acute visual loss
DESCRIPTION
this presentation is about causes of acute visual loss which i made for my seminar during ophthalmology posting.Hope that people can had a benefit from this slide especially medical student.TRANSCRIPT
ACUTE VISUAL LOSSBy:
Dina Hazwani binti Azlang4th year medical student,
Faculty of Medicine,
UiTM, Malaysia.
Causes of acute visual loss
Transient-optic neuritis
Permanent-retinal detachment-CRA obstruction-acute congested glaucoma-trauma
DEFINITION
Separation of neurosensory retina ( NSR ) from the retinal pigment epithelium (RPE) by sub-retinal fluid (SRF) accumulation
CLASSIFICATION Rhegmatogenous RD ( Rhegma = break )
Retinal break(hole/tear)- subretinal fluids seeps & separate neurosensory retina from the underlying pigmented epithelium.
Non-rhegmatogenous RD Tractional ( sensory retina is pulled away from the RPE by
contracting vitreoretinal membranes, eg proliferative diabetic retinopathy)
Exudative ( SRF derived from the choriocapillaries gain access to the subretinal space through damage RPE. Eg choroidal tumours, exophytic retinoblastoma, posterior scleritis )
TYPE OF RETINAL TEARS
RHEGMATOGENOUS RD
Retinal breaks responsible for RD are caused by interplay between Dynamic vitreoretinal traction Predisposing degeneration in peripheral retina
Increased in patients who: Myopic eyes Have undergone cataract surgery Severe eye trauma Age: 40-60 Sex: M:F-3:2 Retinal degenerations
SIGN AND SYMPTOMS Photopsia (sparks or flashes)- Caused by traction on the retina at
sites of vitreoretinal adhesions Vitreous floater Visual field defect ~ dark curtain, cloudy Fall in acuity ~ detached macula Vision loss maybe filmy, cloudy, irregular or curtain-like. One large floater in the middle of the field of vision or a
wavy distortion of objects.
4 ‘F’s
Marcus Gunn pupil (relative afferent pupillary defect)
Opthalmoscopy ; Grey opalescent retina, balloning forward. Extensive detachment of the retina will pull of the
macular.
The billowy, gray spinnaker-like folds represent the detached retina—the part that has become elevated from its attachment to the underlying retinal pigment epithelium.
FRESH RETINAL DETACHMENT
TREATMENT Immediately. Retinal Reattachment surgery
Basic principlesSealing of retinal breaks
By cryocoagulation, photocoagulation or diathermy(to create an adhesion between the pigment epithelium and
the sensory retina)SRF drainage
Allow immediate apposition between sensory retina and RPE By using fine needle
Maintain chorioretinal apposition Scleral buckling Pneumatic retinopaxy
Definition An inflammatory & demyelinating disorder
affecting the optic nerve. It can be classified opthalmoscopically and
aetiologically
CLASSIFICATION
Aetiological Demylinating – common
cause Parainfectious – follow a viral
infection Infectious – may be sinus-
related or a/w cat scratch fever, Lyme ds, cryptococcol meningitis in pt wt AIDS& herpes zoster
Autoimmune
Opthalmoscopic/Anatomical
Retrobulbar neuritis – Papillitis: inflam & demyelinating
optic disc- Hyperamia & oedema
Neuroretinitis – optic disc & surrounding retina in macular area.
What is the most common cause for the optic neuritis?Multiple sclerosis. Long term studies indicated that up to 75% of female patient initially developed optic neuritis ultimately developed MS.
SYMPTOMS Visual loss – Sudden, progressive,profound
(progressively blurrier over a period of hours or days)
Blurred vision in bright light – typical Pain behind the eyes
esp in retrobulbar neuritis aggravated by ocular movement
(esp:downward&upward) Loss/reduce of color vision Preceding history of viral illness
SIGNS Reduced visual acuity Impaired color vision Visual field changes - Central scotoma Swinging flash test – affected pupil will dilate
when flash light is moved from normal to abnormal eye (Marcus gunn pupil)
OpthalmoscopicPapillitis- hyperaemia of disc & blurring marginDisc- edematous& obliterating cup, splinter
hrrge, fine exudateRetinal veins tortous and congested
Swollen of optic disc.
MANAGEMENT Treat the underlying cause- cardiovascular or
neurodegenerative disease. Treatment: steroid to reduce the inflammation
and swelling
35 year-old woman presented with unilateral worsening of vision of left eye, accompany by discomfort of eye movement for two weeks durationVisual acuity of left eye is 6/60.Impaired color vision.There is left afferent pupillary defect and a central scotomaFunduscopy reveals the above image.What is the likely diagnosisA. Optic Nerve GliomaB. Cavernosus Sinus thrombosisC. Grave’s diseaseD. Pituitary AdenomaE. Optic Neuritis
CASE Optic neuritis
Reference
1.Kanski, Clinical Ophthalmology 5th edition.
Thank You…