Acute Visual Loss


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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.

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Acute Visual Loss

  1. 1. ACUTE VISUAL LOSS By: Dina Hazwani binti Azlang 4th year medical student, Faculty of Medicine, UiTM, Malaysia.
  2. 2. Causes of acute visual loss Transient -optic neuritis Permanent -retinal detachment -CRA obstruction -acute congested glaucoma -trauma
  3. 3. DEFINITION  Separation of neurosensory retina ( NSR ) from the retinal pigment epithelium (RPE) by sub-retinal fluid (SRF) accumulation
  4. 4. 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 )
  6. 6. 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
  7. 7. 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
  8. 8.  Marcus Gunn pupil (relative afferent pupillary defect)  Opthalmoscopy ;  Grey opalescent retina, balloning forward.  Extensive detachment of the retina will pull of the macular.
  9. 9.  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.
  11. 11. TREATMENT  Immediately.  Retinal Reattachment surgery Basic principles  Sealing 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
  12. 12.  Definition  An inflammatory & demyelinating disorder affecting the optic nerve.  It can be classified opthalmoscopically and aetiologically
  13. 13. 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/Anatomic al  Retrobulbar neuritis –  Papillitis: inflam & demyelinating optic disc- Hyperamia & oedema  Neuroretinitis – optic disc & surrounding retina in macular area.
  14. 14.  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.
  15. 15. 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
  16. 16. 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)  Opthalmoscopic Papillitis- hyperaemia of disc & blurring margin Disc- edematous& obliterating cup, splinter hrrge, fine exudate Retinal veins tortous and congested
  17. 17. Swollen of optic disc.
  18. 18. MANAGEMENT  Treat the underlying cause- cardiovascular or neurodegenerative disease.  Treatment: steroid to reduce the inflammation and swelling
  19. 19. 35 year-old woman presented with unilateral worsening of vision of left eye, accompany by discomfort of eye movement for two weeks duration Visual acuity of left eye is 6/60. Impaired color vision. There is left afferent pupillary defect and a central scotoma Funduscopy reveals the above image. What is the likely diagnosis A. Optic Nerve Glioma B. Cavernosus Sinus thrombosis C. Grave’s disease D. Pituitary Adenoma E. Optic Neuritis CASE Opticneuritis
  20. 20. Reference 1.Kanski, Clinical Ophthalmology 5th edition.
  21. 21. Thank You…