Acute Visual Loss

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this acute visual loss seminar was presented by my coleague, fahimah during our ophthalmology posting on 4th year medical student.

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Acute Visual Loss

  1. 1. Visual loss By:Fahimah Faculty of Medicine, UiTM, Malaysia
  2. 2. Definition <ul><li>Good </li></ul><ul><li>Low </li></ul><ul><li>blind </li></ul><ul><li>6/6 – 6/12 </li></ul><ul><li>6/18 – 6/60 </li></ul><ul><li>< 3/60 </li></ul>
  3. 3. <ul><li>ACUTE </li></ul><ul><ul><li>Acute glaucoma </li></ul></ul><ul><ul><li>Central retinal artery occlusion </li></ul></ul><ul><ul><li>Optic neuritis </li></ul></ul><ul><ul><li>Retinal detachment </li></ul></ul><ul><li>CHRONIC </li></ul><ul><ul><li>Glaucoma </li></ul></ul><ul><ul><li>Cataract </li></ul></ul><ul><ul><li>Diabetic retinopathy </li></ul></ul><ul><ul><li>Central retinal vein occlusion </li></ul></ul><ul><ul><li>Age-related macular degeneration </li></ul></ul>
  4. 4. GLAUCOMA <ul><li>A progressive optic neuropathy </li></ul><ul><li>Changes of optic disc appearance </li></ul><ul><li>Irreversible visual field defects </li></ul><ul><li>frequently with raised IOP. </li></ul><ul><li>Raised intraocular pressure is a significant risk factor </li></ul><ul><ul><li>Normal IOP: 12-21mmHg </li></ul></ul><ul><li>Worldwide- second leading cause of blindness </li></ul>
  5. 5. <ul><li>High IOP but normal optic discs – Ocular hypertension </li></ul><ul><li>Normal IOP but glaucomatous optic disc damage- Normal tension glaucoma </li></ul>
  6. 6. Mechanism of visual loss in glaucoma Retinal ganglion cell atrophy Thinning of the inner nuclear and nerve fiber layers of retina Axonal loss in the optic nerve Optic disk becomes atrophic Enlargement of the optic cup
  7. 7. Classification <ul><li>Primary Adult Glaucoma </li></ul><ul><ul><li>Open Angle Glaucoma -chronic </li></ul></ul><ul><ul><li>Angle Closure Glaucoma - acute </li></ul></ul><ul><li>Secondary Glaucoma </li></ul><ul><li>Congenital and Developmental Glaucoma </li></ul>
  8. 8. Acute Primary Angle Closure Glaucoma
  9. 9. <ul><li>Occur due to a sudden total angle closure leading to severe rise in IOP </li></ul><ul><li>Does not terminates on its own </li></ul><ul><li>Thus, if not treated, lasts for many days </li></ul>
  10. 10. GROUPS AT RISK <ul><li>HYPERMETROPES </li></ul><ul><ul><li>have shallow ant chamber and shorter axial length eye </li></ul></ul><ul><li>AGE </li></ul><ul><ul><li>with increasing age, lens tend to increase in size </li></ul></ul><ul><li>WOMEN </li></ul><ul><ul><li>hv shallower ant chamber </li></ul></ul><ul><li>RACE </li></ul><ul><ul><li>Asian groups, due to their shallower anterior chamber depth </li></ul></ul>
  11. 11. SYMPTOMS <ul><li>The eye becomes red and painful </li></ul><ul><li>Rapidly progressive impairment of vision </li></ul><ul><li>Photophobic </li></ul><ul><li>Systemically unwell with nausea and abd pain </li></ul><ul><li>Coloured haloes </li></ul>
  12. 12. SIGNS of ACUTE ANGLE-CLOSURE GLAUCOMA <ul><li>Cicumcorneal injection </li></ul><ul><li>Hazy cornea </li></ul><ul><li>Shallow Anterior Chamber </li></ul><ul><li>Anterior Chamber inflammation </li></ul><ul><li>Fixed, mid-dilated, oval pupil </li></ul><ul><li>Markedly increased IOP </li></ul><ul><li>Corneal oedema </li></ul><ul><li>Closed angle on gonioscopy </li></ul>
  13. 13. MECHANISM Apposition of the lens to the back of iris prevent the flow of aqueous Aqueous then collects behind the iris and pushes it on to the trabecular meshwork preventing the drainage of aqueous IOP rises rapidly
  14. 14. Precipitating factors for Angle Closure <ul><li>Mydriasis </li></ul><ul><ul><li>Emotional upset </li></ul></ul><ul><ul><li>Dim illumination </li></ul></ul><ul><ul><li>Medications </li></ul></ul><ul><ul><ul><li>anticholinergic or sympathomimetic activity eg. Atropine, antidepressant, nebulized bronchodilator, or nasal decongestant </li></ul></ul></ul><ul><ul><li>Evening hours </li></ul></ul><ul><li>Extreme miosis </li></ul><ul><li>Prone Position </li></ul>
  15. 15. TREATMENT <ul><li>Medical </li></ul><ul><li>Laser </li></ul><ul><li>Surgery </li></ul>
  16. 16. <ul><li>MEDICAL </li></ul><ul><li>Acetazolamide – to reduce IOP by reducing the secretion of aqueous </li></ul><ul><li>Given 500mg IM or IV </li></ul><ul><li>Pilocarpine 4% drops – to contract the pupil. </li></ul><ul><li>SURGICAL </li></ul><ul><li>Laser peripheral iridotomy </li></ul><ul><li>Surgical peripheral iridectomy </li></ul>
  17. 17. CENTRAL RETINAL ARTERY OCCLUSION
  18. 18. <ul><li>SYMPTOMS </li></ul><ul><ul><li>Painless visual loss ( occur within seconds) </li></ul></ul><ul><ul><li>Previous history of transient visual loss </li></ul></ul><ul><li>SIGNS </li></ul><ul><ul><li>Visual acuity ranges between counting fingers and light perception </li></ul></ul><ul><ul><li>Ophthalmoscopically, the superficial retina becomes opacified except in the foveola (cherry red spot) </li></ul></ul>
  19. 19. Central retinal artery occlusion
  20. 20. Treatment <ul><li>Retinal damage become irreversible after about 90 minutes. </li></ul><ul><li>Decreased IOP: anterior chamber paracentesis, I/V acetozolamide </li></ul><ul><li>Inhaled oxygen-carbon dioxide mixture-induce retinal vasodilation </li></ul><ul><li>Direct infusion of a thrombolytic agent into opthalmic artery (within 8 hours after onset). </li></ul>
  21. 21. reference <ul><li>Kanski , ophthalmology textbook, 5 th edition. </li></ul>

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