume=64 |issue=10 |pages=1810–2 |year=2005 |pmid=15911822|doi=10.1212/01.WNL.0000161843.52641.EC}}</ref>

==References==
{{Reflist|2}}


==External links==
* {{Chorus|02041}}
* {{WhoNamedIt|synd|1082}}
* {{NINDS|nbia}}
* [http://nbiadisorders.org/ NBIA Disorders Association]

{{Diseases of the nervous system}}
{{Metabolic disorders of vitamins, coenzymes, and cofactors}}

{{DEFAULTSORT:Pantothenate Kinase-Associated Neurodegeneration}}
[[Category:Extrapyramidal and movement disorders]]
[[Category:Vitamin, coenzyme, and cofactor metabolism disorders]]

Pantothenate kinase-associated neurodegeneration

2016-02-02T02:17:23Z

Jyostna Chouturi: /* Diagnosis */

__NOTOC__
{{CMG}} {{AE}} {{JC}}
==Overview==
'''Pantothenate kinase-associated neurodegeneration''' (PKAN), also known as '''[[neurodegeneration with brain iron accumulation]] 1''' (NBIA1) and formerly called '''Hallervorden–Spatz syndrome''' (use of this eponym is somewhat discouraged due to [[Julius Hallervorden|Hallervorden]] and [[Hugo Spatz|Spatz]]'s affiliation with the Nazi regime and the ethically questionable manner in which they acted<ref>{{cite journal |last= Bazelon |first=Emily |date= Nov 6, 2013 |title= The Nazi Anatomists |url= http://www.slate.com/articles/life/history/2013/11/nazi_anatomy_history_the_origins_of_conservatives_anti_abortion_claims_that.html |journal= Slate Magazine |location= Web-based |publisher= The Washington Post Company |accessdate= Nov 7, 2013}}</ref><ref>{{whonamedit|doctor|535}}</ref><ref>{{whonamedit|doctor|1063}}</ref>), is a [[degenerative disease]] of the [[brain]] that can lead to [[parkinsonism]], dystonia, dementia, and ultimately death. Neurodegeneration in PKAN is accompanied by an excess of [[iron]] that progressively builds up in the brain.

==Signs and symptoms==
Symptoms typically begin in childhood and are progressive, often resulting in death by early adulthood. Symptoms of PKAN begin before middle childhood, and most often are noticed before ten years of age. Symptoms include:
*[[dystonia]] (repetitive uncontrollable muscle contractions that may cause jerking or twisting of certain muscle groups)
*[[dysphagia]] & [[dysarthria]] due to muscle groups involved in speech being involved
*rigidity/stiffness of limbs
*[[tremor]]
*writhing movements
*[[dementia]]
*[[spasticity]]
*[[Rigidity (neurology)]]
*[[weakness]]
*[[seizure]]s (rare)
*[[toe walking]]
*[[retinitis pigmentosa]], another degenerative disease that affects the individual’s [[retina]], often causing alteration of retinal color and progressive deterioration of the retina at first causing [[night blindness]] and later resulting in a complete loss of vision.

25% of individuals experience an uncharacteristic form of PKAN that develops post-10 years of age and follows a slower, more gradual pace of deterioration than those pre-10 years of age. These individuals face significant speech deficits as well as psychiatric and behavioral disturbances.

Being a progressive, degenerative nerve illness, PKAN leads to early immobility and often death by early adulthood. Death occurs prematurely due to infections such as pneumonia, and the disease in itself is technically not life limiting.

==Genetics==
PKAN is an [[autosomal]] [[recessive]] disorder. The parents of an afflicted child must both be [[heterozygous]] carriers for the disease and therefore must carry one [[mutant]] [[allele]]. As it is an autosomal disorder, those [[heterozygous]] for the disorder may not display any atypical characteristics that are considered suggestive of the disorder, however there have been reported cases of [[compound heterozygosity]] in which heterozygous individuals do develop the classic form of the disease.<ref name="Zhou2001" /><ref>{{cite journal |author=Bei-sha, Tang|title=Novel compound heterozygous mutations in the PANK2 gene in a Chinese patient with atypical pantothenate kinase-associated neurodegeneration |journal=Movement Disorders |volume=20 |issue=7 |pages=819–21 |year=2005 |pmid=15747360 |doi=10.1002/mds.20408 |pmc=2105744|display-authors=etal}}</ref>

The disorder is caused by a mutant [[PANK2]] gene located at the [[chromosome|chromosomal]] [[Locus (genetics)|locus]]: 20p13-p12.3. [[PANK2]] is responsible in coding for the protein [[Pantothenate kinase]] 2, which in turn is responsible for stifling the accumulation of [[N-pantothenoyl-cysteine]] and [[pantetheine]]. It is believed that when this accumulation is not suppressed, the result is direct cell [[toxicity]] or cell toxicity as a result of free radical damage due to the lack of suppression.

PANK2 encodes a 1.85Kb transcript which is derived from seven exons covering a total distance of approximately 3.5Mb of genomic DNA. The PANK2 gene also encodes a 50.5-kDa[[protein]] that is a functional pantothenate [[kinase]], an essential regulatory [[enzyme]] in [[coenzyme A]] (CoA) biosynthesis, and catalyzing the phosphorylation of pantothenate ([[Vitamin B5|vitamin B<sub>5</sub>]]), N-pantothenoyl-cysteine, and pantetheine (OMIM).

Mutant PANK2 gene coded proteins are often caused by null or [[missense mutation]]s most notably a 7bp deletion in the PANK2 [[gene]] coding sequence.

This disorder has been reported in specific communities based on intra-community marriages where both parents of the child are carrying the same mutation. One of the communities reported is Agrawal (Agarwal) Community mainly based in Northern Part of India.The known mutation in Agarwal community is pathogenic mutation 1c.215_216insA in PANK2 gene. This is also coded as chr20:3870292-3870293insA by some labs. It results in a frameshift and premature truncation of the protein 47 amino acids downstream to codon 183 (p.Arg183GlufsTer47; ENST00000316562).
<ref>http://www.scribd.com/doc/95164360/PANK2-Agarwal</ref>
<ref>http://www.britannica.com/bps/additionalcontent/18/27764296/Founder-mutation-in-the-PANK-gene-of-Agrawal-children-with-Neurodegeneration-with-Brain-Iron-accumulation-NBIA</ref>

==Diagnosis==
[[File:Pkan-basal-ganglia-MRI.JPG|300Px]]
A neurological examination would show evidence of muscle rigidity; weakness; and abnormal postures, movements, and tremors. If other family members are also affected, this may help determine the diagnosis. Genetic tests can confirm an abnormal gene causing the disease. However, this test is not yet widely available. Other movement disorders and diseases must be ruled out. Individuals exhibiting any of the above listed symptoms are often tested using [[MRI]] (Magnetic Resonance Imaging) for a number of neuro-related disorders. As PKAN is a disease prominently evident in the brain, MRIs are very useful in making a sound diagnosis. An MRI usually shows iron deposits in the [[basal ganglia]]. Development of diagnostic criteria continues in the hope of further separating PKAN from other forms of neurodegenerative diseases featuring NBIA.

===Neuropathology===
Microscopic features of PKAN include:
*Iron granules
*[[Spheroid bodies]]
*[[Lewy bodies]] within neurons

==Treatment==
There have been no major breakthroughs in the treatment of PKAN, with most [[Pharmacology|pharmacologic]] treatments focusing on the easing or temporary relieving of PKAN’s symptoms. Iron [[chelating]] agents have been used somewhat successfully in retarding the disorder, but they have not been a significant success.

Many believe taking certain vitamins may be beneficial, including [[pantothenate]], [[Coenzyme Q]], and other [[anti-oxidants]].{{Citation needed|date=March 2007}}

Current research focuses on the future use of high dose [[pantothenate]], the PANK2 enzyme substrate, in possibly alleviating symptoms as well as the further development of iron chelating agents that may be better aimed at reaching the central nervous system and working to better remove excess iron from the individual’s system.

Complications may result from the medication used to treat symptoms. Immobility from the disease can also lead to [[skin breakdown]], respiratory infections, and blood clots, among others.

==Prognosis==
Survival rates for those diagnosed with typical PKAN is 11.18 years with a standard deviation of 7.8 years.

==Epidemiology==
[[Prevalence]] data regarding this disorder remains incomplete, however it is estimated that anywhere between 1 in 1,000,000 to 3 in 1,000,000 individuals will be afflicted with this disorder (based upon observed cases in a population), but once again this is only an estimate as the disease is so rare it is difficult to statistically and accurately ascertain.

