Acute visual dysfunction

Sendhil KumarSenior registrar

Ophthalmology DepartmentSCGH

Definition

Loss of vision over few minutes to daysUnilateral or Bilateral

Part or full visual field

Patho-physiology

Optical media

Retinal layer

Optic nerve dysfunction

absentpresent

Anterior or posterior segment media issues

RAPD

+

Optic nerve dysfunction/ gross retinal

pathology

Macular/ limited retina

-

Relevant history

Pain +/-Trauma

Central/PeripheralFlashes/Floaters

Co-morbidsMedication

Examination

• General Status• Vision• RAPD• Slit-Lamp• IOP• Funduscopy

Painless…

Retinal vein occlusion

Central retinal artery occlusion

Retinal detachment

Advance Diabetic Eye Disease

Central Serous Chorioretinopathy

Papiledema

Subretinal bleed

Ischemic optic neuropathy

Painful…

Acute congestive glaucoma

Signs of keratitis

Keratitis

Trauma

Sphincter tear

Cataract Angle recession

Hyphaema

Lens subluxation

Iridodialysis Vossius ring

Rupture of globe

Macular hole Optic neuropathyEquatorial tears

Choroidal rupture and haemorrhageCommotio retinae Avulsion of vitreous base

and retinal dialysis

Flat anterior chamber

Vitreous haemorrhage

Damage to lens and iris

EndophthalmitisTractional retinal detachment

Uveal prolapse

Grading of severity of chemical injuries

• Clear cornea

Grade I (excellent prognosis)

• Limbal ischaemia - nil

• Cornea hazy but visible iris details

Grade II (good prognosis)

• Limbal ischaemia < 1/3

• No iris details

Grade III (guarded prognosis)

• Limbal ischaemia - 1/3 to 1/2

• Opaque cornea

Grade IV (very poor prognosis)

• Limbal ischaemia > 1/2

Optic NeuritisRetrobulbar neuritis (normal disc)

Papillitis (hyperaemia and oedema)

•

•

•

Neuroretinitis (papillitisand macular star)

•

•

•

Slit-lamp