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Sudden Painless Loss Of Vision. By Minal G. Birambole. (internee) G.A.M &R.C, Shiroda,Goa. Sudden loss of vision is alarming to both the patient and the clinician alike.

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Sudden painless loss of vision

Sudden Painless Loss Of Vision


Minal G. Birambole.


G.A.M &R.C,


Causes of sudden loss of vision
Causes of sudden loss of vision the clinician alike.

  • Central Retinal artery occlusion

  • Vitreous hemorrhage

  • Retinal detachment

  • Central Retinal vein occlusion

  • Optic neuritis

  • Methyl alcohol amblypia

Retinal artery occlusion
Retinal artery occlusion the clinician alike.


  • more common in patients suffering from hypertension.

  • Thrombosis

  • Embolism

  • Retinal artritis

  • Angiospasm

Central retinal artery occlusion
Central retinal artery occlusion the clinician alike.

Clinical Features -

  • More common in male

  • Usually unilatral,rarely bilateral

  • It is due to obstruction at the level of lamina cribriosa.

Symptom the clinician alike. –

Painless sudden loss of vision

Signs- the clinician alike.

  • Direct pupilary reflex is absent.

  • Retinal artery markly narrow.

  • Retinal vein look normal.

  • Retina become milky white.

  • Chery red spot (central part of macular area)

  • Blood coloum is segmented.

Ergs of crao
ERGs of CRAO the clinician alike.

Branch retinal artery occlusion
branch retinal artery occlusion the clinician alike.

  • Usually occurs following lodgment of embolus at bifercation.

  • Retina distal to occlusion become odematous.

  • Later on permanent sectorial visual field defect.

Management the clinician alike. –

treatment is unsatisfactory as retinal tissue can’t survive ischemia more than few hours.

Emergency treatment-

  • Immediate lowering of intraocular pressure

    by IV Mannitol

    intermittent occular massage

    paracentesis of anterior chamber

Complication 95% of water.-

neovascular glaucoma with incidence varying from 1% to 5%.

Retinal vein occlusion
Retinal vein occlusion 95% of water.

Etiology -

  • More common than artery occlusion

  • Typically affects elderly patients in 6th or 7th decade in life

  • Pressure on the vein by sclerotic retinal artery

  • Hyperviscocity of blood as in polycythemia

  • Periphlebitis retinae(central or peripheral)

Central retinal vein occlusion
Central retinal vein occlusion angle glaucoma

  • Non ischemic

  • most common clinical variety

  • Characterised by mild to moderate visual loss.

    Fundus examination-

    In early stage-

  • mild venous congesion

  • Tortusity

  • Few superficial flame shaped haemorrhage more in periphery than posterior.

  • Mild papillodema angle glaucoma

  • Mild macular odema

    In later stage-

  • Sheathing arround main vein

  • Few cilioretinal collatrals around disc

  • Retinal haemorrhage partly absorbed

  • Macula shows chronic cystoid odema.

Treatment- angle glaucoma

  • Usually not required

  • Condition resolve with almost normal vision in about 50% cases.

  • No treatment is effective for chronic cystoid macular odema

  • Course of oral steroids 8-12 weeks may be effective.

  • Ischemic- angle glaucoma

    Refers to acute complete occlusion of central retinal vein

    Characterised by marked Sudden loss of vision

Fundus examination- angle glaucoma

in early stage-

  • Massive engorgement

  • Congestion

  • Tortusity of veins

  • Massive retinal haemorrhage

  • Papilloedema

  • Macular area oedematous

in later stage- angle glaucoma

  • Sheathing around vein & collatrals seen around disc

  • Neovascularisation at disc

  • Macula-marked pigmentary change

  • Chronic cystoid oedema

Difference between ischemic from non ischemic
Difference between ischemic from non ischemic angle glaucoma

  • Presence of relative afferent pupillary defect

  • Visual field defect

  • Reduced amplitude of b-wave of ERG.

Complication angle glaucoma-

  • Rubiosis iridis

  • Neovascular glaucoma in more than 50% cases within 3 months

  • Few develops vitreous hemorrhage

Treatment- angle glaucoma

  • Panretinal photocoagulation

  • Cryo-application

  • Photocoagulation

    Above is carried out when most of interretinal blood is absorbed.

Branch retinal vein occlusion
Branch retinal vein occlusion angle glaucoma

  • More common than central retinal vein occlusion

  • Occur at following site

  • main branch at disc margin

  • Major branch vein away from disc

  • At A-V crossing causing quadratic occlusion

  • Small macular occlusion

Treatment- affected vein.

  • Grid photocoagulations-

    in chronic macular odema

  • Scatterphotocoagulations-

    in neovascularisation

Vitreous haemorrhage
Vitreous haemorrhage affected vein.

Usually occur from retinal vessels

Pre retinal intrageal

haemorrhage haemorrhage

Etiology- affected vein.

  • Associated with PVD

  • Trauma to eye

  • Inflamatory disease like chorioretinitis,periphlebitis retinae

  • Vascular disoders like HTN retinopathy

  • Metabolic disease like DM retinopathy

  • Neoplasm

  • idiopathic

Clinical features- affected vein.


  • Distant direct opthalmoscopy-

    black shadow against the red glow in small haemorrhage.

  • Direct & indirect opthalmoscopy-

    presence of blood in vitreous cavity

  • Ultrasonography with B-scan-

    it help in diagnosis.

Symptoms- affected vein.

  • In less haemorrhage-

    sudden development of floaters.

  • In more haemorrhage-

    sudden painless loss of vision

Treatment- affected vein.