==History==
PKAN was first described by Hallervorden and Spatz (1922). Their discovery was brought about by a diagnosis of a family of 12 in which five sisters exhibited progressively increasing dementia and dysarthria. [[Autopsy|Autopsies]] revealed brown discolorations in different areas of the brain (particularly of interest were the globus pallidus and substantia nigra regions). Further investigation and description was brought about by Meyer (1958) who diagnosed 30 separate cases of PKAN. Meyer(1958) was followed by Elejalde et al. (1978) who described 5 affected family members and hypothesized that the disorder originated in central [[Europe]], backing up his hypothesis with clinical and genetic analysis. Further investigation and insights were provided by Malmstrom-Groth and Kristensson (1982)<ref>{{cite journal |author=Malmström-Groth AG, Kristensson K |title=Neuroaxonal dystrophy in childhood. Report of two second cousins with PKAN, and a case of Seitelberger's disease |journal=Acta paediatrica Scandinavica |volume=71 |issue=6 |pages=1045–9 |year=1982|pmid=7158329 |doi=10.1111/j.1651-2227.1982.tb09574.x}}</ref> and Jankovic et al. (1985).<ref>{{cite journal |author=Jankovic J, Kirkpatrick JB, Blomquist KA, Langlais PJ, Bird ED|title=Late-onset Hallervorden-Spatz disease presenting as familial parkinsonism |journal=Neurology |volume=35 |issue=2 |pages=227–34 |date=February 1985 |pmid=3969211 |doi= 10.1159/000153550|url=}}</ref>

Diagnosis of PKAN hit a milestone with the availability of MRIs, as well as the in-depth descriptions of those MRIs provided by Littrup and Gebarski (1985),<ref>{{cite journal|author=Jankovic J, Kirkpatrick JB, Blomquist KA, Langlais PJ, Bird ED |title=Late-onset Hallervorden-Spatz disease presenting as familial parkinsonism |journal=Neurology |volume=35|issue=2 |pages=227–34 |year=1985 |pmid=3969211 |doi=10.1159/000153550}}</ref> Tanfani et al. (1987),<ref>{{cite journal |author=Tanfani G, Mascalchi M, Dal Pozzo GC, Taverni N, Saia A, Trevisan C |title=MR imaging in a case of Hallervorden-Spatz disease |journal=Journal of computer assisted tomography |volume=11 |issue=6 |pages=1057–8 |year=1987|pmid=3680689 |doi=10.1097/00004728-198711000-00027}}</ref> Sethi et al. (1988),<ref>{{cite journal |author=Sethi KD, Adams RJ, Loring DW, el Gammal T |title=Hallervorden-Spatz syndrome: clinical and magnetic resonance imaging correlations |journal=Ann. Neurol. |volume=24 |issue=5 |pages=692–4 |year=1988 |pmid=3202617 |doi=10.1002/ana.410240519}}</ref> Angelini et al. (1992),<ref>{{cite journal |author=Angelini L, Nardocci N, Rumi V, Zorzi C, Strada L, Savoiardo M |title=Hallervorden-Spatz disease: clinical and MRI study of 11 cases diagnosed in life |journal=J. Neurol. |volume=239 |issue=8 |pages=417–25 |year=1992 |pmid=1447570 |doi=10.1007/BF00856805}}</ref> Casteels et al. (1994),<ref>{{cite journal |vauthors=Casteels I, Spileers W, Swinnen T, etal |title=Optic atrophy as the presenting sign in Hallervorden-Spatz syndrome |journal=Neuropediatrics |volume=25 |issue=5|pages=265–7 |year=1994 |pmid=7885538 |doi=10.1055/s-2008-1073034}}</ref> and Malandrini et al. (1995).<ref>{{cite journal |author=Malandrini A, Bonuccelli U, Parrotta E, Ceravolo R, Berti G, Guazzi GC |title=Myopathic involvement in two cases of Hallervorden-Spatz disease |journal=Brain Dev. |volume=17 |issue=4 |pages=286–90 |year=1995 |pmid=7503394|doi=10.1016/0387-7604(95)00039-E}}</ref> The gene was localized to chromosome 20p by Taylor et al. (1996) <ref name="Taylor1996">{{cite journal |author= Taylor TD, Litt M, Kramer P, Pandolfo M, Angelini L, Nardocci N, Davis S, Pineda M, Hattori H, Flett PJ, Cilio MR, Bertini E, Hayflick SJ |title=Homozygosity mapping of Hallervorden-Spatz syndrome to chromosome 20p12.3-p13 |journal=Nat. Genet. |volume=14 |issue=4 |pages=479–81 |year=1996 |pmid=8944032 |doi=10.1038/ng1296-479}}</ref> who suggested that this disorder should be referred to as neurodegeneration with brain iron accumulation (NBIA1) to avoid the objectionable eponym of Hallervorden-Spatz. The disease was named 'pantothenate kinase-associated neurodegeneration' or PKAN by Zhou et al. (2001)<ref name="Zhou2001">{{cite journal |author=Zhou B, Westaway SK, Levinson B, Johnson MA, Gitschier J, Hayflick SJ |title=A novel pantothenate kinase gene (PANK2) is defective in Hallervorden-Spatz syndrome |journal=Nat. Genet. |volume=28 |issue=4 |pages=345–9 |year=2001 |pmid=11479594|doi=10.1038/ng572}}</ref> who suggested the name to avoid misinterpretation and to better reflect the true nature of the disorder. Most recently Pellecchia et al. (2005) published a report of 16 patients afflicted with PKAN, confirmed by genetic analysis.<ref>{{cite journal |vauthors=Pellecchia MT, Valente EM, Cif L, etal |title=The diverse phenotype and genotype of pantothenate kinase-associated neurodegeneration |journal=Neurology |volume=64 |issue=10 |pages=1810–2 |year=2005 |pmid=15911822|doi=10.1212/01.WNL.0000161843.52641.EC}}</ref>

==References==
{{Reflist|2}}


==External links==
* {{Chorus|02041}}
* {{WhoNamedIt|synd|1082}}
* {{NINDS|nbia}}
* [http://nbiadisorders.org/ NBIA Disorders Association]

{{Diseases of the nervous system}}
{{Metabolic disorders of vitamins, coenzymes, and cofactors}}

{{DEFAULTSORT:Pantothenate Kinase-Associated Neurodegeneration}}
[[Category:Extrapyramidal and movement disorders]]
[[Category:Vitamin, coenzyme, and cofactor metabolism disorders]]

Pantothenate kinase-associated neurodegeneration

2016-02-02T02:15:14Z

Jyostna Chouturi:

__NOTOC__
{{CMG}} {{AE}} {{JC}}
==Overview==
'''Pantothenate kinase-associated neurodegeneration''' (PKAN), also known as '''[[neurodegeneration with brain iron accumulation]] 1''' (NBIA1) and formerly called '''Hallervorden–Spatz syndrome''' (use of this eponym is somewhat discouraged due to [[Julius Hallervorden|Hallervorden]] and [[Hugo Spatz|Spatz]]'s affiliation with the Nazi regime and the ethically questionable manner in which they acted<ref>{{cite journal |last= Bazelon |first=Emily |date= Nov 6, 2013 |title= The Nazi Anatomists |url= http://www.slate.com/articles/life/history/2013/11/nazi_anatomy_history_the_origins_of_conservatives_anti_abortion_claims_that.html |journal= Slate Magazine |location= Web-based |publisher= The Washington Post Company |accessdate= Nov 7, 2013}}</ref><ref>{{whonamedit|doctor|535}}</ref><ref>{{whonamedit|doctor|1063}}</ref>), is a [[degenerative disease]] of the [[brain]] that can lead to [[parkinsonism]], dystonia, dementia, and ultimately death. Neurodegeneration in PKAN is accompanied by an excess of [[iron]] that progressively builds up in the brain.

==Signs and symptoms==
Symptoms typically begin in childhood and are progressive, often resulting in death by early adulthood. Symptoms of PKAN begin before middle childhood, and most often are noticed before ten years of age. Symptoms include:
*[[dystonia]] (repetitive uncontrollable muscle contractions that may cause jerking or twisting of certain muscle groups)
*[[dysphagia]] & [[dysarthria]] due to muscle groups involved in speech being involved
*rigidity/stiffness of limbs
*[[tremor]]
*writhing movements
*[[dementia]]
*[[spasticity]]
*[[Rigidity (neurology)]]
*[[weakness]]
*[[seizure]]s (rare)
*[[toe walking]]
*[[retinitis pigmentosa]], another degenerative disease that affects the individual’s [[retina]], often causing alteration of retinal color and progressive deterioration of the retina at first causing [[night blindness]] and later resulting in a complete loss of vision.

25% of individuals experience an uncharacteristic form of PKAN that develops post-10 years of age and follows a slower, more gradual pace of deterioration than those pre-10 years of age. These individuals face significant speech deficits as well as psychiatric and behavioral disturbances.

Being a progressive, degenerative nerve illness, PKAN leads to early immobility and often death by early adulthood. Death occurs prematurely due to infections such as pneumonia, and the disease in itself is technically not life limiting.

==Genetics==
PKAN is an [[autosomal]] [[recessive]] disorder. The parents of an afflicted child must both be [[heterozygous]] carriers for the disease and therefore must carry one [[mutant]] [[allele]]. As it is an autosomal disorder, those [[heterozygous]] for the disorder may not display any atypical characteristics that are considered suggestive of the disorder, however there have been reported cases of [[compound heterozygosity]] in which heterozygous individuals do develop the classic form of the disease.<ref name="Zhou2001" /><ref>{{cite journal |author=Bei-sha, Tang|title=Novel compound heterozygous mutations in the PANK2 gene in a Chinese patient with atypical pantothenate kinase-associated neurodegeneration |journal=Movement Disorders |volume=20 |issue=7 |pages=819–21 |year=2005 |pmid=15747360 |doi=10.1002/mds.20408 |pmc=2105744|display-authors=etal}}</ref>

The disorder is caused by a mutant [[PANK2]] gene located at the [[chromosome|chromosomal]] [[Locus (genetics)|locus]]: 20p13-p12.3. [[PANK2]] is responsible in coding for the protein [[Pantothenate kinase]] 2, which in turn is responsible for stifling the accumulation of [[N-pantothenoyl-cysteine]] and [[pantetheine]]. It is believed that when this accumulation is not suppressed, the result is direct cell [[toxicity]] or cell toxicity as a result of free radical damage due to the lack of suppression.

