Acute loss of vision | Flashcards
In a patient with ALOV, what would be a helpful way of starting the history and why?
Ask them about previous ocular history first rather than the current presenting complaint as they might be very anxious
What would you ask in the history of someone presenting with ALOV (7)?
- Previous ocular history
- CVD
- common cause of eye problems - Family history
- Drugs
- Eye drops (contain strong drugs)
- Symptoms
- Duration/recovery
What can you specifically ask about symptoms in a history of a patient with ALOV (6)?
- Monocular and/or binocular
- Time of event, method of symptom awareness
i. e. what were you doing when you noticed it? e.g. sitting watching tv, waking up, accidentally covered one eye? - Change in symptoms and how long did it take to change, what helped as it got better (i.e. gradual or sudden)
- Associated symptoms e.g. flashes, floaters, numbness, feeling dizzy
- Duration/recovery
- Nature of visual loss
- general, central and associated field, peripheral only, global effect on function (bump into objects, fall down steps, can’t read)
If the patient says that they noticed their LOV by accidentally covering one eye, what does this mean about the timing of the event?
May not be acute, it might be gradual but they did not notice
What 6 examinations do you need to do for ALOV?
- VA in both eyes
- Visual field loss
- central only
- perpheral and central
- altitudinal
- hemianopia - Pupil reactions
- APD - Anterior segment
- Red reflex - can you see to the back of the eye?
- Fundoscopy
What are 6 monocular causes of ALOV? (think anatomically from front of eye to back)
- Acute corneal disease
- Acute chamber haemorrhage
- Acute cataract
- Vitreous haemorrhage
- Optic nerve
- Retina
What are 4 features of acute corneal disease in the cause of monocular ALOV?
- Rare to be painless
- Painless with HSV as it renders it anaesthetic
- Central cloudy cornea leading to visual loss
- Can come on quickly over 1 day
What are 2 features of anterior chamber haemorrhage in the cause of monocular ALOV?
- Rare for acute painless things occurrng in anterior chamber
- Can be caused by uveitis glaucoma haemorrhage - spontaneous anterior chamber haemorrhage so vison goes blurry (rare)
What are features of acute cataract in the cause of monocular ALOV?
Can occur as quickly as overnight/over a week
e.g. when struck by lightening, or when capsule of lens becomes porous to fluid and becomes opalescent
What are 2 clinical features of vitreous haemorrhage the cause of monocular ALOV?
What can cause vitreous haemorrhages?
- Less rare
- Causes acute LOV, and if it is a dense vitreous haemorrhage it will cause substantial visual loss
Caused by proliferative diabetic retinopathy, retinal tear, posterior vitreous detachment
What are 3 optic nerve causes of monocular ALOV?
- Optic neuritis - can range from NPL to vaguely blury
- Ischaemic optic neuropathy - acute cessation of blood supply to optic nerve
- When only half of optic nerve is affected, can lead to an altitudinal field defect (loss of inferior or superior field of vision, which does not cross the horizontal plane) - Check for cranial arteritis
What are the 3 signs and symptoms of cranial arteritis?
- Acute visual loss
- Over age of 60
- Associated with headache, pain on chewing/combing hair
What 2 investigations must you do for cranial arteritis and who would you refer to?
- Raised ESR
2. Referral to ophthalmologist
What are the 6 retinal monocular causes of ALOV?
- Branch retinal vein occulsion
- Branch retinal artery occlusion
- Central retinal vein occlusion
- Central retinal artery occlusion
- Retinal detachment
- Macular haemorrhage
What are the 3 binocular global causes of ALOV according to anatomical region (front to back)?
- Chiasm
- pituitary apoplexy - Optic nerve
- infiltrative, severe papilloedema (IIH)
- Optic neuritis - Cortex (brain)
- migraine (temporary visual field loss in zig zag pattern)
- CVA (patterns of field loss)
What are the 4 clinical features of pituitary apoplexy?
- Rapidly expanding pituitary tumour
- Bilateral, acute visual loss
- Eyes seem ok but have bilateral pupil afferent defect
- Can be painless
What visual field loss would a stroke to the occipital cortex cause?
Homonymous hemaniopia (visual field defect on one side in each eye)
What visual field loss would a lesion to the optic nerve cause?
LOV in one eye
What visual field loss would a lesion to the optic chiasm cause (2)?
- Can be total LOV in both eyes
2. Bitemporal hemaniopia
What visual field loss would a lesion behind the optic chiasm cause?
Field defect is more homonymous