this presentation is about causes of acute visual loss which i made for my seminar during ophthalmology posting.Hope that people can had a benefit from this slide especially medical student.

1. ACUTE VISUAL
LOSS
By:
Dina Hazwani binti Azlang
4th
year medical student,
Faculty of Medicine,
UiTM, Malaysia.

2. Causes of
acute
visual loss
Transient
-optic
neuritis
Permanent
-retinal detachment
-CRA obstruction
-acute congested
glaucoma
-trauma

4. DEFINITION
 Separation of neurosensory retina ( NSR ) from the
retinal pigment epithelium (RPE) by sub-retinal
fluid (SRF) accumulation

5. CLASSIFICATION
 Rhegmatogenous RD ( Rhegma = break )
Retinal break(hole/tear)- subretinal fluids seeps & separate
neurosensory retina from the underlying pigmented epithelium.
 Non-rhegmatogenous RD
 Tractional ( sensory retina is pulled away from the RPE by
contracting vitreoretinal membranes, eg proliferative diabetic
retinopathy)
 Exudative ( SRF derived from the choriocapillaries gain access
to the subretinal space through damage RPE. Eg choroidal
tumours, exophytic retinoblastoma, posterior scleritis )

6. TYPE OF RETINAL TEARS

7. RHEGMATOGENOUS RD
 Retinal breaks responsible for RD are caused by
interplay between
 Dynamic vitreoretinal traction
 Predisposing degeneration in peripheral retina
 Increased in patients who:
 Myopic eyes
 Have undergone cataract surgery
 Severe eye trauma
 Age: 40-60
 Sex: M:F-3:2
 Retinal degenerations

8. SIGN AND SYMPTOMS
 Photopsia (sparks or flashes)- Caused by traction on the retina at sites
of vitreoretinal adhesions
 Vitreous floater
 Visual field defect ~ dark curtain, cloudy
 Fall in acuity ~ detached macula
 Vision loss maybe filmy, cloudy, irregular or curtain-like.
 One large floater in the middle of the field of vision or a wavy
distortion of objects.
 4 ‘F’s

9.  Marcus Gunn pupil (relative afferent pupillary defect)
 Opthalmoscopy ;
 Grey opalescent retina, balloning forward.
 Extensive detachment of the retina will pull of the macular.

10.  The billowy, gray spinnaker-like folds represent the
detached retina—the part that has become elevated from its
attachment to the underlying retinal pigment epithelium.

12. FRESH RETINAL DETACHMENT

13. TREATMENT
 Immediately.
 Retinal Reattachment surgery
Basic principles
 Sealing of retinal breaks
 By cryocoagulation, photocoagulation or diathermy
(to create an adhesion between the pigment epithelium and the
sensory retina)
 SRF drainage
 Allow immediate apposition between sensory retina and RPE
 By using fine needle
 Maintain chorioretinal apposition
 Scleral buckling
 Pneumatic retinopaxy

15.  Definition
 An inflammatory & demyelinating disorder affecting
the optic nerve.
 It can be classified opthalmoscopically and
aetiologically

16. CLASSIFICATION
Aetiological
 Demylinating – common cause
 Parainfectious – follow a viral
infection
 Infectious – may be sinus-
related or a/w cat scratch fever,
Lyme ds, cryptococcol
meningitis in pt wt AIDS&
herpes zoster
 Autoimmune
Opthalmoscopic/Anatomic
al
 Retrobulbar neuritis –
 Papillitis: inflam & demyelinating
optic disc- Hyperamia & oedema
 Neuroretinitis – optic disc &
surrounding retina in macular
area.

17.  What is the most common cause for the
optic neuritis?
Multiple sclerosis. Long term studies
indicated that up to 75% of female patient
initially developed optic neuritis
ultimately developed MS.

18. SYMPTOMS
 Visual loss – Sudden, progressive,profound
(progressively blurrier over a period of hours or days)
 Blurred vision in bright light – typical
 Pain behind the eyes
 esp in retrobulbar neuritis
 aggravated by ocular movement (esp:downward&upward)
 Loss/reduce of color vision
 Preceding history of
viral illness

19. SIGNS
 Reduced visual acuity
 Impaired color vision
 Visual field changes - Central scotoma
 Swinging flash test – affected pupil will dilate when
flash light is moved from normal to abnormal eye
(Marcus gunn pupil)
 Opthalmoscopic
Papillitis- hyperaemia of disc & blurring margin
Disc- edematous& obliterating cup, splinter hrrge,
fine exudate
Retinal veins tortous and congested

20. Swollen of optic
disc.

23. MANAGEMENT
 Treat the underlying cause- cardiovascular or
neurodegenerative disease.
 Treatment: steroid to reduce the inflammation and
swelling

24. 35 year-old woman presented with unilateral worsening
of vision of left eye, accompany by discomfort of eye
movement for two weeks duration
Visual acuity of left eye is 6/60.
Impaired color vision.
There is left afferent pupillary defect and a central
scotoma
Funduscopy reveals the above image.
What is the likely diagnosis
A. Optic Nerve Glioma
B. Cavernosus Sinus thrombosis
C. Grave’s disease
D. Pituitary Adenoma
E. Optic Neuritis
CASE
Opticneuritis

25. Reference
1.Kanski, Clinical Ophthalmology 5th
edition.

26. Thank
You…