PANK2 encodes a 1.85Kb transcript which is derived from seven exons covering a total distance of approximately 3.5Mb of genomic DNA. The PANK2 gene also encodes a 50.5-kDa[[protein]] that is a functional pantothenate [[kinase]], an essential regulatory [[enzyme]] in [[coenzyme A]] (CoA) biosynthesis, and catalyzing the phosphorylation of pantothenate ([[Vitamin B5|vitamin B<sub>5</sub>]]), N-pantothenoyl-cysteine, and pantetheine (OMIM).

Mutant PANK2 gene coded proteins are often caused by null or [[missense mutation]]s most notably a 7bp deletion in the PANK2 [[gene]] coding sequence.

This disorder has been reported in specific communities based on intra-community marriages where both parents of the child are carrying the same mutation. One of the communities reported is Agrawal (Agarwal) Community mainly based in Northern Part of India.The known mutation in Agarwal community is pathogenic mutation 1c.215_216insA in PANK2 gene. This is also coded as chr20:3870292-3870293insA by some labs. It results in a frameshift and premature truncation of the protein 47 amino acids downstream to codon 183 (p.Arg183GlufsTer47; ENST00000316562).
<ref>http://www.scribd.com/doc/95164360/PANK2-Agarwal</ref>
<ref>http://www.britannica.com/bps/additionalcontent/18/27764296/Founder-mutation-in-the-PANK-gene-of-Agrawal-children-with-Neurodegeneration-with-Brain-Iron-accumulation-NBIA</ref>

==Diagnosis==
[[File:Pkan-basal-ganglia-MRI.JPG]]
A neurological examination would show evidence of muscle rigidity; weakness; and abnormal postures, movements, and tremors. If other family members are also affected, this may help determine the diagnosis. Genetic tests can confirm an abnormal gene causing the disease. However, this test is not yet widely available. Other movement disorders and diseases must be ruled out. Individuals exhibiting any of the above listed symptoms are often tested using [[MRI]] (Magnetic Resonance Imaging) for a number of neuro-related disorders. As PKAN is a disease prominently evident in the brain, MRIs are very useful in making a sound diagnosis. An MRI usually shows iron deposits in the [[basal ganglia]]. Development of diagnostic criteria continues in the hope of further separating PKAN from other forms of neurodegenerative diseases featuring NBIA.

===Neuropathology===
Microscopic features of PKAN include:
*Iron granules
*[[Spheroid bodies]]
*[[Lewy bodies]] within neurons

==Treatment==
There have been no major breakthroughs in the treatment of PKAN, with most [[Pharmacology|pharmacologic]] treatments focusing on the easing or temporary relieving of PKAN’s symptoms. Iron [[chelating]] agents have been used somewhat successfully in retarding the disorder, but they have not been a significant success.

Many believe taking certain vitamins may be beneficial, including [[pantothenate]], [[Coenzyme Q]], and other [[anti-oxidants]].{{Citation needed|date=March 2007}}

Current research focuses on the future use of high dose [[pantothenate]], the PANK2 enzyme substrate, in possibly alleviating symptoms as well as the further development of iron chelating agents that may be better aimed at reaching the central nervous system and working to better remove excess iron from the individual’s system.

Complications may result from the medication used to treat symptoms. Immobility from the disease can also lead to [[skin breakdown]], respiratory infections, and blood clots, among others.

==Prognosis==
Survival rates for those diagnosed with typical PKAN is 11.18 years with a standard deviation of 7.8 years.

==Epidemiology==
[[Prevalence]] data regarding this disorder remains incomplete, however it is estimated that anywhere between 1 in 1,000,000 to 3 in 1,000,000 individuals will be afflicted with this disorder (based upon observed cases in a population), but once again this is only an estimate as the disease is so rare it is difficult to statistically and accurately ascertain.

==History==
PKAN was first described by Hallervorden and Spatz (1922). Their discovery was brought about by a diagnosis of a family of 12 in which five sisters exhibited progressively increasing dementia and dysarthria. [[Autopsy|Autopsies]] revealed brown discolorations in different areas of the brain (particularly of interest were the globus pallidus and substantia nigra regions). Further investigation and description was brought about by Meyer (1958) who diagnosed 30 separate cases of PKAN. Meyer(1958) was followed by Elejalde et al. (1978) who described 5 affected family members and hypothesized that the disorder originated in central [[Europe]], backing up his hypothesis with clinical and genetic analysis. Further investigation and insights were provided by Malmstrom-Groth and Kristensson (1982)<ref>{{cite journal |author=Malmström-Groth AG, Kristensson K |title=Neuroaxonal dystrophy in childhood. Report of two second cousins with PKAN, and a case of Seitelberger's disease |journal=Acta paediatrica Scandinavica |volume=71 |issue=6 |pages=1045–9 |year=1982|pmid=7158329 |doi=10.1111/j.1651-2227.1982.tb09574.x}}</ref> and Jankovic et al. (1985).<ref>{{cite journal |author=Jankovic J, Kirkpatrick JB, Blomquist KA, Langlais PJ, Bird ED|title=Late-onset Hallervorden-Spatz disease presenting as familial parkinsonism |journal=Neurology |volume=35 |issue=2 |pages=227–34 |date=February 1985 |pmid=3969211 |doi= 10.1159/000153550|url=}}</ref>

Diagnosis of PKAN hit a milestone with the availability of MRIs, as well as the in-depth descriptions of those MRIs provided by Littrup and Gebarski (1985),<ref>{{cite journal|author=Jankovic J, Kirkpatrick JB, Blomquist KA, Langlais PJ, Bird ED |title=Late-onset Hallervorden-Spatz disease presenting as familial parkinsonism |journal=Neurology |volume=35|issue=2 |pages=227–34 |year=1985 |pmid=3969211 |doi=10.1159/000153550}}</ref> Tanfani et al. (1987),<ref>{{cite journal |author=Tanfani G, Mascalchi M, Dal Pozzo GC, Taverni N, Saia A, Trevisan C |title=MR imaging in a case of Hallervorden-Spatz disease |journal=Journal of computer assisted tomography |volume=11 |issue=6 |pages=1057–8 |year=1987|pmid=3680689 |doi=10.1097/00004728-198711000-00027}}</ref> Sethi et al. (1988),<ref>{{cite journal |author=Sethi KD, Adams RJ, Loring DW, el Gammal T |title=Hallervorden-Spatz syndrome: clinical and magnetic resonance imaging correlations |journal=Ann. Neurol. |volume=24 |issue=5 |pages=692–4 |year=1988 |pmid=3202617 |doi=10.1002/ana.410240519}}</ref> Angelini et al. (1992),<ref>{{cite journal |author=Angelini L, Nardocci N, Rumi V, Zorzi C, Strada L, Savoiardo M |title=Hallervorden-Spatz disease: clinical and MRI study of 11 cases diagnosed in life |journal=J. Neurol. |volume=239 |issue=8 |pages=417–25 |year=1992 |pmid=1447570 |doi=10.1007/BF00856805}}</ref> Casteels et al. (1994),<ref>{{cite journal |vauthors=Casteels I, Spileers W, Swinnen T, etal |title=Optic atrophy as the presenting sign in Hallervorden-Spatz syndrome |journal=Neuropediatrics |volume=25 |issue=5|pages=265–7 |year=1994 |pmid=7885538 |doi=10.1055/s-2008-1073034}}</ref> and Malandrini et al. (1995).<ref>{{cite journal |author=Malandrini A, Bonuccelli U, Parrotta E, Ceravolo R, Berti G, Guazzi GC |title=Myopathic involvement in two cases of Hallervorden-Spatz disease |journal=Brain Dev. |volume=17 |issue=4 |pages=286–90 |year=1995 |pmid=7503394|doi=10.1016/0387-7604(95)00039-E}}</ref> The gene was localized to chromosome 20p by Taylor et al. (1996) <ref name="Taylor1996">{{cite journal |author= Taylor TD, Litt M, Kramer P, Pandolfo M, Angelini L, Nardocci N, Davis S, Pineda M, Hattori H, Flett PJ, Cilio MR, Bertini E, Hayflick SJ |title=Homozygosity mapping of Hallervorden-Spatz syndrome to chromosome 20p12.3-p13 |journal=Nat. Genet. |volume=14 |issue=4 |pages=479–81 |year=1996 |pmid=8944032 |doi=10.1038/ng1296-479}}</ref> who suggested that this disorder should be referred to as neurodegeneration with brain iron accumulation (NBIA1) to avoid the objectionable eponym of Hallervorden-Spatz. The disease was named 'pantothenate kinase-associated neurodegeneration' or PKAN by Zhou et al. (2001)<ref name="Zhou2001">{{cite journal |author=Zhou B, Westaway SK, Levinson B, Johnson MA, Gitschier J, Hayflick SJ |title=A novel pantothenate kinase gene (PANK2) is defective in Hallervorden-Spatz syndrome |journal=Nat. Genet. |volume=28 |issue=4 |pages=345–9 |year=2001 |pmid=11479594|doi=10.1038/ng572}}</ref> who suggested the name to avoid misinterpretation and to better reflect the true nature of the disorder. Most recently Pellecchia et al. (2005) published a report of 16 patients afflicted with PKAN, confirmed by genetic analysis.<ref>{{cite journal |vauthors=Pellecchia MT, Valente EM, Cif L, etal |title=The diverse phenotype and genotype of pantothenate kinase-associated neurodegeneration |journal=Neurology |volume=64 |issue=10 |pages=1810–2 |year=2005 |pmid=15911822|doi=10.1212/01.WNL.0000161843.52641.EC}}</ref>

