Acute Visual Loss

Vision loss is considered acute when he develops within minutes to days. It can be affected one or both eyes, and only parts of the visual field. Patients with small visual field defects (eg., By a small detachment of the retina) describe their symptoms as sometimes blurred. Pathophysiology of acute loss of vision, there are three main reasons: A haze of the normally transparent structures on the retina pass through the light beams (e.g., cornea, vitreous.) Abnormal states of retinal affections of the optic nerve or visual pathways. Etiology The most common causes of acute visual loss are: closure of the central retinal artery (central retinal artery occlusion, central retinal vein occlusion) Ischemic optic neuropathy (common in patients with temporal arteritis) vitreous hemorrhage (caused by diabetic retinopathy or trauma) injuries In addition, a “can suddenly a noted “vision loss (pseudo-sudden loss of vision) with a” vision loss be confused acute “. So perhaps suddenly noticed a patient with long-standing Sehkraftminderung in one eye (eg., By a pronounced cataracts) when covering the healthy eye only the reduced vision in the other eye. The presence or absence of pain helps classify the vision loss (see Table: Major causes of acute visual loss). Most interference that may cause a complete loss of vision, are also lighter expression possible, so that they only affect a portion of the eye and result in only a partial visual field loss (z. B. occlusion of a branch of the Retinalarterie or vein, local retinal detachment). Less common causes of acute visual loss are: Anterior uveitis (often, but before the loss of vision is usually stronger eye pain, so usually the evaluation takes place in time) Aggressive retinitis Certain medications (such as methanol, salicylates, ergot alkaloids, quinine.). Important causes of acute visual loss caused findings Diagnostic measures Acute loss of vision without eye pain Retinal artery occlusion monocular blindness to hours lasts minutes (typically <5 minutes if due to cerebrovascular disease) arteritic may carotid ultrasound echocardiography MRI or CT ECG Continuous monitoring of cardiac rhythm ischemic optic neuropathy (usually at Pat ienten with temporal arteritis, so-called. giant cell [temporal] arteritis) Sometimes headache, rapid fatigue of the jaw or tongue (claudication), pressure-sensitive or swollen temporal artery, abgeblasste and swollen papilla with surrounding bleeding, occlusion of Retinalarterie or its branches Sometimes proximal myalgias with stiffness (due to a rheumatic polymyalgia) ESR, C-reactive protein (CRP), often inability to write platelet count biopsy of the temporal artery Functional vision loss (unusual) Normal light reaction of the pupil, positive optokinetic nystagmus, no objective abnormalities in the eye examination the name or outstretched hands to bring together sometimes inappropriate emotional poverty in the face de r complained restriction Clinical study In dubious diagnostic ophthalmic examination and derivation of VEP macular hemorrhage due to neovascularization in age-related macular degeneration blood within or underneath the retina and the macula around Clinical examination Non-arteritic ischemic optic neuropathy papilledema and bleeding sometimes loss of the lower and central visual field risk factors (z. As diabetes, hypertension, hypotensive crisis) ESR, CRP, and platelet count may biopsy to exclude a temporal arteritis eyepieces migraine flashing scotoma, scotomas in the mosaic pattern or complete loss of vision; Duration usually 10-60 minutes and often followed by headaches often in young patients Clinical examination Retinal artery occlusion Almost immediately onset, pale retina, cherry-red spot, sometimes Hollenhorst plaques (photorefractive properties at the site of arterial occlusion) risk factors for vascular disease ESR, CRP and platelet count to rule out temporal arteritis carotid ultrasound echocardiography may MRI or CT ECG Continuous monitoring of cardiac rhythm retinal detachment Recently increase in floaters ( "floaters"), photopsias ( "flashes of light"), or both face sfeldausfall, retinal folds risk factors (eg. B. trauma, eye surgery, severe myopia, advanced age in men) Clinical examination retinal vein occlusion often multiple, widely scattered ( "dissiminierte") Retinal bleeding risk factors (eg. As diabetes, hypertension, hyperviscosity syndrome, sickle cell anemia) Clinical examination transient ischemic attack or ischemic stroke bilaterally symmetrical (homonymous) visual field defect, no effect on visual acuity in the intact regions (except bilateral occipital lesion; rare, but at Basilarisverschluss possible) risk factors for atherosclerosis carotid ultrasound Echocardiography may MRI or CT ECG Continuous monitoring of cardiac rhythm vitreous hemorrhage Recently appearing floaters or cobwebs in seeing risk factors (eg. As diabetes, retinal tear, sickle cell anemia, trauma) may ocular ultrasound examination of the retina Acute vision loss with eye pain Acute angle-closure glaucoma rings around lights, nausea, headache, photophobia, conjunctivitis, corneal edema, shallow anterior chamber, intraocular pressure typically> 40 Immediate ophthalmologic examination Gonioscopy corneal ulcer under fluorescein staining and / or the slit lamp visible ulcer risk factors (eg. as injuries, contact lenses) Ophthalmic Investigation endophthalmitis floaters, conjunctival injection, attenuated red reflex, hypopyon or a combination of these symptoms risk factors (infection after eye surgery, traumatic globe rupture or intraocular foreign bodies in a history of such. As in metal working, fungaemia or bacteremia) Immediate ophthalmologic examination with culture of the anterior chamber and vitreous humor neuritis n. Optic (usually painful, but not always) Mild pain on eye movement, afferent pupillary defect (occurs early) visual field defects (in the usually central) Striking Farbsehprüfung may papilledema gadolinium MRI in view of a possible multiple sclerosis and related diseases. In the current study history history are the questions with regard to the start of that period, the progress and the position of the visual loss in the foreground (assembled or binocular, partial or entire