Sudden V L

OCULAR EMERGENCIES CAUSING
SUDDEN VISUAL LOSS

SUDDEN VISUAL LOSS
Sudden visual loss can be painful or painless. So
accordingly the causes can be:
Sudden painless loss of vision
• Retinal Detachment
• Central Retinal Artery
occlusion
• Central retinal vein
occlusion
• Vitreous hemorrhage
• Optic neuritis
Sudden painful loss of vision
• Acute angle closure
glaucoma
• Corneal ulcer
RETINAL DETACHMENT
• It is the separation of neurosensory retina proper from the pigment epithelium.
• Retinal detachment occurs when subretinal fluid accumulates in the potential space
between the neurosensory retina and the underlying retinal pigment epithelium.
• Depending on the mechanism of subretinal fluid accumulation, retinal detachments
have been classified into:
➡️Rhegmatogenous –It is usually associated with a retinal break (hole or
tear) through which subretinal fluid (SRF) seeps and separates the sensory
retina from the pigmentary epithelium.
➡️Tractional – It occurs due to retina being mechanically pulled away from its bed
by the contraction of fibrous tissue in the vitreous
➡️Exudative –It occurs due to the retina being pushed away by a
neoplasm or accumulation of fluid beneath the retina
following inflammatory or vascular lesions.
SYMPTOMS
• Sudden painless loss of vision

• Dark spots (floaters) in front of the eye
• Photopsia, i.e., sensation of flashes of light
Predisposing Treatment
factors • Sealing of retinal breaks with
• Age and sex cryocoagulation, photocoagulation
• Myopia diathermy
• SRF Drainage
• Aphakia
• Scleral buckling
• Retinal • Pneumatic retinopexy
degeneration • Exudative RD may spontaneously
• Trauma regress on treatment of the
causative disease
CENTRAL RETINAL ARTERY
OCCLUSION
CAUSES
• Atherosclerosis-related Thrombosis
• Retinal arteritis with occlusion
• Emboli
• Angiospasm
• Raised IOP
SIGNS
• Obstruction at the level of lamina
cribrosa
• Direct pupillary light reflex is absent.
• On ophthalmoscopic examination
retinal arteries are
markedly narrowed. Retina becomes
milky white due to oedema.
• Central part of the macular area
shows cherry-red spot due to
vascular choroid shining through the
thin retina of this region.
Treatment
• Immediate lowering of intraocular pressure
• Intravenous steroids
• Anticoagulants
• Vasodilators and inhalation of co2 and o2 relieve
angiospasms
CRVO
Etiology
• Hyperviscosity of blood
• Periphlebitis
• Raised introcular pressure
• Local causes are orbital cellulitis, facial erysipelas
and cavernous sinus thrombosis.
Signs and symptoms
• Painless loss of vision
• Usually unilateral
• Extensive retinal hemorrhages in all
4 quadrants- Blood and thunder
appearance
• Dialated tortuous veins
• Cotton wool spots
• Macular edema
• Optic disc edema
• Neovascularisation
Management
Systemic medications include :
• Anticoagulants
• Antiepileptics
• Fibrinolytic agents
• Hemodilution
Ocular treatment includes :
• Panretinal photocoagulation
• Pharmacotherapy
VITREOUS HEMORRHAGE
CAUSES
• Spontaneous (a/w PVD)
• Trauma to eye
• Vascular disorders like hypertensive retinopathy,and central
retinal vein occlusion.
• Metabolic diseases such as diabetic retinopathy.
• Inflammatory conditions like periphlebitis,chorioretinitis
• 6. Blood dyscrasias e.g., retinopathy of anaemia,hemophilia
• Neoplasms
Signs & Symptoms
• Floaters(if small VH) /
painless loss of vision
• Distant direct
ophthalmoscopy reveals
black shadows against the
red glow in small
haemorrhages and no red
glow in a large haemorrhage.
• Direct and indirect
ophthalmoscopy may show
presence of blood in the
vitreous cavity.
Rx
• Conservative treatment consists of bed rest,elevation of
patient’s head and bilateral eye patches.
• Treatment of the cause
• Pars plana vitrectomy if spontaneous regression does
not occur within 3 months
OPTIC NEURITIS
• Optic neuritis includes inflammatory and demyelinating
disorders of the optic nerve.
• Based on ophthalmoscopic appearance, it can be
divided as
1. Papillitis- MC in children, hyperimia and edema of the
optic disc
2. Neuroretinitis-papillitis + inflammation of the retinal
nerve fibre layer and macular star
3. Retrobulbar neuritis-common in adults with multiple
sclerosis
optic nerve head not involved
Aetiology
• Idiopathic
• Demyelinating s – Mc – Multiple sclerosis
• Infectious –
endophthalmitis,sinusitis,viral,bacterial,Fungal etc
• Immune mediated – uveitis, sarcoidosis etc
• Metabolic – Diabetes,anemia etc
Signs and symptoms
Signs
• Decreased visual acuity. • Visual field defects
• On ophthalmic
• RAPD. examination- optic disc
• Decreased colour vision hyperemia,optic disc
Swelling with blurred
• Decreased contrast sensitivity
margins,Flame shaped
Symptoms
hemorrhages,Tortuous
• Loss of vision retinal vein,Exudates on
• Deep orbital retroocular or brow disc etc
pain
• Neuralgia or headache
Treatment
• Steroid regimen
Intravenous methylprednisolone 1g daily for 3 days f/b
Oral prednisolone (1mg/kg) For 11 days and then
tapered
• Immunomodulatory treatment
interferon beta -1a
Glatiramer acetate
Teriflunomide
Betaseron
Some of the other causes of sudden visual loss include
• Amaurosis Fugax
• Acute angle closure glaucoma
• Giant cell arteritis
• Hyphema
• Endophthalmitis
• Ocular injuries
THANKYOU..

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OCULAR EMERGENCIES CAUSING

SUDDEN VISUAL LOSS

• Sudden painless loss of vision

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