==References==
{{Reflist|2}}


==External links==
* {{Chorus|02041}}
* {{WhoNamedIt|synd|1082}}
* {{NINDS|nbia}}
* [http://nbiadisorders.org/ NBIA Disorders Association]

{{Diseases of the nervous system}}
{{Metabolic disorders of vitamins, coenzymes, and cofactors}}

{{DEFAULTSORT:Pantothenate Kinase-Associated Neurodegeneration}}
[[Category:Extrapyramidal and movement disorders]]
[[Category:Vitamin, coenzyme, and cofactor metabolism disorders]]

File:Pkan-basal-ganglia-MRI.JPG

2016-02-02T02:13:48Z

Jyostna Chouturi:

Pantothenate kinase-associated neurodegeneration

2016-02-02T02:12:38Z

Jyostna Chouturi:

__NOTOC__
{{CMG}} {{AE}} {{JC}}
==Overview==
'''Pantothenate kinase-associated neurodegeneration''' (PKAN), also known as '''[[neurodegeneration with brain iron accumulation]] 1''' (NBIA1) and formerly called '''Hallervorden–Spatz syndrome''' (use of this eponym is somewhat discouraged due to [[Julius Hallervorden|Hallervorden]] and [[Hugo Spatz|Spatz]]'s affiliation with the Nazi regime and the ethically questionable manner in which they acted<ref>{{cite journal |last= Bazelon |first=Emily |date= Nov 6, 2013 |title= The Nazi Anatomists |url= http://www.slate.com/articles/life/history/2013/11/nazi_anatomy_history_the_origins_of_conservatives_anti_abortion_claims_that.html |journal= Slate Magazine |location= Web-based |publisher= The Washington Post Company |accessdate= Nov 7, 2013}}</ref><ref>{{whonamedit|doctor|535}}</ref><ref>{{whonamedit|doctor|1063}}</ref>), is a [[degenerative disease]] of the [[brain]] that can lead to [[parkinsonism]], dystonia, dementia, and ultimately death. Neurodegeneration in PKAN is accompanied by an excess of [[iron]] that progressively builds up in the brain.

==Signs and symptoms==
Symptoms typically begin in childhood and are progressive, often resulting in death by early adulthood. Symptoms of PKAN begin before middle childhood, and most often are noticed before ten years of age. Symptoms include:
*[[dystonia]] (repetitive uncontrollable muscle contractions that may cause jerking or twisting of certain muscle groups)
*[[dysphagia]] & [[dysarthria]] due to muscle groups involved in speech being involved
*rigidity/stiffness of limbs
*[[tremor]]
*writhing movements
*[[dementia]]
*[[spasticity]]
*[[Rigidity (neurology)]]
*[[weakness]]
*[[seizure]]s (rare)
*[[toe walking]]
*[[retinitis pigmentosa]], another degenerative disease that affects the individual’s [[retina]], often causing alteration of retinal color and progressive deterioration of the retina at first causing [[night blindness]] and later resulting in a complete loss of vision.

25% of individuals experience an uncharacteristic form of PKAN that develops post-10 years of age and follows a slower, more gradual pace of deterioration than those pre-10 years of age. These individuals face significant speech deficits as well as psychiatric and behavioral disturbances.

Being a progressive, degenerative nerve illness, PKAN leads to early immobility and often death by early adulthood. Death occurs prematurely due to infections such as pneumonia, and the disease in itself is technically not life limiting.

==Genetics==
PKAN is an [[autosomal]] [[recessive]] disorder. The parents of an afflicted child must both be [[heterozygous]] carriers for the disease and therefore must carry one [[mutant]] [[allele]]. As it is an autosomal disorder, those [[heterozygous]] for the disorder may not display any atypical characteristics that are considered suggestive of the disorder, however there have been reported cases of [[compound heterozygosity]] in which heterozygous individuals do develop the classic form of the disease.<ref name="Zhou2001" /><ref>{{cite journal |author=Bei-sha, Tang|title=Novel compound heterozygous mutations in the PANK2 gene in a Chinese patient with atypical pantothenate kinase-associated neurodegeneration |journal=Movement Disorders |volume=20 |issue=7 |pages=819–21 |year=2005 |pmid=15747360 |doi=10.1002/mds.20408 |pmc=2105744|display-authors=etal}}</ref>

The disorder is caused by a mutant [[PANK2]] gene located at the [[chromosome|chromosomal]] [[Locus (genetics)|locus]]: 20p13-p12.3. [[PANK2]] is responsible in coding for the protein [[Pantothenate kinase]] 2, which in turn is responsible for stifling the accumulation of [[N-pantothenoyl-cysteine]] and [[pantetheine]]. It is believed that when this accumulation is not suppressed, the result is direct cell [[toxicity]] or cell toxicity as a result of free radical damage due to the lack of suppression.

PANK2 encodes a 1.85Kb transcript which is derived from seven exons covering a total distance of approximately 3.5Mb of genomic DNA. The PANK2 gene also encodes a 50.5-kDa[[protein]] that is a functional pantothenate [[kinase]], an essential regulatory [[enzyme]] in [[coenzyme A]] (CoA) biosynthesis, and catalyzing the phosphorylation of pantothenate ([[Vitamin B5|vitamin B<sub>5</sub>]]), N-pantothenoyl-cysteine, and pantetheine (OMIM).

Mutant PANK2 gene coded proteins are often caused by null or [[missense mutation]]s most notably a 7bp deletion in the PANK2 [[gene]] coding sequence.

This disorder has been reported in specific communities based on intra-community marriages where both parents of the child are carrying the same mutation. One of the communities reported is Agrawal (Agarwal) Community mainly based in Northern Part of India.The known mutation in Agarwal community is pathogenic mutation 1c.215_216insA in PANK2 gene. This is also coded as chr20:3870292-3870293insA by some labs. It results in a frameshift and premature truncation of the protein 47 amino acids downstream to codon 183 (p.Arg183GlufsTer47; ENST00000316562).
<ref>http://www.scribd.com/doc/95164360/PANK2-Agarwal</ref>
<ref>http://www.britannica.com/bps/additionalcontent/18/27764296/Founder-mutation-in-the-PANK-gene-of-Agrawal-children-with-Neurodegeneration-with-Brain-Iron-accumulation-NBIA</ref>

==Diagnosis==
[[Image:Pkan-basal-ganglia-MRI.JPG|thumb|MRI image shows iron deposits in the basal ganglia, the so-called eye-of-the-tiger sign (T2w GRASE sequence).]]
A neurological examination would show evidence of muscle rigidity; weakness; and abnormal postures, movements, and tremors. If other family members are also affected, this may help determine the diagnosis. Genetic tests can confirm an abnormal gene causing the disease. However, this test is not yet widely available. Other movement disorders and diseases must be ruled out. Individuals exhibiting any of the above listed symptoms are often tested using [[MRI]] (Magnetic Resonance Imaging) for a number of neuro-related disorders. As PKAN is a disease prominently evident in the brain, MRIs are very useful in making a sound diagnosis. An MRI usually shows iron deposits in the [[basal ganglia]]. Development of diagnostic criteria continues in the hope of further separating PKAN from other forms of neurodegenerative diseases featuring NBIA.

===Neuropathology===
Microscopic features of PKAN include:
*Iron granules
*[[Spheroid bodies]]
*[[Lewy bodies]] within neurons

==Treatment==
There have been no major breakthroughs in the treatment of PKAN, with most [[Pharmacology|pharmacologic]] treatments focusing on the easing or temporary relieving of PKAN’s symptoms. Iron [[chelating]] agents have been used somewhat successfully in retarding the disorder, but they have not been a significant success.

Many believe taking certain vitamins may be beneficial, including [[pantothenate]], [[Coenzyme Q]], and other [[anti-oxidants]].{{Citation needed|date=March 2007}}

Current research focuses on the future use of high dose [[pantothenate]], the PANK2 enzyme substrate, in possibly alleviating symptoms as well as the further development of iron chelating agents that may be better aimed at reaching the central nervous system and working to better remove excess iron from the individual’s system.

