Vision loss

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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] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Synonyms and keywords: Visual loss


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.


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


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.


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).


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

Life-Threatening Causes

Common Causes

Causes by Organ System

Cardiovascular Al amyloidosis, Arachnoiditis, Arteriovenous malformation, Atherosclerosis, Basilar artery insufficiency syndrome, Basilar artery migraine , Cardiomyopathy, Carotid atherosclerosis, Carotid-cavernous fistula, Central retinal artery occlusion, Central retinal vein occlusion, Central serous chorioretinopathy, Cerebrovascular accident, Charge syndrome, Giant cell arteritis, Hurler syndrome, Hypertension of pregnancy, Ischemic optic neuropathy, Malignant hypertension, Microvascular diabetes complications, Microvascular disease, Ocular ischemic syndrome, Retinal artery occlusion, Retinal vein occlusion , Stroke, Takayasu arteritis, Temporal arteritis, Transient ischaemic attack, Vascular diseases, Vascular retinopathies, Vasculitis , Vertebral artery dissection
Chemical/Poisoning Aminosalicylic acid, Capreomycin sulfate, Herbal agent overdose , Irinotecan hydrochloride, Mayapple poisoning , Monosodium methanarsenate , O'higgins disease , Radium chloride, Strontium chloride, Valganciclovir hydrochloride
Dental Oligodontia
Dermatologic Albinism, Alezzandrini syndrome , Behcet's disease, Cross syndrome, Ectodermal dysplasia , Keratitis, Keratomalacia, Mucous membrane pemphigoid, Oculocutaneous albinism, Pachydermoperiostosis, Panuveitis , Pigmentary retinopathy , Rufous oculocutaneous albinism , Shingles
Drug Side Effect Amitriptyline, Carbachol, Carbamazepine, Celecoxib, Cesium, Chalazion, Chlorpheniramine, Cinnarizine, Clomifene, Coenzyme q - cytochrome c reductase, Deferoxamine, Desipramine, Diphenhydramine, Dothiepin, Hydroxyzine, Ivabradine, Lithium, Mefloquine, Methanol, Monosodium methanarsenate , Monosodium methyl arsenate, Morpholine , Nortriptyline, Phenylbutazone, Physostigmine, Pipecolic acidemia, Prochlorperazine, Pterygium, Quinidine, Rofecoxib, Sclerostin, Septum pellucidum, Temozolomide, Thalidomide, Verteporfin, Vigabatrin
Ear Nose Throat No underlying causes
Endocrine Albinism, Ceroid lipofuscinosis, Citrullinemia , Empty sella syndrome , Graves ophthalmopathy, Infantile refsum disease, Kallmann syndrome, Linear iga bullous dermatosis, Mucopolysaccharidosis, Mucosa-associated lymphoid tissue, Multiple endocrine neoplasia type 1 , Nelson syndrome, Niemann-pick disease, Nyssen-van bogaert syndrome , Pellagra-like syndrome, Pituitary adenoma, Thyroid eye disease 
Environmental Foreign body
Gastroenterologic Diabetic ketoacidosis, Herpetic keratitis , Hurler syndrome, Mucormycosis , Sandhoff disease
Genetic 13q deletion syndrome, 3 alpha methylglutaconicaciduria, Alström syndrome, Amaurosis congenita of leber , Amelogenesis imperfecta, Ampola syndrome , Bardet-biedl syndrome, Blue cone monochromatism , Cassia stocco dos santos syndrome, Cenani lenz syndactylism, Charcot-marie-tooth syndrome, Chromosome 11, deletion 11p , Chromosome 13, partial monosomy 13q , Chromosome 13q deletion syndrome , Chromosome 13q deletion , Chromosome 14q, partial deletion , Chromosome 17, deletion 17q23 q24 , Chromosome 2p deletion syndrome , Classic childhood ald , Cohen syndrome, Congenital disorder of glycosylation type 1g , Cross syndrome, Deletion 11p , Deletion 13q , Didmoad syndrome, Ehlers-danlos syndrome , Emanuel syndrome , Familial amyloid polyneuropathy, Familial infantile metachromatic leukodystrophy, Franceschetti-klein syndrome , Francois dyscephalic syndrome , Goldberg–shprintzen syndrome, Gronblad-strandberg-touraine syndrome, Gustavson syndrome , Hallervorden-spatz syndrome , Hand-schuller-christian syndrome, Hereditary diseases, Herns syndrome , Imidazole syndrome, Incontinentia pigmenti, Infant cytomegalic virus , Juvenile retinoschisis , Kearns–sayre syndrome, Krause-kivlin syndrome, Lawrence-moon syndrome, Leber's congenital amaurosis, Lobstein disease, Mercaptolactace-cysteine disulfiduria, Neuroaxonal dystrophy, Noble-bass-sherman syndrome , Norrie syndrome , Oguchi disease , Osteochondrodysplatic dwarfism, Partial monosomy 13q, Plum syndrome , Polychondritis , Pseudoxanthoma elasticum, Purtscher's retinopathy, Pyle disease , Rieger syndrome , Roberts syndrome, Roy-maroteaux-kremp syndrome , Schindler disease, Sialidosis, Simell-takki syndrome, Singh-chhaparwal-dhanda syndrome, Small syndrome , Smith martin dodd syndrome, Spherophakia-brachymorphia syndrome, Stargardt disease, Stevens-johnson syndrome, Stickler syndrome, Syndactyly, Tapetal-like reflex , Tay-sachs disease, Treacher collins syndrome, Usher syndrome
Hematologic Aspartoacylase deficiency, Avitaminosis, Brain aneurysm, Canavan leukodystrophy , Catastrophic antiphospholipid syndrome, Cree leukoencephalopathy , Diabetes insipidus, Ebola , Familial infantile metachromatic leukodystrophy, Galactokinase deficiency, Homonymous hemianopia, Hypoglycaemia, Intraocular hemorrhage, Krabbe leukodystrophy, Langerhans cell histiocytosis, Leukodystrophy, Lymphoma, Metachromatic leukodystrophy, Neurodegeneration with brain iron accumulation, Ornithine translocase deficiency, Posterior leucoencephalopathy syndrome, Progressive multifocal leukoencephalopathy, Sickle cell anemia, Subacute sclerosing leukoencephalitis , Transthyretin amyloidosis , Vitamin a deficiency
Iatrogenic No underlying causes
Infectious Disease Acanthamoeba, Achromatopsia, Acromegaloid, Acute disseminated encephalomyelitis, Acute retinal necrosis, Alveolar hydatid disease, Blepharitis, Congenital cytomegalovirus infection, Congenital rubella syndrome, Congenital toxoplasmosis, Creutzfeldt jakob disease, Cytomegalovirus retinitis , Cytomegalovirus , Ebola , Euphorbiaceae, Feline spongiform encephalopathy , Fundus albipunctatus, Giant cell arteritis, Helminth infections , Herpes simplex, Hiv, Infant cytomegalic virus , Inflammatory processes, Mucormycosis , Multifocal choroiditis, Mycosis fungoides, Ocular herpes , Ocular histoplasmosis syndrome , Panuveitis , Papillitis, Presumed ocular histoplasmosis syndrome, Rhabditida, Rhinocerebral mucormycosis , Rhinocerebral zygomycosis , Rhino-orbito-cerebral phycomycosis , Rift valley fever, Secernentea, Shingles, Syphilis, Toxoplasmosis, Uveitis
Musculoskeletal/Orthopedic Cardiomyopathy, Cartilaginous, Ciliary muscle spasm, Cycloplegia, Dysosteosclerosis , Episodic ataxia, Neuropathic ataxia , Osteoporosis , Posterior column ataxia , Rhabdomyosarcoma, Spastic tetraplegic , Spinocerebellar ataxia
Neurologic Acute disseminated encephalomyelitis, Alpers' disease, Amaurosis fugax, Anencephaly , Arachnoiditis, Basilar artery migraine , Batten disease, Bessman-baldwin syndrome , Bilateral occipital lobe infarct, Bilateral optic neuritis, Bilateral papilloedema, Bonnet-dechaume-blanc syndrome, Brain aneurysm, Brain tumors, Cerebral palsy, Ceroid lipofuscinosis, Charcot-marie-tooth syndrome, Cluster headache, Concussion, Conversion disorder, Craniodiaphyseal dysplasia , Craniometaphyseal dysplasia, Craniosynostosis , Craniotelencephalic dysplasia , Creutzfeldt jakob disease, Devic disease , Empty sella syndrome , Encephalocele anterior , Encephalocele frontal , Encephalocele, Endophthalmitis, Episodic ataxia, Esthesioneuroblastoma , Fahr's syndrome, Familial amyloid polyneuropathy, Feline spongiform encephalopathy , Flynn-aird syndrome , Ghose-sachdev-kumar syndrome , Heidenhain syndrome , Hydranencephaly , Hydrocephalus , Increased intracranial pressure, Infantile neuroaxonal dystrophy, Ischemic optic neuropathy, Jensen syndrome , Lethal congenital contracture syndrome, Lowe oculocerebrorenal syndrome , Microcephaly , Midline craniofacial anomalies , Migraine, Minamata disease, Mitochondrial disease , Morning glory disc anomaly, Multiple lentigines syndrome, Multiple sclerosis , Neuroaxonal dystrophy, Neurodegeneration with brain iron accumulation, Neurodegenerative syndrome, Neurofibromatosis, Neuromyelitis optica, Neuropathic ataxia , Neuropathy , Niemann-pick disease, Night blindness, Oculocerebrorenal syndrome, Olivopontocerebellar atrophy , Ophthalmoplegia, Optic nerve compression, Optic nerve disorder, Optic neuritis, Optic pathway glioma , Opticoacoustic nerve atrophy dementia , Pantothenate kinase-associated neurodegeneration , Papilledema, Papilloedema, Paraneoplastic cerebellar degeneration, Peripheral type neurofibromatosis , Photopsia, Posterior column ataxia , Progressive supranuclear palsy, Pseudotumor cerebri, Retinal migraine , Rhinocerebral mucormycosis , Rhinocerebral zygomycosis , Rhino-orbito-cerebral phycomycosis , Rift valley fever, Senior-loken syndrome , Spastic tetraplegic , Spinocerebellar ataxia, Subacute myelo-optic neuropathy, Subacute sclerosing panencephalitis, Sudanophilic cerebral sclerosis, Tay-sachs disease, Temporal arteritis, Tolosa-hunt syndrome, Treacher collins syndrome, Vertebral artery dissection, Visual hallucinations
Nutritional/Metabolic Avitaminosis, Blue diaper syndrome, Diabetes insipidus, Diabetic eye disease , Diabetic ketoacidosis, Diabetic retinopathy , Gangliosidosis , Hypoglycaemia, Imidazole syndrome, Microvascular diabetes complications, Mucolipidosis, Nutritional deficiencies, Osteoporosis , Pyruvate decarboxylase deficiency , Pyruvate decarboxylase, Schindler disease, Sclerosteosis , Senter syndrome , Sialidosis, Vitamin a deficiency,
Obstetric/Gynecologic Hypertension of pregnancy, Pre-eclampsia
Oncologic Brain tumors, Car syndrome , Eye cancer, Eye melanoma , Glioblastoma , Intraocular melanoma, Langerhans cell histiocytosis, Lymphoma, Melanoma of the choroid , Multiple endocrine neoplasia type 1 , Nasopharyngeal carcinoma, Nasopharynx cancer , Occipital lobe tumours, Ocular oncology, Orbit tumour , Orbital lymphangioma , Orbital mass, Paraneoplastic cerebellar degeneration, Phacolytic glaucoma , Pituitary adenoma, Pseudotumor cerebri, Retinoblastoma , Rhabdomyosarcoma, Trachoma , Uveal melanoma
Ophthalmologic Acute posterior multifocal placoid pigment epitheliopathy, Acute retinal necrosis, Age-related macular degeneration, Amaurosis fugax, Amblyopia, Angioid streaks , Aniridia , Anisometropia , Anophthalmia, Anophthalmos, Anterior segment mesenchymal dysgenesis, Arteriovenous malformation, Asthenopia , Autoimmune uveitis , Axenfeld-rieger syndrome, Basement membrane corneal dystrophy, Benign essential blepharospasm, Bessman-baldwin syndrome , Best vitelliform macular dystrophy, Best's disease, Bilateral occipital lobe infarct, Bilateral optic neuritis, Blepharitis, Blind spot, Blindness, Bothnia retina dystrophy, Calcification of basal ganglia , Carotid-cavernous fistula, Cataract, Central retinal artery occlusion, Central retinal vein occlusion, Central serous chorioretinopathy, Chandler's syndrome, Chorioretinitis , Choroideremia , Choroiditis , Cloudy cornea (patient information), Cogan-reese syndrome , Cogan's syndrome , Coloboma, Color blindness, Cone dystrophy , Cone rod dystrophy , Congenital x-linked retinoschisis , Conversion disorder, Cornea plana 1, Corneal dystrophy, Corneal foreign body, Corneal hypesthesia , Corneal opacity, Corneal ulcer , Cortical blindness, Cortical hyperostosis, Craniodiaphyseal dysplasia , Cycloplegia, Cystoid macular dystrophy, Cytomegalovirus retinitis , Dermatoosteolysis, Devic disease , Diabetic eye disease , Diabetic retinopathy , Dry eye, Eales disease, Endophthalmitis, Enhanced s-cone syndrome , Essential iris atrophy, Eye cancer, Eye injury, Eye melanoma , Fuchs atrophia gyrata chorioideae et retinae , Fuchs' dystrophy, Glaucoma, Hemianopia , Hyperopia, Hyperornithinemia , Hyphema, Infantile cortical