Vision Loss
Sudden decrease of vision is usually an ominous sign. Most often the cause of permanent loss is at the retinal or optic nerve level. For the optic nerve to be associated there must be inflammation. For the retina to be the cause, there must be hemorrhaging or edema. Neurologic conditions are often associated with the transient variation of vision disturbances. Sudden decrease or loss of vision is invariably unilateral; if bilateral, it is associated with posterior cortex circulation or hysteria.
Differential Diagnosis
- Vascular causes
–Amaurosis fugax: TIA of the retina lasting 5–60 minutes
–Stroke causes loss of side vision usually to the left or right, may be interpreted as loss of vision in the right or left eye
–Retinal vascular occlusion: Venous shows gradual decline with retinal hemorrhaging; arterial has sudden onset with minimal to no retinal hemorrhaging
-
Transient monocular blindness (TMB)
–Lasts seconds
–Due to positional changes in optic disc
edema with increased intracranial hypertension, orthostatic hypotension, thyroid eye disease, and space-occupying lesions
-
Migraine variants are transient and may be associated with headache after presentation
-
Optic nerve edema or swelling from demyelinating disease, nonarteritic and arteritic optic neuropathy, toxicity (e.g., lead, chloramphenicol)
-
Optic atrophy
-
Retinal etiologies
–Retinal surface wrinkling disorders
–Idiopathic central serous retinopathy often
associated with stress
–Retinal detachment with probable history of floaters before loss of vision
-
Angle closure glaucoma
-
Postsurgical
–Endophthalmitis: Often associated with ocular surgery and red eye
–Cystoid macular edema may occur after ocular surgery
-
Vitreous hemorrhage
–You will not be able to see into the eye
-
Infectious causes
–Retinitis and/or uveitis due to toxoplasmosis, cytomegalovirus, Lyme, histoplasmosis
-
Trauma
-
Hysterical blindness
-
Cataracts
-
Hypoglycemia
-
Retinitis pigmentosa
Workup and Diagnosis
History
–Be aware that patients often have vision reduction over time (e.g., from cataracts) and only perceive the loss as sudden
–Onset, duration, trauma; transience vs permanence of visual loss or change
–Associated signs and symptoms of demyelinizing disease, toxoplasmosis, bartonellosis, Lyme disease
–PMH including migraines, hypertension, diabetes, thyroid disease, rheumatic disease, vascular disease, atrial fibrillation, lipid status
- Physical exam
–Obtain visual acuity and confrontation visual fields in
both eyes
–Redness, pain, photophobia
–Pupillary evaluation: look for Marcus Gunn pupil,
which usually differentiates optic nerve from other
causes
–Extraocular muscle evaluation
–Perform a dilated fundus evaluation
–Evaluate for proptosis
-
Radiology
–CT or MRI of orbits and brain is indicated for
associated neurologic signs, history of trauma
-
Evaluation for stroke if right- or left-sided
-
Ophthalmology consultation for dilated retinal exam, evaluation, and management
Treatment
-
Transient symptoms are usually due to migraine, stroke, or increased intracranial pressure; appropriate therapy for these disorders
-
Manage any underlying systemic disease
-
If angle closure glaucoma, stat consult for immediate medical and surgical intervention
-
Retinitis or uveitis: Management of underlying cause; NSAIDs and steroids
-
If hemorrhage in the macula from macular degeneration or histoplasmosis, laser therapy or intravitreal steroids may save the vision
-
Vitreous hemorrhage may be evacuated after establishing and treating cause
-
Macular edema may be treated with topical steroids, Diamox, intravitreal steroids, NSAIDs
-
Retinal vascular occlusion: Intraocular surgery or laser therapy may alleviate symptoms
Book Source Details
- Book Title: In A Page: Pediatric Signs and Symptoms
- Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
- Year of Publication: 2007
- Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Cloudy vision
Read excerpts from these other book chapters related to Cloudy vision:
Medical Books Excerpts
- EYE PAIN
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- SCOTOMA
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- EYE PAIN
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Eye pain
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Scotoma
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Halo vision
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Hemianopsia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Scotoma
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Vision loss
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Scotoma
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Eye pain
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Vision loss
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Eye pain
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Halo vision
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Hemianopsia
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Scotoma
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Vision loss
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Scotoma
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
- EYE PAIN
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Cloudy vision
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More About This Book:
Title: In A Page: Pediatric Signs and Symptoms
Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 1-4051-0427-9
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» Next page: EYE PAIN (Differential Diagnosis in Primary Care)
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