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Visual Loss

Visual Loss. Sana Rasool FY1 Ophthalmology The Royal Oldham Hospital. Acute Visual Loss. Central Retinal Artery Occlusion. Sudden onset Severe loss of whole visual field Amaurosis fugax No associated symptoms O/E- RAPD; pale retina; ‘cherry red spot’ at macula

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Visual Loss

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  1. Visual Loss Sana Rasool FY1 Ophthalmology The Royal Oldham Hospital

  2. Acute Visual Loss

  3. Central Retinal Artery Occlusion • Sudden onset • Severe loss of whole visual field • Amaurosis fugax • No associated symptoms • O/E- RAPD; pale retina; ‘cherry red spot’ at macula • Invxs- CV exam; FBC, ESR, Lipids

  4. Central Retinal Artery Occlusion • Tx- exclude GCA; no specific tx • Outcome- 90% DO NOT recover sight

  5. Central retinal vein occlusion • Sudden onset • Mild-severe loss of whole field • No associated symptoms • O/E- +/- RAPD, haemorrhages, optic disc swelling • Invxs- FBC, ESR, plasma proteins, clotting, lipids • Tx- aspirin

  6. Central retinal vein occlusion

  7. Vitreous Haemorrhage • Sudden onset • Mild-severe loss of whole field • Floaters in vision • Unilateral • Common in proliferative DR • Commonest cause- tear in retinal vessel • O/E- pupils normal

  8. Vitreous Haemorrhage • Invxs- Glucose, USS- visualise retina • Tx- observe; laser- to stop further bleeding • Outcome- progresses to retinal detachment if not treated

  9. Vitreous Haemorrhage

  10. Gradual Visual Loss

  11. Optic Neuritis • 20-40 yrs female • Onset over few days • Reduced colour perception • Mild-moderate field loss • Pain on eye movement • O/E +/- RAPD

  12. Optic Neuritis • Invxs- If not recovered by 6 weeks • ESR • MRI • Tx- steroids may help • Outcome- 45-80% develop MS in later life

  13. Retinal Detachment • Flashing lights and floaters • Increased risk in myopic pts, FHx RD • Onset over few days • O/E +/- RAPD; grey, wrinkled, mobile retina • URGENT REFERRAL- surgical reattachment

  14. Retinal Detachment

  15. Cataract • Older patients usually • Onset over several years • Glare- esp during night driving • O/E- poor red reflex • Surgery to replace lens

  16. Cataract

  17. Dry Macular Degeneration • Widespread atrophic changes in macular area • ~85% ARMD • Wear and tear of RPE many years • Bilateral • Invx- FFA

  18. Dry Macular Degeneration

  19. Wet Macular Degeneration • More aggressive • Exudative • ~15% ARMD • More rapid clinical course • Can involve both eyes • Invx- FFA • Laser photocoagulation

  20. Wet Macular Degeneration

  21. Thank You!! Any questions?

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