1 / 22

Acute Visual Loss Dr Shueh Wen Lim

Acute Visual Loss Dr Shueh Wen Lim. Case 1 – Mrs Smith. 70yo woman presents with sudden onset loss of vision in her right eye half hour ago No improvement since No previous ophthalmic history What are your DDx?. DDx.

tillie
Download Presentation

Acute Visual Loss Dr Shueh Wen Lim

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Acute Visual Loss Dr Shueh Wen Lim

  2. Case 1 – Mrs Smith • 70yo woman presents with sudden onset loss of vision in her right eye half hour ago • No improvement since • No previous ophthalmic history • What are your DDx?

  3. DDx • Retinal vessels • Central/ branch retinal artery occlusion • Central/ branch retinal vein occlusion • Vitreous • Vitreous haemorrhage (diabetic complications) • Retinal detachment • Macula • ARMD – ‘wet’ ARMD • Optic nerve • Anterior ischemic optic neuropathy: arteritic, non-artertic • Optic neuritis • Cerebral cortex • Stroke: homonymous hemianopia • Transient vision loss – amaurosisfugax

  4. What else would you like to know about the patient?

  5. Case 1 – Mrs Smith • Hx • Sudden onset while she was gardening • Painless, no associated redness • Hx of transient blurring of vision 2 weeks ago but recovered • Medhx – IHD, diabetes (on meds) • Ex • Visual acuity <6/60 right eye, 6/9 left eye • RAPD • Fundus exam

  6. RAPD

  7. What is the most likely dx?

  8. CRAO • Pale oedematous retina • Thin attenuated vessels • Cherry red spot • Embolus may be seen • Optic disc not pale or swollen After 6 weeks: • Cherry red spot recedes • Optic disc pallor becomes evident

  9. CRAO • Ix • CDV RFs – lipids, fasting BSL • ESR, CRP (r/o GCA) • Carotid US • Echocardiogram • ± Thrombophilia screen • Mx • Urgent referral to ophthal • Ocular massage • Lower IOP (diamox 500mg stat ± ant chamber paracentesis) • Long term aspirin?

  10. Case 2 – Mr Lee • Similar hx • 65 yo p/w sudden and painless loss of vision in left eye • Hx of DM and HTN • Similar ex • 6/60 left eye, 6/9 right eye • RAPD • Fundus exam

  11. What is the most likely dx?

  12. CRVO • Intraretinal flame-shaped haemorrhages (visible in all four quadrants) • Optic disc swelling • Dilated, tortuous veins • Cotton wool spots

  13. CRVO • Mx • Check BP • Screen for diabetes, hyperlipidemia • Thrombophilic screen in younger pts • 2 major complications • Macular edema • Neovascularisation of iris and retina

  14. Case 3 – Mrs Abdullah • Hx • 70yo lady p/w sudden onset loss of vision in her right eye • Generalised muscle pain and weakness (but untreated for past 8 months) • Been feeling poor for the past 4 weeks with a flu and fever that she hasn’t been able to shake • Moderate severe headaches during the time • Unable to chew food properly because ‘it hurts’, lost 5kgs • Pmedhx: T2DM, smoker • Visual acuity • Hand movements in right eye, 6/6 left eye • RAPD in right eye

  15. What is the most likely dx?

  16. Anterior Ischemic Optic Neuropathy • Fundoscopy • Pale, swollen optic disc • Some haemorrhages, cotton wool spots • Mx • ESR (urgent!), CRP, plt count • Temporal artery biopsy • High dose systemic steroids (but always check for RFs that may C/I or complicate Rx with steroids)

  17. Case 4 – Mr Holmes • Hx • 69yo man who p/w painless loss of vision • Recent hx of increased number of visual floaters and flashes • “Dark shadow” in the visual field of left eye • High myopia since 15yo, T2DM • Ex • Loss of red reflex • RAPD

  18. What is the most likely dx?

  19. Retinal detachment • Separation of sensory retina from the retinal pigment epithelium • Risk factors • High myopes • Ocular trauma • DM • Previous eye surgery eg cataract removal • Visual acuity will be affected only if central macula is affected • Examination • Abnormal red reflex • RAPD • ‘Tobacco dust’ • Detached retina (grey area) • Urgent opinion from ophthalmologist- surgery?

  20. Wet (neovascular) AMD

  21. Vitreous haemorrhage

  22. Questions?

More Related