Vision loss

Jump to navigation Jump to search

For patient information, click here

WikiDoc Resources for Vision loss

Articles

Most recent articles on Vision loss

Most cited articles on Vision loss

Review articles on Vision loss

Articles on Vision loss in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Vision loss

Images of Vision loss

Photos of Vision loss

Podcasts & MP3s on Vision loss

Videos on Vision loss

Evidence Based Medicine

Cochrane Collaboration on Vision loss

Bandolier on Vision loss

TRIP on Vision loss

Clinical Trials

Ongoing Trials on Vision loss at Clinical Trials.gov

Trial results on Vision loss

Clinical Trials on Vision loss at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Vision loss

NICE Guidance on Vision loss

NHS PRODIGY Guidance

FDA on Vision loss

CDC on Vision loss

Books

Books on Vision loss

News

Vision loss in the news

Be alerted to news on Vision loss

News trends on Vision loss

Commentary

Blogs on Vision loss

Definitions

Definitions of Vision loss

Patient Resources / Community

Patient resources on Vision loss

Discussion groups on Vision loss

Patient Handouts on Vision loss

Directions to Hospitals Treating Vision loss

Risk calculators and risk factors for Vision loss

Healthcare Provider Resources

Symptoms of Vision loss

Causes & Risk Factors for Vision loss

Diagnostic studies for Vision loss

Treatment of Vision loss

Continuing Medical Education (CME)

CME Programs on Vision loss

International

Vision loss en Espanol

Vision loss en Francais

Business

Vision loss in the Marketplace

Patents on Vision loss

Experimental / Informatics

List of terms related to Vision loss

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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). The effects of visual loss can, before the acquisition of alternative adaptations and skills, be devastating; especially when a person's vision disappears over a short period of time.

Classification

  • Vision Loss may be:
  • 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).

Acute Visual Loss

Acute visual loss may be dramatic in presentation, and is almost always alarming to the person experiencing the loss.

It may be caused by media opacities, retinal disease, optic nerve disease, visual pathway disorders, or functional disorders, or it may be in fact an acute discovery of chronic visual loss.

Causes

Transient Vision Loss (<24 hours)

  • Amaurosis fugax
  • Vision loss is unilateral and lasts only minutes
  • Vision loss lasts 10-60 minutes
  • 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

  • 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

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?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Causes of Transient Visual Loss Based on the Duration[1]
TVL lasts seconds TVL lasts minutes TVL lasts hours
  • Papilledema
  • Optic neuropathy
  • Congenital disc anomaly
  • Thromboembolism (rare)
  • Migraine
  • Giant cell arteritis
  • Thromboembolism
  • Hypercoagulable state
  • Antiphospholipid antibody syndrome
  • Spontaneous hyphema
  • Intermittent angle closure glaucoma
  • Morning glory syndrome
  • Peripapillary staphyloma
  • Carotid artery dissection
  • Venous stasis retinopathy
  • Post-scleral buckle
  • Spontaneous hyphema
  • Thromboembolism
  • Carotid stenosis
  • Migraine
 

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

Related Chapters

References

  1. Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach. ISBN 978-1588901361.

Template:WH Template:WS