Acute visual loss

3. Acute visual dysfunction
Sendhil Kumar
Senior registrar
Ophthalmology Department
SCGH

4. Definition
Loss of vision over few minutes to days
Unilateral or Bilateral
Part or full visual field

5. Patho-physiology
Optical media
Retinal layer
Optic nerve dysfunction

6. absent
present
RAPD
+
Optic nerve
dysfunction/
gross retinal
pathology
-
Macular/
limited
retina
Anterior or posterior
segment media issues

7. Relevant history
Pain +/Trauma
Central/Peripheral
Flashes/Floaters
Co-morbids
Medication

8. Examination
•
•
•
•
•
•
General Status
Vision
RAPD
Slit-Lamp
IOP
Funduscopy

9. Painless…

10. Retinal vein occlusion

11. Central retinal artery occlusion

12. Retinal detachment

13. Advance Diabetic Eye Disease

14. Central Serous Chorioretinopathy

15. Papiledema

16. Subretinal bleed

17. Ischemic optic neuropathy

18. Painful…

19. Acute congestive glaucoma

20. Signs of keratitis

21. Keratitis

22. Trauma
Hyphaema
Sphincter tear
Cataract
Lens subluxation
Iridodialysis
Angle recession
Vossius ring
Rupture of globe

23. Commotio retinae
Choroidal rupture and
haemorrhage
Avulsion of vitreous base
and retinal dialysis
Equatorial tears
Macular hole
Optic neuropathy

24. Flat anterior chamber
Uveal prolapse
Vitreous haemorrhage
Tractional retinal detachment
Damage to lens and iris
Endophthalmitis

25. Grading of severity of chemical injuries
Grade I (excellent prognosis)
•
•
Grade III (guarded
prognosis)
Grade IV (very poor
prognosis)
•
No iris details
•
Opaque cornea
•
Limbal ischaemia - 1/3 to 1/2
•
Limbal ischaemia > 1/2
rade II (good prognosis)
Cornea hazy but visible
iris details
Limbal ischaemia < 1/3
Clear cornea
Limbal ischaemia - nil

26. Optic Neuritis
Retrobulbar neuritis
(normal disc)
Papillitis (hyperaemia and
oedema)
•
Neuroretinitis (papillitis
and macular star)
•
•
•
•
•

27. Slit-lamp