Complications may result from the medication used to treat symptoms. Immobility from the disease can also lead to [[skin breakdown]], respiratory infections, and blood clots, among others.

==Prognosis==
Survival rates for those diagnosed with typical PKAN is 11.18 years with a standard deviation of 7.8 years.

==Epidemiology==
[[Prevalence]] data regarding this disorder remains incomplete, however it is estimated that anywhere between 1 in 1,000,000 to 3 in 1,000,000 individuals will be afflicted with this disorder (based upon observed cases in a population), but once again this is only an estimate as the disease is so rare it is difficult to statistically and accurately ascertain.

==History==
PKAN was first described by Hallervorden and Spatz (1922). Their discovery was brought about by a diagnosis of a family of 12 in which five sisters exhibited progressively increasing dementia and dysarthria. [[Autopsy|Autopsies]] revealed brown discolorations in different areas of the brain (particularly of interest were the globus pallidus and substantia nigra regions). Further investigation and description was brought about by Meyer (1958) who diagnosed 30 separate cases of PKAN. Meyer(1958) was followed by Elejalde et al. (1978) who described 5 affected family members and hypothesized that the disorder originated in central [[Europe]], backing up his hypothesis with clinical and genetic analysis. Further investigation and insights were provided by Malmstrom-Groth and Kristensson (1982)<ref>{{cite journal |author=Malmström-Groth AG, Kristensson K |title=Neuroaxonal dystrophy in childhood. Report of two second cousins with PKAN, and a case of Seitelberger's disease |journal=Acta paediatrica Scandinavica |volume=71 |issue=6 |pages=1045–9 |year=1982|pmid=7158329 |doi=10.1111/j.1651-2227.1982.tb09574.x}}</ref> and Jankovic et al. (1985).<ref>{{cite journal |author=Jankovic J, Kirkpatrick JB, Blomquist KA, Langlais PJ, Bird ED|title=Late-onset Hallervorden-Spatz disease presenting as familial parkinsonism |journal=Neurology |volume=35 |issue=2 |pages=227–34 |date=February 1985 |pmid=3969211 |doi= 10.1159/000153550|url=}}</ref>

Diagnosis of PKAN hit a milestone with the availability of MRIs, as well as the in-depth descriptions of those MRIs provided by Littrup and Gebarski (1985),<ref>{{cite journal|author=Jankovic J, Kirkpatrick JB, Blomquist KA, Langlais PJ, Bird ED |title=Late-onset Hallervorden-Spatz disease presenting as familial parkinsonism |journal=Neurology |volume=35|issue=2 |pages=227–34 |year=1985 |pmid=3969211 |doi=10.1159/000153550}}</ref> Tanfani et al. (1987),<ref>{{cite journal |author=Tanfani G, Mascalchi M, Dal Pozzo GC, Taverni N, Saia A, Trevisan C |title=MR imaging in a case of Hallervorden-Spatz disease |journal=Journal of computer assisted tomography |volume=11 |issue=6 |pages=1057–8 |year=1987|pmid=3680689 |doi=10.1097/00004728-198711000-00027}}</ref> Sethi et al. (1988),<ref>{{cite journal |author=Sethi KD, Adams RJ, Loring DW, el Gammal T |title=Hallervorden-Spatz syndrome: clinical and magnetic resonance imaging correlations |journal=Ann. Neurol. |volume=24 |issue=5 |pages=692–4 |year=1988 |pmid=3202617 |doi=10.1002/ana.410240519}}</ref> Angelini et al. (1992),<ref>{{cite journal |author=Angelini L, Nardocci N, Rumi V, Zorzi C, Strada L, Savoiardo M |title=Hallervorden-Spatz disease: clinical and MRI study of 11 cases diagnosed in life |journal=J. Neurol. |volume=239 |issue=8 |pages=417–25 |year=1992 |pmid=1447570 |doi=10.1007/BF00856805}}</ref> Casteels et al. (1994),<ref>{{cite journal |vauthors=Casteels I, Spileers W, Swinnen T, etal |title=Optic atrophy as the presenting sign in Hallervorden-Spatz syndrome |journal=Neuropediatrics |volume=25 |issue=5|pages=265–7 |year=1994 |pmid=7885538 |doi=10.1055/s-2008-1073034}}</ref> and Malandrini et al. (1995).<ref>{{cite journal |author=Malandrini A, Bonuccelli U, Parrotta E, Ceravolo R, Berti G, Guazzi GC |title=Myopathic involvement in two cases of Hallervorden-Spatz disease |journal=Brain Dev. |volume=17 |issue=4 |pages=286–90 |year=1995 |pmid=7503394|doi=10.1016/0387-7604(95)00039-E}}</ref> The gene was localized to chromosome 20p by Taylor et al. (1996) <ref name="Taylor1996">{{cite journal |author= Taylor TD, Litt M, Kramer P, Pandolfo M, Angelini L, Nardocci N, Davis S, Pineda M, Hattori H, Flett PJ, Cilio MR, Bertini E, Hayflick SJ |title=Homozygosity mapping of Hallervorden-Spatz syndrome to chromosome 20p12.3-p13 |journal=Nat. Genet. |volume=14 |issue=4 |pages=479–81 |year=1996 |pmid=8944032 |doi=10.1038/ng1296-479}}</ref> who suggested that this disorder should be referred to as neurodegeneration with brain iron accumulation (NBIA1) to avoid the objectionable eponym of Hallervorden-Spatz. The disease was named 'pantothenate kinase-associated neurodegeneration' or PKAN by Zhou et al. (2001)<ref name="Zhou2001">{{cite journal |author=Zhou B, Westaway SK, Levinson B, Johnson MA, Gitschier J, Hayflick SJ |title=A novel pantothenate kinase gene (PANK2) is defective in Hallervorden-Spatz syndrome |journal=Nat. Genet. |volume=28 |issue=4 |pages=345–9 |year=2001 |pmid=11479594|doi=10.1038/ng572}}</ref> who suggested the name to avoid misinterpretation and to better reflect the true nature of the disorder. Most recently Pellecchia et al. (2005) published a report of 16 patients afflicted with PKAN, confirmed by genetic analysis.<ref>{{cite journal |vauthors=Pellecchia MT, Valente EM, Cif L, etal |title=The diverse phenotype and genotype of pantothenate kinase-associated neurodegeneration |journal=Neurology |volume=64 |issue=10 |pages=1810–2 |year=2005 |pmid=15911822|doi=10.1212/01.WNL.0000161843.52641.EC}}</ref>

==References==
{{Reflist|2}}


==External links==
* {{Chorus|02041}}
* {{WhoNamedIt|synd|1082}}
* {{NINDS|nbia}}
* [http://nbiadisorders.org/ NBIA Disorders Association]

{{Diseases of the nervous system}}
{{Metabolic disorders of vitamins, coenzymes, and cofactors}}

{{DEFAULTSORT:Pantothenate Kinase-Associated Neurodegeneration}}
[[Category:Extrapyramidal and movement disorders]]
[[Category:Vitamin, coenzyme, and cofactor metabolism disorders]]

Vision loss

2016-02-02T02:07:34Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Juvenile macular degeneration and hypotrichosis]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Krause syndrome]]
*[[Langerhans cell histiocytosis]]
*[[Lattice corneal dystrophy type 1]]
*[[Laurence-moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Leber hereditary optic neuropathy]]
*[[Leg absence, deformity, cataract]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome (lccs)]]
*[[Linear igA dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Lowe oculocerebrorenal syndrome]]
*[[Lymphoma, mucosa-associated lymphoid tissue]]
*[[Macular degeneration]]
*[[Macular dystrophy, concentric annular]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marsden syndrome]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mental retardation, hypocupremia, hypobetalipoproteinemia]]
*[[Mental retardation unusual facies ampola type]]
*[[Mental retardation, x-linked, wittwer type]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol poisoning]]
*[[Microcephaly, microphthalmos]]
*[[Microphthalmia]]
*[[Microvascular complications of diabetes]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Pantothenate kinase-associated neurodegeneration]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt's disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T02:06:33Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herns syndrome]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Juvenile macular degeneration and hypotrichosis]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Krause syndrome]]
*[[Langerhans cell histiocytosis]]
*[[Lattice corneal dystrophy type 1]]
*[[Laurence-moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Leber hereditary optic neuropathy]]
*[[Leg absence, deformity, cataract]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome (lccs)]]
*[[Linear igA dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Lowe oculocerebrorenal syndrome]]
*[[Lymphoma, mucosa-associated lymphoid tissue]]
*[[Macular degeneration]]
*[[Macular dystrophy, concentric annular]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marsden syndrome]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mental retardation, hypocupremia, hypobetalipoproteinemia]]
*[[Mental retardation unusual facies ampola type]]
*[[Mental retardation, x-linked, wittwer type]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol poisoning]]
*[[Microcephaly, microphthalmos]]
*[[Microphthalmia]]
*[[Microvascular complications of diabetes]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Pantothenate kinase-associated neurodegeneration]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt's disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}

Vision loss

2016-02-02T01:58:39Z

Jyostna Chouturi: /* Causes in Alphabetical Order */

__NOTOC__
'''For patient information, click [[Vision loss (patient information)|here]]'''
{{SI}}
{{CMG}} {{AE}} {{JC}}

{{SK}} Visual loss
==Overview==
'''Vision loss''' is the absence of [[Visual perception|vision]] where it existed before, which can happen either [[Acute (medical)|acutely]] (i.e. abruptly) or [[chronic (medicine)|chronically]] (i.e. over a long period of time). It may be caused by media opacities, [[retina]]l disease, [[optic nerve]] disease, [[#visual pathway disorder|visual pathway disorder]]s, or [[#Functional disorder|functional disorder]]s, or it may be due to an abnormality in the central nervous system.