hyperostosis, Intraocular hemorrhage, Intraocular melanoma, Intraocular pressure, Iridocorneal endothelial syndrome, Iridocyclitis, Iridogoniodysgenesis, Lattice corneal dystrophy , Leber's congenital amaurosis, Leber's optic atrophy, Lens pathology, Lowe oculocerebrorenal syndrome , Macular degeneration, Macular dystrophy, Macular edema, Macular hole, Maculopathy, Malignant hypertension, Marsden syndrome , Marshall syndrome, Melanoma of the choroid , Metamorphopsia, Metaphyseal dysplasia, Microphthalmia, Microphthalmos, Morning glory disc anomaly, Multifocal choroiditis, Neuromyelitis optica, Night blindness, Nutritional amblyopia, Obal syndrome, Occipital lobe tumours, Ocular cicatricial pemphigoid , Ocular herpes , Ocular histoplasmosis syndrome , Ocular ischemic syndrome, Ocular oncology, Ocular trauma, Oculocerebrorenal syndrome, Oculocutaneous albinism, Oguchi disease , Oligodontia, Olivopontocerebellar atrophy , Open-angle glaucoma, Ophthalmia neonatorum, Ophthalmoplegia, Optic atrophy, Optic nerve compression, Optic nerve disorder, Optic neuritis, Optic pathway glioma , Opticoacoustic nerve atrophy dementia , Orbit tumour , Orbital lymphangioma , Orbital mass, Osteochondrodysplatic dwarfism, Papillitis, Periorbital cellulitis, Photopsia, Pigmentary retinopathy , Posterior vitreous detachment , Presbyopia , Presumed ocular histoplasmosis syndrome, Progressive multifocal leukoencephalopathy, Protanopia , Purtscher's retinopathy, Raised intraocular pressure, Ramos-arroyo syndrome , Reese-ellsworth syndrome , Refractive error, Refsum disease , Retinal artery occlusion, Retinal cone dystrophy , Retinal degeneration , Retinal detachment, Retinal dysplasia, Retinal migraine , Retinal tear , Retinal vein occlusion , Retinitis pigmentosa, Retinitis punctata albescens , Retinoblastoma , Retinopathy, Retinoschisis , Retrolental fibroplasia, Rollet syndrome , Rufous oculocutaneous albinism , Scleritis, Senile macular degeneration, Senile retinoschisis, Senior-loken syndrome , Septo-optic dysplasia, Simell-takki syndrome, Singh-chhaparwal-dhanda syndrome, Small syndrome , Smith martin dodd syndrome, Spherophakia-brachymorphia syndrome, Stargardt disease, Stevens-johnson syndrome, Stickler syndrome, Subacute combined degeneration of the cord, Subacute myelo-optic neuropathy, Subacute sclerosing leukoencephalitis , Subacute sclerosing panencephalitis, Superior orbital fissure, Thyroid eye disease , Usher syndrome, Uveal diseases, Uveal melanoma, Uveitis, Vascular diseases, Vascular retinopathies, Vasculitis , Vasterbotten dystrophy , Verloes van maldergem marneffe syndrome , Vision impairment , Visual hallucinations
Overdose/Toxicity No underlying causes
Psychiatric Hysteria, Mental retardation , Psychogenic, Shaken baby syndrome,
Pulmonary Alveolar hydatid disease, Sarcoidosis
Renal/Electrolyte Alport syndrome, Hypophosphatemia, Renal tubulopathy
Rheumatology/Immunology/Allergy Al amyloidosis, Behcet's disease, Besnier-boeck-schaumann disease , Inflammatory processes, Leprosy, Mucous membrane pemphigoid, Sarcoidosis
Sexual Herpes simplex, Hiv, Syphilis
Trauma Concussion, Eye injury, Head injury , Ocular trauma, Retinal tear , Superior orbital fissure
Urologic Hypophosphatemia
Miscellaneous No underlying causes

Causes in Alphabetical Order


History and Symptoms


  • Age
  • Onset:
  • Rate of loss
  • Any specific trauma
  • Headaches
  • Medication
  • Specific medical history
  • Alcohol, drug and/or tabacco use

Physical Examination


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
  • 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)?
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


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


Corneal Hydrops

Corneal transplant

Retinal Detachment

Surgical repair


Surgical removal

Temporal Arteritis

Temporal biopsy and steroids.

Related Chapters


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

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