  • Conservative treatment-

    bed rest

    elevation of patients head

    bilateral eye patches

  • Treatment of cause-

    management of retinal break, phlebitis, proliferative retinopathy.

  • Vitrectomy- affected vein.

    by pars plana route, if haemorrhage is not absorb after 3 months.

Retinal detachment
Retinal detachment affected vein.

Separation of neurosensory retina proper from the pigment epithelium.


  • Primary retinal detachment

  • Secondary retinal detachment

Primary retinal detachment
Primary retinal detachment affected vein.

Usually associated with retinal break

Sub retinal fluid seeps

Separate the sensory retina from pigmentary epithelium

Etiology- affected vein.

  • Most common in 40-60 yrs.

  • More in males

  • 40% cases are myopic

  • More common in aphakes

  • Retinal degenaration

  • Trauma

  • Senile post.vitreous detachment

Pathogenesis- affected vein.

Senile acute predisposing

Post.vitreous retinal

Detachment degenaration aphakia

Retinal break trauma

Degenarated fluid seeps through retinal breaks

Retinal detachment

Clinical features- affected vein.

Prodromal symptom-

dark spot in front of the eye



  • loss in field of vision which progress total loss when detachment progress to macular area.

  • Sudden painless loss of vision

Sign- affected vein.

  • External examination-

    eye is usually normal

  • Intraoccular pressure is low

  • Plain mirror examination-

    an altered red reflex in pupilary area.

  • Opthlmoscopy- affected vein.

    • Detach retina gives grey reflex & raised anteriorly.

    • it thrown in to folds which oscilate with the movement of eye

    • Total detachment of retina funnel shaped, being attached only at disc & ora serrata

    • Retinal vessels appear dark tortuous.

Complication- affected vein.

proliferative vitreoretinopathy

complicated cataract


phthisis bulbi

Uveitis affected vein.

Pthisis bulbi affected vein.

Treatment- affected vein.

  • Sealing of retinal breaks-

    by producing aseptic chorioretinitis,



  • Scleral buckling-

    To bring the sclrochoroid & retina near to each other

  • Drainage of SRF

chororetinitis affected vein.

Solid retinal detachment
Solid retinal detachment affected vein.

Occurs due to retina being pushed sway by neoplasm or accumulation of fluid beneath the retina.


  • Systemic disease-

    toxaemia in pregnancy

    renal HTN

    blood dyscrasias

    polyarthritis nodosa

  • Occular disease- affected vein.

    • Inflammation like the Harada’s disease, posterior scleritis,orbital cellulitis

    • Vascular disease like central serous retinopathy & exudative retinopathy

    • Neoplasm like malignant melanoma of choroids

Clinical features- affected vein.

Can be differentiate from simple

  • Absence of photopsia

  • Holes or tears

  • Folds

  • Undulation

  • Smooth & convex detachment

  • At summit of tumour,it usually rounded & fixed

  • Pattern of retinal vessel is disturbed

Treatment- affected vein.

  • Absorption of fluid

  • Treatment of causative factor

  • If tumour-enucleation

Optic neuritis
Optic neuritis affected vein.

Includes inflammatory & demyelinating disorder of optic nerve


  • Idiopathic

  • Hereditary optic neuritis

  • Demyelinating disorders-

    multiple sclerosis

    neuromyelitis optica

Clinical features- affected vein.

Classified in to three-

  • Papilitis

  • Neuroretinitis

  • Retrobulber neuritis

  • Papilitis- affected vein.

    It is inflammation of optic disc.

    Usually unilateral


    • Sudden profusal visual loss is hallmark of papilitis

    • Dark adaptation is depressed

    • Light brightness is depressed

    • Colour object may look wash away

    • Depth perception percularly for moving object may be impaird.

Signs- affected vein.

  • Visual acuty reduced markly

  • colour vision often severly impaired

  • Pupil-ill-stained constriction to light

  • Ophthalmoscope-

    • Hyperemia of disc

    • Bluring of margin

    • Disc become oedematous & physiological cup is obliterated

    • Retinal veins are congested

    • Splinter haemorrhage is seen.

  • Visual field change- affected vein.

    central or centroceacal scotoma.

    the field defect are more marked to red colour than white

  • Visually evoked response (VER)shows reduced amplitude & delayed in the transmission time.

Methyl alcohol amblyopia
Methyl alcohol amblyopia affected vein.

Acute onset

Resulting in optic atrophy & permanent blindness


  • Intake of wood alcohol spirit in cheap adulterated beverages

  • Inhalation of fumes in industries

  • Absorbed from skin following prolonged daily use of linments

Pathogenesis- affected vein.

Methyl alcohol metabolized very slowly,

stay longer period

Oxidised in to formic acid & formaldehyde


Degenaration of ganglion cell of retina

Complete blindness

Clinical features- affected vein.

  • Headache

  • Dizziness

  • Nausea

  • Vomiting

  • Abdominal pain

  • Delirium

  • Stupor

  • Even death

Diagnostic sign- affected vein.

Presence of charecteristic odour due to excretion of formaldehyde

Occular features-

mild disc oedema

markedly narrowed blood vessels

bilatral optic atrophy

Treatment- affected vein.

  • Gastric lavage

  • Admission of alkali to overcame acidosis.sodabicarb may be given orally or IV

  • Eliminative treatment by diaphoresis in the form of peritoneal dialysis

  • Prognosis is usually poor, death may occur.

The eye is the lamp of the body affected vein.

If your eyes are good,

Your whole body will be full of light,


Take care of your eyes.

Thank you affected vein.