LOSS OF VISION

Question 1

DDx: Acute Painfull Loss of Vision

Answer 1

RED EYE

Acute Closure Glaucoma
Hyphema
Keratitis
Lens Dislocation
Anterior Uveitis
Endophthalmitis
Orbital Cellulitis

NO RED EYE
Optic Neuritis
Lens Dislocation

Question 2

DDx: Acute Painless Monocular Vision Loss

Answer 2

Optic Neuritis
Central Retinal Artery Occlusion
Central Retinal Vein Occlusion
Temporal Arteritis
Vitreous Hemorrhage
Retinal Detachement
Amaurosis Fugax
Acute Maculopathy
Posterior Uveitis
Ischemic Optic Neuropathy

Question 3

DDx: Chornic Loss of Vision

Answer 3

Macular Degeneration
Diabetic Retinopathy
Cataract

Question 4

MANAGEMENT

Answer 4

ASK ABOUT:
Onset
Laterality
Pain
Redness
Trauma

ASSOCIATED SYMPTOMS:
Facial Droop
Lateralizing Signs
Paresthesias

headache
jaw claudication
constitutional symptoms.

PMHx:
Vascular Disease
Diabetes
Refractive Status
Contact Lens Use
Eye Surgery

Question 5

CRAO

Answer 5

CLINICAL FEATURES

Acute Painless monocular vision loss
May be preceded by amarosis fugax

Afferent pupillary defect

Fundoscopy:
pale retina
cherry red fovea
Box Carring

RISK FACTORS

Carotid Artery Atherosclerosis (MC)
Cardiac Embolism (<40 yrs)
CVD
Dissection
Leukemia

INVESTIGATIONS
CBC: to assess for polycythemia or thrombocytosis.
ESR and CRP for consideration of giant cell arteritis in at-risk patients.
Coagulation panel (prothrombin time/partial thromboplastin time/international normalized ratio) for consideration of hypercoagulable conditions.

MANAGEMENT

Currently, no standard guideline-endorsed therapies exist.

Evidence-based treatment and information about the course of the disease are lacking

Consult opthalmology and neurology

Digital Ocular Massage: Direct pressure to the globe over a closed eyelid (typically with the flat surface of the finger pad) for 10-15 seconds followed by a quick release.This can be repeated for 15-20 minutes

ETIOLOGY

Carotid embolus
Cardiac embolus
Retinal artery thrombosis
Giant Cell arteritis
Vasculitis
Sickle Cell Disease
Trauma
Vasospasm
Glaucoma
Low retinal blood flow

Question 6

CRVO

Answer 6

CLINICAL FEATURES

Sudden painless loss of vision
Vision loss if variable
+/- Relative afferent pupillary defect

Fundoscopic exam:
“Blood and Thunder” fundus

RISK FACTORS

Diabetes
HTN
Cerebrovascular Disease
Cardiovascular Disease
Dyslipidemia
Hypercoagulable states
Vasculitis
Glaucoma
Thyroid disease
Orbital tumors

MANAGEMENT

COnsult Opthalmology