==Classification==
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
*Unilateral
*Bilateral
*Transient
*Persistant
*Sudden
*Gradual
*Painless
*Painful<br>

==Pathophysiology==
===Media Opacity===
Opacities of the clear refractive media of the [[eye]] such as the [[cornea]], anterior chamber, [[lens (anatomy)|lens]], and [[vitreous humor]] may cause acute visual loss as manifested by blurry vision or reduced [[visual acuity]].
While [[pupillary reflex]]es may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, [[hyphema]], [[cataract]] and vitreous hemorrhage.

===Retinal Disease===
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include [[retinal detachment]]; [[macula]]r disease (''e.g.'', [[macular degeneration]]); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

===Optic Nerve Disease===
Diseases which affect the optic nerve may cause acute visual loss.
[[Sign (medicine)|Sign]]s include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The [[optic nerve]] can be affected by many diseases including [[optic neuritis]], [[retrobulbar neuritis]], [[papillitis]], [[papilledema]], [[glaucoma]], [[ischemic optic neuropathy]], and [[giant cell arteritis]].

===Hypoxia===
The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a [[brownout (medical)|brownout]] or [[brownout (medical)|greyout]]) accompanied by loss of peripheral perception may result from low blood pressure, [[Shock (medical)|shock]], [[g-LOC]] (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

===Visual Pathway Disorder===
Visual pathway disorders are any problems that may impede the [[visual pathway]].
Rarely, acute visual loss is caused by [[homonymous hemianopia]] and, more rarely, [[cortical blindness]].

===Functional Disorder===
The term functional disorder is now used where hysterical and [[malingering]] were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

==Causes==
===Transient Vision Loss (<24 hours)===
*Amaurosis fugax
:*Vision loss is unilateral and lasts only minutes
*[[Migrane]]
:*Vision loss lasts 10-60 minutes
*Ocular ischemic syndrome ([[Cartoid Occlusive Disease]])
*[[Papilledema]]
:*Raised intracranial pressure
:*Malignant hypertension
*Retinal detachment
*Sudden change in blood pressure
:*Orthostatic hypotension
*Transient acute increase in thraocular pressure
:*Acute Angle Closure [[Glaucoma]]
:*Retro-or peribulbar hemorrhage
*Vertebrobasilar artery insufficiency
:*Vision loss is bilateral and lasts minutes
*Vitreous hemorrhage
*Vitreous detachment
===Vision Loss > 24 hours:Sudden, Painless===
*Exposure(Welder's flash)
:*prolonged exposure to intense light/sunlight
*Ischemic optic neuropathy
:*To prevent permanent loss, rule out giant cell/temporal arteritis
*Other retinal or central nervous system disease
:*Occipital lobe CVA causing cortical blindness
*[[Optic Neuritis]]
*Retinal artery/vein occlusion
*Retinal detachment
*Vitreous or aqueous hemmorrhage (hyphema)
===Vision Loss >24 hours:Gradual, Painless===
*[[Cataracts]]
*[[Cerebral Neoplasm]]
*Chronic retinopathy
:*Age related macular degeneration
:*[[Diabetic Retinopathy]]
*Chronic corneal disease
:*Corneal dystrophy
*Corneal Ulcer
*Open angle [[Glaucoma]]
*Optic neuropathy/atrophy
:*Compressive lesion
:*Toxic-metabolic cause
:*Radiation
*Pseudotumor cerebri
*Refractive error
*Retitnitis pigmentosa
===Vision Loss >24 hours:Painful===
*Acute Angle Closure [[Glaucoma]]
*Corneal hydrops
:*Keratoconus
*Corneal abrasion/ulcer
*Herepes simplex/zoster
*Ocular onchocerciasis
:*"River blindness"
:*''Onchocera volvulus'' worm
*Optic neuritis
*Orbital apex/superior orbital fissure/cavernous sinus syndrome
*[[Uveitis]]