field, determining the exact failure area). Important optical symptoms are floaters, flashes and rings around lights, impaired color vision and serration or mosaic pattern (flashing scotoma). The patient is asked to eye pain and if they are sustained or occur only with eye movements. The review of organ systems is looking for extraocular symptoms that may be associated with the disease: rapid fatigue of the jaw or tongue (claudication), temporal headaches, proximal muscle pain and stiffness (Giant) and headache (retinal migraine). The personal history includes well-known risk factors for eye disease (eg. As contact lens use, severe myopia, previous eye surgery or injury), risk factors for vascular disease (eg. As diabetes, high blood pressure) and hematological diseases (eg. As sickle cell anemia or diseases associated with an increased blood viscosity are connected, such as a Waldenstrom or multiple myeloma). In the family history werden.Körperliche to different forms of migraine Respected investigation should it be determined the vital signs, including body temperature. If the suspicion of a transient ischemic attack is a complete neurological examination is performed. The temples are sampled on pulsations, tenderness or nodules over the course of the temporal artery. However, most of the studies on the eye itself refers belong to eye examination. Visual acuity determination of the peripheral visual field by Fingerperimetrie examination of the central visual field using the Amsler grid Direct and consensual light reaction with the swinging-flashlight test test of ocular motility testing color vision with corresponding color plates eyelids, sclera and conjunctiva are examined as possible, with the slit lamp. Corneal fluorescein staining with an examination of the anterior chamber in patients with eye pain or conjunctival injection on cells and positive Tyndall (flare). Investigation of the lens using the direct ophthalmoscopy, the slit lamp, or both (a possible cataract determining the intraocular pressure ophthalmoscopy preferably after pupil dilation with a drop einesSympathomimetikums, z. B. 2.5% phenylephrine or a Zykloplegikums (z. B. cyclopentolate 1 % or tropicamide 1%) or both; maximum dilation, after about 20 min). It is judged throughout the fundus, including the retina, the macula, the fovea, the vessels of the optic disc and its edges. When the light reactions of the pupils are normal and suspicion of a functional visual loss is (rare), the optokinetic nystagmus is checked. If no optokinetic drum is available near the patient’s eye, a mirror can be moved slowly. If the patient can see the eyes tend to follow the movement of the mirror (which is rated as the presence of optokinetic nystagmus). Warning The acute loss of vision itself is a warning sign, the cause is usually schwerwiegend.Interpretation the findings It is recommended in the diagnosis of acute vision loss systematic approach. Certain patterns of malfunctioning of the field of view indicate a specific cause. Other findings raise the suspicion of the cause of acute vision loss: difficulties in adjusting the fundus reflex during ophthalmoscopy speak for a haze of the transparent structures (for example, caused by corneal ulcer, vitreous hemorrhage or severe endophthalmitis.). Retinal abnormalities that are hard enough to cause an acute loss of vision, can be detected with the ophthalmoscope, especially if the pupils are dilated. A retinal detachment can manifest itself through Retinal folds; a retinal vein occlusion demonstrated by circumscribed retinal hemorrhage and retinal artery occlusion manifests itself as a pale retina with a cherry-red spot of the fovea. A afferent pupillary defect (lack of direct light reaction at normal consensual pupillary response) in otherwise normal examination findings (except sometimes an abnormal papilla) indicates an abnormality of the optic nerve, or retinal out (i. E. Praechiasmal). In addition, the following guidelines are useful: A monocular symptoms indicate a lesion anterior to the optic chiasm. Bilateral, symmetrical (homonyms) visual field defects suggest a postchiasmale lesion Persistent eye pain talk (ulcer or abrasion), inflammation of the anterior chamber or elevated intraocular pressure for a corneal lesion, while motion-dependent eye pain characteristic of optic neuritis. Temporal headache suggest a giant or a migraine. Tests ESR, C-reactive protein and platelet count be performed in all patients whose symptoms (eg. As temporal headache, jaw claudication proximal muscle pain, stiffness) painful pressure or or symptoms (eg. As hardened temporal artery, Retinaabblassung, papilledema ) indicate an optic nerve, or retinal ischemia to preclude giant cell arteritis. Further tests are listed in important causes of acute visual loss. Of particular importance is the following: The retina is sonographically examined if it was not clear to judge under indirect ophthalmoscopy with dilated pupils by an eye doctor. The gadolinium MRI is indicated for patients with motion-dependent eye pain or an afferent pupillary defect to exclude multiple sclerosis, especially if the ophthalmoscope a Optikusschwellung had noticed. Therapy underlying disorders are treated. Treatment should generally begin immediately if the cause is treatable. In many cases (eg. As for circulatory disorders), a treatment of the eye affected probably will not help, but the risk for a similar process in the contralateral eye or a complication same cause reduced (eg., Stroke). Key points The diagnosis and treatment should be made as soon as possible. An acute monocular vision loss with afferent pupillary defect suggests a lesion of the eye or optic nerve anterior to the optic chiasm. However (praechiasmal) should be Patients with acute monocular visual loss or afferent pupillary defect and in patients with or without ophthalmoscopic Optikusanomalien without further abnormalities in the eye examination assume a Optikusschädigung (often ischemic). In patients with acute monocular vision loss, eye pain and conjunctival injection presumably acute narrow- angle glaucoma, endophthalmitis or severe anterior uveitis is a corneal ulcer, is based.

Health Life Media Team

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