Acute and Chronic visual loss By Dr. ABDULMAJID ALSHEHAH Ophthalmology consultant Anterior Segment...
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Transcript of Acute and Chronic visual loss By Dr. ABDULMAJID ALSHEHAH Ophthalmology consultant Anterior Segment...
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Acute and Chronic visual loss
ByDr. ABDULMAJID ALSHEHAH
Ophthalmology consultantAnterior Segment and Uveitis consultant
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DDx of acute vision loss
Painful (usually)
•Corneal Abrasion•Corneal ulcer •acute angle closure glaucoma •Acute uveitis (sometimes painless)
•Endophthalmitis
Painless (usually)
•hyphema•Vitreous hemorrhage.•Retinal Artery Occlusion• Retinal Vein Occlusion•Retinal Detachment• Optic Neuritis (can be associated with ocular pain on eye movement)
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Acute visual loss
• In medicine, an acute disease is a disease with a rapid onset and/or a short course.
• minutes up to few weeks
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History taking for a patient with loss of vision
• For how long?• One or both eyes• History of eye trauma• History of eye surgery• Associated symptoms
(pain).• Medical illnesses (DM)
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Examining a patient with loss of vision
• VA• Confrontation VF
testing• Pupillary reactions• Ophthalmoscopy (red
reflex+fundus).• Penlight exam.• Tonometry.
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corneal epithelial defect (CED) or corneal abrasion
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Corneal ulcer or microbial keratitis• History of (trauma, CL wear)• Need urgent referral to
ophthalmologist• Need samples for microbiology• Might need hospitalization• Treated with frequent application
of topical broad spectrum antibiotics.
• If neglected can lead to corneal perforation and endophthalmitis
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acute angle closure glaucoma • C/O acute vision loss, pain,
headache, vomiting
• Corneal edema• Mid-dilated non-reactive pupil• Ciliary injection• High IOP (around 50s)• Optic disc swelling
• Systemic IOP lowering medications
• YAG laser peripheral iridotomy ASAP
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Acute uveitis• Most commonly idiopathic
• can be associated with pain and high IOP• Characterized by: ciliary injection, keratic
precipitates (KPs), iris nodules, synechia, vitritis, vasculitis, chorioretinitis and/or papillitis.
• Any type of uveitis (anterior, intermediate and posterior) can cause acute loss of vision but usually posterior (toxoplasmosis retinitis)
• Rule out infection and malignancy• Treatment is usually with Local or systemic
immunosuppression
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Endophthalmitis• Painful loss of vision• Usually Recent intraocular
surgery.• Usually unilateral (except
septicemia)• Need urgent referral to
ophthalmologist.• Need vitreous samples for
microbiology• Need intravitreal antibiotic
injections• Might need retina surgery.
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Hyphema • History of trauma (usually) • Medical illness (DM, HTN)
• Painless loss of vision• Rubiosis (NVI) due to CRVO or
PDR• High IOP
• Treat the cause • Steroids and cycloplegic topical
drops.• Might need surgery (AC washout)
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Vitreous hemorrhage• History of trauma • Medical illness (DM, HTN)
• Painless loss of vision• Rubiosis (NVI) due to CRVO or
PDR• Retinal Hrg, NVD, NVE
• Treat the cause • Might need surgery (PPV)
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Retinal Artery Occlusion
• BRAO
• CRAO
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Retinal Vein Occlusion
• BRVO
• CRVO
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Retinal Detachment
• Typical black curtain complaint
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Optic Neuritis
• RAPD• Color vision• VF
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Chronic visual loss
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Chronic visual loss
• DDX1- amblyopia2- corneal opacities3- cataract4- glaucoma5- retinal vascular diseases6- macular degeneration (rare in
KSA)7- chronic uveitis8- neglected or persistent cause of
acute visual loss
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Corneal opacities
• Corneal scars (Trachoma, old trauma, old
infection, advanced keratoconus)
• Corneal dystrophies(macular stromal corneal dystrophy,
congenital hereditary corneal dystrophy CHED, Fuchs corneal dystrophy)
• Corneal degenerations(band keratopathy, CDK)
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Treatment of corneal opacities
• Refraction • Laser (if superficial
opacity)• Corneal transplant
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Qustions