Vision loss: Difference between revisions
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*[[Craniotelencephalic dysplasia]] | *[[Craniotelencephalic dysplasia]] | ||
*[[Cree leukoencephalopathy]] | *[[Cree leukoencephalopathy]] | ||
*[[Creutzfeldt | *[[Creutzfeldt Jakob disease]] | ||
*[[Cycloplegia]] | *[[Cycloplegia]] | ||
*[[Cystoid macular dystrophy]] | *[[Cystoid macular dystrophy]] | ||
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*[[Cytomegalovirusin hiv patients]] | *[[Cytomegalovirusin hiv patients]] | ||
*[[Daphne poisoning]] | *[[Daphne poisoning]] | ||
*[[Deafness | *[[Deafness, opticoacoustic nerve atrophy, dementia]] | ||
*[[Deletion 11p]] | *[[Deletion 11p]] | ||
*[[Deletion 13q]] | *[[Deletion 13q]] | ||
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*[[Leber congenital amaurosis]] | *[[Leber congenital amaurosis]] | ||
*[[Leber hereditary optic neuropathy]] | *[[Leber hereditary optic neuropathy]] | ||
*[[Leg absence | *[[Leg absence, deformity, cataract]] | ||
*[[Leprosy]] | *[[Leprosy]] | ||
*[[Lethal congenital contracture syndrome (lccs)]] | *[[Lethal congenital contracture syndrome (lccs)]] | ||
*[[Linear | *[[Linear igA dermatosis]] | ||
*[[Lithium]] | *[[Lithium]] | ||
*[[Lobstein disease]] | *[[Lobstein disease]] | ||
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*[[Lymphoma, mucosa-associated lymphoid tissue]] | *[[Lymphoma, mucosa-associated lymphoid tissue]] | ||
*[[Macular degeneration]] | *[[Macular degeneration]] | ||
*[[Macular dystrophy, concentric annular | *[[Macular dystrophy, concentric annular]] | ||
*[[Macular hole]] | *[[Macular hole]] | ||
*[[Malignant hypertension]] | *[[Malignant hypertension]] | ||
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*[[Mefloquine]] | *[[Mefloquine]] | ||
*[[Melanoma of the choroid]] | *[[Melanoma of the choroid]] | ||
*[[Mental retardation | *[[Mental retardation, hypocupremia, hypobetalipoproteinemia]] | ||
*[[Mental retardation unusual facies ampola type | *[[Mental retardation unusual facies ampola type]] | ||
*[[Mental retardation, x-linked, wittwer type]] | *[[Mental retardation, x-linked, wittwer type]] | ||
*[[Mercury poisoning -- consumption of contaminated fish]] | *[[Mercury poisoning -- consumption of contaminated fish]] | ||
*[[Metachromatic leukodystrophy]] | *[[Metachromatic leukodystrophy]] | ||
*[[Methanol poisoning]] | *[[Methanol poisoning]] | ||
*[[Microcephaly | *[[Microcephaly, microphthalmos]] | ||
*[[Microphthalmia | *[[Microphthalmia]] | ||
*[[Microphthalmia syndromic]] | *[[Microphthalmia syndromic]] | ||
*[[Microvascular complications of diabetes]] | *[[Microvascular complications of diabetes]] | ||
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*[[Multiple lentigines syndrome]] | *[[Multiple lentigines syndrome]] | ||
*[[Multiple sclerosis]] | *[[Multiple sclerosis]] | ||
*[[Mycosis fungoides, familial | *[[Mycosis fungoides, familial]] | ||
*[[Nalidixic acid]] | *[[Nalidixic acid]] | ||
*[[Nasopharyngeal carcinoma]] | *[[Nasopharyngeal carcinoma]] | ||
*[[Nelson syndrome]] | *[[Nelson syndrome]] | ||
*[[Neuraminidase deficiency | *[[Neuraminidase deficiency]] | ||
*[[Neuroaxonal dystrophy, infantile]] | *[[Neuroaxonal dystrophy, infantile]] | ||
*[[Neurodegeneration with brain iron accumulation 2]] | *[[Neurodegeneration with brain iron accumulation 2]] | ||
*[[Neurodegenerative syndrome, x-linked, hamel type]] | *[[Neurodegenerative syndrome, x-linked, hamel type]] | ||
*[[Neuromyelitis optica]] | *[[Neuromyelitis optica]] | ||
*[[Neuropathy | *[[Neuropathy, ataxia, retinitis pigmentosa]] | ||
*[[Neurofibromatosis]] | *[[Neurofibromatosis]] | ||
*[[Niemann-pick disease]] | *[[Niemann-pick disease]] | ||
*[[Night blindness | *[[Night blindness, skeletal anomalies, unusual facies]] | ||
*[[Night blindness, congenital stationary, autosomal dominant | *[[Night blindness, congenital stationary, autosomal dominant]] | ||
*[[Noble-bass-sherman syndrome | *[[Noble-bass-sherman syndrome]] | ||
*[[Norrie syndrome]] | *[[Norrie syndrome]] | ||
*[[Nortriptyline]] | *[[Nortriptyline]] | ||
*[[Nutritional amblyopia]] | *[[Nutritional amblyopia]] | ||
*[[Nyssen-van bogaert-meyer syndrome]] | *[[Nyssen-van bogaert-meyer syndrome]] | ||
*[[Obal syndrome | *[[Obal syndrome]] | ||
*[[Occipital lobe tumours]] | *[[Occipital lobe tumours]] | ||
*[[Ocular cicatricial pemphigoid]] | *[[Ocular cicatricial pemphigoid]] | ||
*[[Ocular herpes]] | *[[Ocular herpes]] | ||
*[[Ocular histoplasmosis syndrome | *[[Ocular histoplasmosis syndrome]] | ||
*[[Ocular ischemic syndrome]] | *[[Ocular ischemic syndrome]] | ||
*[[Ocular trauma]] | *[[Ocular trauma]] | ||
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*[[Orbital lymphangioma]] | *[[Orbital lymphangioma]] | ||
*[[Orbital mass]] | *[[Orbital mass]] | ||
*[[Osteochondrodysplatic dwarfism | *[[Osteochondrodysplatic dwarfism, deafness, retinitis pigmentosa]] | ||
*[[Osteopetrosis lethal]] | *[[Osteopetrosis lethal]] | ||
*[[Osteoporosis | *[[Osteoporosis, macrocephaly, joint hyperlaxity]] | ||