===Life-Threatening Causes===

===Common Causes===

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[2-hydroxyglutaricaciduria]]
*[[3-Methylglutaconic aciduria|3 alpha methylglutaconicaciduria, type 3]]
*[[Septum pellucidum|Absence of septum pellucidum with porencephalia syndrome]]
*[[Acanthamoeba|Acanthamoeba infection of the eye]]
*[[Eye injury|Accidental eye injury]]
*[[Achromatopsia|Achromatopsia incomplete, x-linked]]
*[[Pachydermoperiostosis]]
*[[Acute disseminated encephalomyelitis]]
*[[Maculopathy|Acute maculopathy]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Acute retinal necrosis|Acute retinal necrosis syndrome]]
*[[Age-related macular degeneration]]
*[[Albinism]]
*[[Alezzandrini syndrome]]
*[[Alpers' disease|Alpers syndrome]]
*[[Alport syndrome]]
*[[Alström syndrome]]
*[[Alveolar hydatid disease]]
*[[Amaurosis fugax]]
*[[Amblyopia]]
*[[Amitriptyline]]
*[[Amelogenesis imperfecta]]
*[[Mercaptolactace-cysteine disulfiduria|Ampola syndrome]]
*[[Anencephaly]]
*[[Angioid streaks]]
*[[Aniridia]]
*[[Anisometropia]]
*[[Anterior segment mesenchymal dysgenesis]]
*[[Arachnoiditis]]
*[[Arteriovenous malformation]]
*[[Aspartoacylase deficiency]]
*[[Asthenopia]]
*[[Avitaminosis]]
*[[Axenfeld-Rieger syndrome|Axenfeld-rieger syndrome]]
*[[Bardet-Biedl syndrome|Bardet-biedl syndrome]]
*[[Basement membrane corneal dystrophy]]
*[[Basilar artery insufficiency syndrome]]
*[[Batten disease]]
*[[Behcet's disease]]
*[[Benign essential blepharospasm]]
*[[Sarcoidosis|Besnier-boeck-schaumann disease]]
*[[Imidazole syndrome|Bessman-baldwin syndrome]]
*[[Best's disease]]
*[[Cortical blindness|Bilateral occipital lobe infarct]]
*[[Optic neuritis|Bilateral optic neuritis]]
*[[Papilloedema|Bilateral papilloedema]]
*[[Blepharitis]]
*[[Blind spot]]
*[[Blindness]]
*[[Blue cone monochromatism]]
*[[Blue diaper syndrome]]
*[[Blue-ringed octopus poisoning]]
*[[Bothnia retina dystrophy]]
*[[Brain aneurysm]]
*[[Brain tumors]]
*[[Fahr's syndrome|Basal ganglia calcification]]
*[[Canavan leukodystrophy]]
*[[Carbachol]]
*[[Carbamazepine]]
*[[Cassia Stocco dos Santos syndrome]]
*[[Atherosclerosis|Carotid atherosclerosis]]
*[[Carotid-cavernous fistula]]
*[[Cataract]]
*[[Catastrophic antiphospholipid syndrome]]
*[[Celecoxib]]
*[[Central retinal vein occlusion]]
*[[Central serous chorioretinopathy]]
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis, neuronal 1, infantile]]
*[[Chalazion]]
*[[Chandler's syndrome]]
*[[Charcot-Marie-Tooth Syndrome|Charcot-marie-tooth disease, x-linked recessive]]
*[[CHARGE syndrome]]
*[[Cesium]]
*[[Chlorpheniramine]]
*[[Chorioretinitis]]
*[[Choroideremia]]
*[[Choroiditis]]
*[[Chromosome 11 (human)|Chromosome 11, deletion 11p]]
*[[13q deletion syndrome|Chromosome 13q deletion syndrome]]
*[[Chromosome 14 (human)|Chromosome 14q, partial deletion]]
*[[Chromosome 17 (human)|Chromosome 17, deletion 17q23 q24]]
*[[Chromosome 2 (human)|Chromosome 2p deletion syndrome]]
*[[Ciliary muscle]]
*[[Cinnarizine]]
*[[Citrullinemia]]
*[[Clomifene]]
*[[Cluster headache]]
*[[Cobra poisoning]]
*[[Coenzyme Q - cytochrome c reductase|Coenzyme q cytochrome c reductase deficiency]]
*[[Iridocorneal endothelial syndrome|Cogan-reese syndrome]]
*[[Cohen syndrome]]
*[[Coloboma]]
*[[Color blindness|Colour vision impairment]]
*[[Concussion]]
*[[Cone dystrophy]]
*[[Congenital toxoplasmosis]]
*[[Conversion disorder]]
*[[Cornea plana 1]]
*[[Corneal dystrophy]]
*[[Cloudy cornea (patient information)|Corneal edema]]
*[[Krause-Kivlin syndrome|Corneal opacity]]
*[[Corneal ulcer]]
*[[Cortical blindness]]
*[[Infantile cortical hyperostosis|Cortical hyperostosis-syndactyly]]
*[[Craniodiaphyseal dysplasia]]
*[[Craniometaphyseal dysplasia]]
*[[Cree leukoencephalopathy]]
*[[Creutzfeldt Jakob disease]]
*[[Cycloplegia]]
*[[Macular edema|Cystoid macular dystrophy]]
*[[Cytomegalovirus retinitis]]
*[[Daphne poisoning]]
*[[Deferoxamine|Desferrioxamine toxicity]]
*[[Desipramine]]
*[[Devic's disease]]
*[[Diabetic retinopathy|Diabetic eye disease]]
*[[Diabetic ketoacidosis]]
*[[Diabetic retinopathy]]
*[[Wolfram syndrome|DIDMOAD syndrome]]
*[[Diphenhydramine]]
*[[Dothiepin]]
*[[Dry eye]]
*[[Eales disease]]
*[[Ebola]]
*[[Ectodermal dysplasia]]
*[[Ehlers-Danlos syndrome|Ehlers-danlos syndrome]]
*[[Emanuel syndrome]]
*[[Empty sella syndrome]]
*[[Encephalocele]]
*[[Endophthalmitis]]
*[[Episodic ataxia]]
*[[Iridocorneal endothelial syndrome|Essential iris atrophy]]
*[[Esthesioneuroblastoma]]
*[[Euphorbiaceae]]
*[[Ocular oncology|Eye cancer]]
*[[Eye injury]]
*[[Melanoma of the eye (patient information)|Eye melanoma]]
*[[Metachromatic leukodystrophy]]
*[[Feline spongiform encephalopathy]]
*[[Minamata disease|Fetal methylmercury syndrome]]
*[[Flynn-Aird syndrome]]
*[[Foreign body]]
*[[Treacher Collins syndrome|Franceschetti-klein syndrome]]
*[[Francois dyscephalic syndrome]]
*[[Fuchs' dystrophy]]
*[[Fundus albipunctatus]]
*[[Galactokinase deficiency]]
*[[Giant cell arteritis]]
*[[Glaucoma]]
*[[Glioblastoma]]
*[[GM1 gangliosidoses|Gm1 gangliosidosis]]
*[[GM2-gangliosidosis, AB variant|Gm2-gangliosidosis, ab variant]]
*[[Goldberg–Shprintzen syndrome]]
*[[Pseudoxanthoma elasticum|Gronblad-strandberg-touraine syndrome]]
*[[Guizar-vasquez-sanchez-manzano syndrome]]
*[[Gustavson syndrome]]
*[[Hallervorden-spatz syndrome]]
*[[Langerhans cell histiocytosis|Hand-schuller-christian syndrome]]
*[[Head injury]]
*[[Heidenhain syndrome]]
*[[Helminth infections]]
*[[Hemianopia]]
*[[Herns syndrome]]
*[[Herpes simplex|Neonatal herpes]]
*[[Herpetic keratitis]]
*[[HIV]]
*[[Homonymous hemianopia]]
*[[Hurler syndrome]]
*[[Hydranencephaly]]
*[[Hydrocephalus]]
*[[Hydroxyzine]]
*[[Hyperopia]]
*[[Ornithine translocase deficiency|Hyperornithinemia]]
*[[Hypertension of pregnancy]]
*[[Hyphema]]
*[[Hypoglycaemia]]
*[[Hypophosphatemia]]
*[[Hysteria]]
*[[Incontinentia pigmenti]]
*[[Increased intracranial pressure]]
*[[Congenital cytomegalovirus infection|Infant cytomegalic virus]]
*[[Infantile refsum disease]]
*[[Inflammatory processes]]
*[[Intraocular melanoma]]
*[[Iridocyclitis]]
*[[Iridogoniodysgenesis, dominant type]]
*[[Ischemic optic neuropathy]]
*[[Ivabradine]]
*[[Jensen syndrome]]
*[[Juvenile macular degeneration and hypotrichosis]]
*[[Kallmann syndrome]]
*[[Kearns–Sayre syndrome]]
*[[Keratitis]]
*[[Keratomalacia]]
*[[Krabbe leukodystrophy]]
*[[Krause syndrome]]
*[[Langerhans cell histiocytosis]]
*[[Lattice corneal dystrophy type 1]]
*[[Laurence-moon syndrome]]
*[[Leber's congenital amaurosis]]
*[[Leber hereditary optic neuropathy]]
*[[Leg absence, deformity, cataract]]
*[[Leprosy]]
*[[Lethal congenital contracture syndrome (lccs)]]
*[[Linear igA dermatosis]]
*[[Lithium]]
*[[Lobstein disease]]
*[[Lowe oculocerebrorenal syndrome]]
*[[Lymphoma, mucosa-associated lymphoid tissue]]
*[[Macular degeneration]]
*[[Macular dystrophy, concentric annular]]
*[[Macular hole]]
*[[Malignant hypertension]]
*[[Marsden syndrome]]
*[[Marshall syndrome]]
*[[Mefloquine]]
*[[Uveal melanoma|Melanoma of the choroid]]
*[[Mental retardation, hypocupremia, hypobetalipoproteinemia]]
*[[Mental retardation unusual facies ampola type]]
*[[Mental retardation, x-linked, wittwer type]]
*[[Mercury poisoning]]
*[[Metachromatic leukodystrophy]]
*[[Methanol poisoning]]
*[[Microcephaly, microphthalmos]]
*[[Microphthalmia]]
*[[Microvascular complications of diabetes]]
*[[Midline craniofacial anomalies and morning glory disc anomaly]]
*[[Migraine]]
*[[Mitochondrial diseases]]
*[[Monosodium methyl arsenate]]
*[[Morpholine]]
*[[Motor and sensory neuropathy, optic atrophy and sensorineural hearing loss]]
*[[Mucolipidosis]]
*[[Mucopolysaccharidosis|Mucopolysaccharidosis type i hurler syndrome/scheie syndrome]]
*[[Mucormycosis]]
*[[Multifocal choroiditis]]
*[[Multiple endocrine neoplasia type 1]]
*[[Multiple lentigines syndrome]]
*[[Multiple sclerosis]]
*[[Mycosis fungoides]]
*[[Nalidixic acid]]
*[[Nasopharyngeal carcinoma]]
*[[Nelson syndrome]]
*[[Neuraminidase deficiency]]
*[[Neuroaxonal dystrophy, infantile]]
*[[Neurodegeneration with brain iron accumulation 2]]
*[[Neurodegenerative syndrome, x-linked, hamel type]]
*[[Neuromyelitis optica]]
*[[Neuropathy, ataxia, retinitis pigmentosa]]
*[[Neurofibromatosis]]
*[[Niemann-Pick disease|Niemann-pick disease]]
*[[Night blindness, skeletal anomalies, unusual facies]]
*[[Night blindness, congenital stationary, autosomal dominant]]
*[[Noble-bass-sherman syndrome]]
*[[Norrie syndrome]]
*[[Nortriptyline]]
*[[Occipital lobe tumours]]
*[[Mucous membrane pemphigoid|Ocular cicatricial pemphigoid]]
*[[Presumed ocular histoplasmosis syndrome|Ocular histoplasmosis syndrome]]
*[[Ocular ischemic syndrome]]
*[[Cross syndrome|Oculocerebral-hypopigmentation syndrome]]
*[[Oculocutaneous albinism]]
*[[Oguchi disease]]
*[[Olivopontocerebellar atrophy|Olivopontocerebellar atrophy type 3]]
*[[Open-angle glaucoma]]
*[[Ophthalmia neonatorum]]
*[[Ophthalmoplegia]]
*[[Optic neuritis]]
*[[Optic pathway glioma]]
*[[Osteopetrosis]]
*[[Partial monosomy 13q]]
*[[Pantothenate kinase-associated neurodegeneration]]
*[[Uveitis|Panuveitis]]
*[[Papilledema]]
*[[Papillitis]]
*[[Paraneoplastic cerebellar degeneration]]
*[[Pepper spray]]
*[[Periorbital cellulitis]]
*[[Phenylbutazone]]
*[[Phenytoin toxicity]]
*[[Phosgene oxime|Phosgene oxime exposure]]
*[[Photopsia]]
*[[Physostigmine]]
*[[Retinitis pigmentosa|Pigmentary retinopathy]]
*[[Pituitary adenoma]]
*[[Pipecolic acidemia]]
*[[Plum syndrome]]
*[[Polychondritis]]
*[[Posterior leucoencephalopathy syndrome]]
*[[Posterior vitreous detachment]]
*[[Pre-eclampsia|Pregnancy hypertension]]
*[[Presbyopia]]
*[[AL amyloidosis|Primary systemic amyloidosis]]
*[[Prochlorperazine]]
*[[Progressive multifocal leukoencephalopathy]]
*[[Progressive supranuclear palsy]]
*[[Color blindness|Protanopia]]
*[[Pseudotumor cerebri]]
*[[Pseudoxanthoma elasticum-like disorder with multiple coagulation factor deficiency]]
*[[Psychogenic]]
*[[Pterygium]]
*[[Purtscher's retinopathy|Purtscher retinopathy]]
*[[Metaphyseal dysplasia|Pyle disease]]
*[[Pyruvate decarboxylase|Pyruvate decarboxylase deficiency]]
*[[Quinidine]]
*[[Intraocular pressure|Raised intraocular pressure]]
*[[Ramos-Arroyo syndrome|Ramos-arroyoclark syndrome]]
*[[Refractive error]]
*[[Retinal degeneration]]
*[[Retinal detachment]]
*[[Retinal dysplasia]]
*[[Retinal migraine]]
*[[Retinal tear]]
*[[Retinal vein occlusion]]
*[[Retinitis punctata albescens]]
*[[Retinoblastoma]]
*[[Retinopathy]]
*[[Retinoschisis]]
*[[Retrolental fibroplasia]]
*[[Rhabditida]]
*[[Rhabdomyosarcoma]]
*[[Zygomycosis|Rhinocerebral mucormycosis]]
*[[Rift valley fever]]
*[[Roberts syndrome]]
*[[Rofecoxib]]
*[[Sandhoff disease]]
*[[Sarcoidosis]]
*[[Schindler disease]]
*[[Scleritis]]
*[[Sclerostin|Sclerosteosis]]
*[[Secernentea|Secernentea infections]]
*[[Septo-optic dysplasia]]
*[[Shaken baby syndrome]]
*[[Shingles]]
*[[Sialidosis]]
*[[Sickle cell anemia]]
*[[Smith Martin Dodd syndrome|Smith-martin-dodd syndrome]]
*[[Cerebral palsy|Spastic tetraplegic]]
*[[Spherophakia-brachymorphia syndrome]]
*[[Spinocerebellar ataxia]]
*[[Stargardt's disease]]
*[[Glaucoma|Steroid induced glaucoma]]
*[[Stevens-Johnson syndrome]]
*[[Stickler syndrome]]
*[[Stroke]]
*[[Subacute combined degeneration of the cord]]
*[[Subacute myelo-optic neuropathy|Subacute myelo-optico neuropathy syndrome]]
*[[Subacute sclerosing panencephalitis|Subacute sclerosing leukoencephalitis]]
*[[Sudanophilic cerebral sclerosis]]
*[[Superior orbital fissure|Superior orbital fissure syndrome]]
*[[Cenani Lenz syndactylism]]
*[[Syphilis]]
*[[Takayasu arteritis]]
*[[Tay-Sachs disease]]
*[[Temozolomide]]
*[[Temporal arteritis]]
*[[Thalidomide]]
*[[Thallium poisoning]]
*[[Graves ophthalmopathy|Thyroid eye disease]]
*[[Tolosa-Hunt syndrome]]
*[[Toxins]]
*[[Toxoplasmosis]]
*[[Trachoma]]
*[[Transient ischaemic attack]]
*[[Familial amyloid polyneuropathy|Transthyretin amyloidosis]]
*[[Treacher Collins syndrome]]
*[[Usher syndrome]]
*[[Uveal melanoma]]
*[[Uveitis]]
*[[Vasculitis]]
*[[Bothnia retina dystrophy|Vasterbotten dystrophy]]
*[[Vertebral artery dissection]]
*[[Verteporfin]]
*[[Vigabatrin]]
*[[Vision impairment]]
*[[Visual hallucinations]]
*[[Vitamin A deficiency|Vitamin a deficiency]]
*[[Posterior vitreous detachment|Vitreous detachment]]
*[[Vitreous floaters]]
*[[Vitelliform macular dystrophy]]
*[[Intraocular hemorrhage|Vitreous haemorrhage]]
*[[Angiomatosis|Von hippel-lindau disease]]
*[[Stickler syndrome|Wagner-stickler syndrome]]
*[[WAGR syndrome]]
*[[Wegener's granulomatosis]]
*[[Weill-Marchesani syndrome|Weill-marchesani syndrome]]
*[[Wells jankovic syndrome]]
*[[Wildervanck syndrome]]
*[[Wilms tumor]]
*[[Winchester syndrome]]
*[[Wolf-Hirschhorn syndrome|Wittwer sydnrome]]
*[[Wolfram syndrome]]
*[[Woods black norbury syndrome]]
*[[Wrinkly skin syndrome]]
*[[Bonnet-Dechaume-Blanc syndrome|Wyburn mason's syndrome]]
*[[Xanthomatosis cerebrotendinous]]
*[[Ziconotide]]
*[[Zunich neuroectodermal syndrome]]
*[[Zygomycosis]]
}}