*[[Osteoporosis | *[[Osteoporosis, macrocephaly, mental retardation]] | ||
*[[Pantothenate kinase-associated neurodegeneration]] | *[[Pantothenate kinase-associated neurodegeneration]] | ||
*[[Panuveitis]] | *[[Panuveitis]] | ||
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*[[Posterior column ataxia with retinitis pigmentosa]] | *[[Posterior column ataxia with retinitis pigmentosa]] | ||
*[[Posterior leucoencephalopathy syndrome]] | *[[Posterior leucoencephalopathy syndrome]] | ||
*[[Posterior vitreous detachment | *[[Posterior vitreous detachment]] | ||
*[[Pregnancy | *[[Pregnancy hypertension]] | ||
*[[Presbyopia]] | *[[Presbyopia]] | ||
*[[AL amyloidosis|Primary systemic amyloidosis]] | *[[AL amyloidosis|Primary systemic amyloidosis]] | ||
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*[[Refractive errors]] | *[[Refractive errors]] | ||
*[[Refsum disease with increased pipecolic acidemia]] | *[[Refsum disease with increased pipecolic acidemia]] | ||
*[[Renal tubulopathy | *[[Renal tubulopathy, diabetes mellitus, cerebellar ataxia]] | ||
*[[Retina conditions]] | *[[Retina conditions]] | ||
*[[Retinal arterial occlusion]] | *[[Retinal arterial occlusion]] | ||
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*[[Rhino-orbito-cerebral phycomycosis]] | *[[Rhino-orbito-cerebral phycomycosis]] | ||
*[[Rieger syndrome]] | *[[Rieger syndrome]] | ||
*[[Rift valley fever | *[[Rift valley fever]] | ||
*[[Roberts syndrome]] | *[[Roberts syndrome]] | ||
*[[Rofecoxib]] | *[[Rofecoxib]] | ||
*[[Rollet syndrome | *[[Rollet syndrome]] | ||
*[[Roy-maroteaux-kremp syndrome]] | *[[Roy-maroteaux-kremp syndrome]] | ||
*[[Rufous oculocutaneous albinism]] | *[[Rufous oculocutaneous albinism]] | ||
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*[[Secondary causes of glaucoma]] | *[[Secondary causes of glaucoma]] | ||
*[[Senile macular degeneration]] | *[[Senile macular degeneration]] | ||
*[[Senile retinoschisis | *[[Senile retinoschisis]] | ||
*[[Senior-loken syndrome]] | *[[Senior-loken syndrome]] | ||
*[[Septo-optic dysplasia]] | *[[Septo-optic dysplasia]] | ||
*[[Shaken baby syndrome]] | *[[Shaken baby syndrome]] | ||
*[[Shingles | *[[Shingles]] | ||
*[[Sialidosis type 1]] | *[[Sialidosis type 1]] | ||
*[[Sickle cell anemia]] | *[[Sickle cell anemia]] | ||
Revision as of 20:43, 16 December 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Jyostna Chouturi, M.B.B.S [2]
Synonyms and keywords: Visual loss
Overview
Vision loss is the absence of vision where it existed before, which can happen either acutely (i.e. abruptly) or chronically (i.e. over a long period of time). It may be caused by media opacities, retinal disease, optic nerve disease, visual pathway disorders, or functional disorders, 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
Pathophysiology
Media Opacity
Opacities of the clear refractive media of the eye such as the cornea, anterior chamber, lens, and vitreous humor may cause acute visual loss as manifested by blurry vision or reduced visual acuity. While pupillary reflexes 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; macular 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. Signs 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 or greyout) accompanied by loss of peripheral perception may result from low blood pressure, 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
- 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
| Cardiovascular | No underlying causes |
| Chemical/Poisoning | No underlying causes |
| Dental | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | No underlying causes |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | No underlying causes |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying causes |
| Infectious Disease | No underlying causes |
| Musculoskeletal/Orthopedic | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional/Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | No underlying causes |
| Ophthalmologic | No underlying causes |
| Overdose/Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal/Electrolyte | No underlying causes |
| Rheumatology/Immunology/Allergy | No underlying causes |
| Sexual | No underlying causes |
| Trauma | No underlying causes |
| Urologic | No underlying causes |
| Miscellaneous | No underlying causes |
Causes in Alphabetical Order
Diagnosis
History and Symptoms
History
include:
- 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
Abbreviations: TVL, transient visual loss.
Monocular TVL | |||||||||||||||||||||||||||||||||||
Does Monocular TVL Occur Only in Certain Positions of Gaze (Gaze-Evoked TVL)? | |||||||||||||||||||||||||||||||||||
YES | NO | ||||||||||||||||||||||||||||||||||
Orbital MRI | |||||||||||||||||||||||||||||||||||
Structural lesion of orbit | No structural lesion of orbit | ||||||||||||||||||||||||||||||||||
Duration of TVL? | |||||||||||||||||||||||||||||||||||
| |||||||||||||||||||||||||||||||||||
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
References
- ↑ Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach. ISBN 978-1588901361.