==Diagnosis==
===History and Symptoms===
'''History'''<br>
include:<br>
*Age
*Onset:
*Rate of loss
*Any specific trauma
*Headaches
*Medication
*Specific medical history
*Alcohol, drug and/or tabacco use

===Physical Examination===

====Eyes====
The examination should focus on:
*Acuity
*Blood pressure
*Color vision
*Cranial exam
*cranial nerve innervation
*Fundus
*Intraocular pressure
*Ocular media opacity
*Optic disc exam

===Laboratory Findings===
*ESR
*Fasting blood glucose
*HgBa1c
*PPD
*RPR
*FTR-ABS
*ACE level
*Vitamin B12
*Folate

=== MRI and CT ===
*CT/MRI of head and chest

==Evaluation of Monocular Transient Visual Loss==

<span style="font-size: 85%;">
'''Abbreviations''':
'''TVL''', transient visual loss.
</span>
{{Family tree/start}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A01 | | | | | | | |A01=<div style="text-align: center; padding: 15px;"><BIG>'''Monocular TVL'''</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A02 | | | | | | | |A02=<div style="padding: 15px; font-weight: bold;"><BIG>Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |,|-|-|^|-|-|.| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A03 | | | | A04 | | | | |A03=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>YES</BIG></div>|A04=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>NO</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | A05 | | | | |!| | | | | |A05=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Orbital MRI</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | |!| | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | |,|-|-|^|-|-|.| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | A06 | | | | A07 | |!| | |A06=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Structural lesion of orbit</BIG></div>|A07=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>No structural lesion of orbit</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A08 |-|'| | | |A08=<div style="text-align: center; padding: 15px; font-weight: bold;"><BIG>Duration of TVL?</BIG></div>}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | |!| | | | | |}}
{{Family tree|boxstyle=text-align: left; font-size: 80%; padding: 0px; | | | | | | | | A09 | |A09=<table style="width: 100%; border: 2px solid #A8A8A8;" align="center">
<caption> <small><i>Causes of Transient Visual Loss Based on the Duration</i><ref name="isbn978-1588901361">{{cite book | author = | authorlink = | editor = | others = | title = Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach | edition = | language = | publisher = | location = | year = | origyear = | pages = | quote = | isbn = 978-1588901361 | oclc = | doi = | url = | accessdate = }}</ref></small>
</caption>
<tr>
<td align="center" style="background: #C2DFFF; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts seconds</b>
</td>
<td align="center" style="background: #B0B0B0; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts minutes</b>
</td>
<td align="center" style="background: #FFB5DA; font-size: 75%; padding: 5px; width: 33%;"> <b>TVL lasts hours</b>
</td></tr>
<tr>
<td style="font-size: 90%; padding: 0 5px; background: #E0EFFF;" valign="top">
<ul>
<li> Papilledema
</li>
<li> Optic neuropathy
</li>
<li> Congenital disc anomaly
</li>
<li> Thromboembolism (rare)
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" valign="top">
<ul>
<li> Migraine
</li>
<li> Giant cell arteritis
</li>
<li> Thromboembolism
</li>
<li> Hypercoagulable state
</li>
<li> Antiphospholipid antibody syndrome
</li>
<li> Spontaneous hyphema
</li>
<li> Intermittent angle closure glaucoma
</li>
<li> Morning glory syndrome
</li>
<li> Peripapillary staphyloma
</li>
<li> Carotid artery dissection
</li>
<li> Venous stasis retinopathy
</li>
<li> Post-scleral buckle
</li>
</ul>
</td>
<td style="font-size: 90%; padding: 0 5px; background: #FEDAEC;" valign="top">
<ul>
<li> Spontaneous hyphema
</li>
<li> Thromboembolism
</li>
<li> Carotid stenosis
</li>
<li> Migraine
</li>
</ul>
</td></tr></table>}}
{{Family tree/end}}

== Treatment ==
===Medical Therapy===
*Systemic Steroids can be prescribed for the following:
:*Temporal arteritis
:*Optic neuritis
:*Pituitary apoplexy
:*Herpes zoster
*Nonarteritic ischemic optic neuropathy patients
:*Asprin
*Cavernous sinus thrombosis
:*Antibiotics
:*Anticoagulation
*Corneal hydrops
:*Cycloplegic,hypertonic NaCl ointment

===Surgery===
===Corneal Hydrops===
Corneal transplant
===Retinal Detachment===
Surgical repair
===Cataracts===
Surgical removal
===Temporal Arteritis===
Temporal biopsy and steroids.

==Related Chapters==
*[[Blindness]]
*[[Eye examination]]
*[[Low vision]]
*[[Visual acuity]]
*[[Visual impairment]]
==References ==
{{reflist|2}}

[[Category:Neurology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Blindness]]
[[Category:Ophthalmology]]

{{WH}}
{{WS}}