Sudden Visual Loss
No Results
No Results
processing….
Sudden visual loss is a common complaint with variable presentations among patients of different ages.
The differential diagnoses of sudden vision loss are vast. In general, monocular vision loss usually indicates an ocular problem. Binocular vision loss is usually cerebral in origin. Monocular vision loss may respect the horizontal midline. Binocular vision loss may respect the vertical midline.
Some patients describe their symptoms as a gradually descending gray-black curtain or as blurring, fogging, or dimming of vision. Symptoms usually last a few minutes but can persist for hours. Variation in frequency ranges from a single episode to many episodes per day; recurrences may continue for years but more frequently occur over seconds to hours.
Many different causes of sudden visual loss are recognized; however, the most common reason for painless sudden visual loss is ischemia. Vision loss with positive scotoma may be seen with migraine. Vision loss with a negative scotoma may be seen with amaurosis fugax. Ischemia, often via mechanical obstruction, can affect any aspect of the visual system. Those who develop ischemia of the eye often have other evidence of atherosclerotic disease, such as coronary artery disease and peripheral vascular disease, which increases their susceptibility to ischemic events in other parts of the body. Risk factors include smoking, hypercholesterolemia, and hypertension.
Other etiologies of sudden visual loss include infection/inflammation, vasculitis, trauma, mechanical dysfunction, and idiopathic causes.
Ischemia compromises cell metabolism by reducing delivery of oxygen and other important nutrients to tissues. The resulting functional deficit may be temporary or permanent, depending on the degree of damage. Nomenclature of eye ischemia as given by Hedges and others includes the following [1] :
Transient visual obscuration (TVO) – Episodes lasting seconds that are associated with papilledema and increased intracranial pressure
Amaurosis fugax – Brief, fleeting attack of monocular partial or total blindness that lasts seconds to minutes
Transient monocular visual loss (TMVL) or transient monocular blindness (TMB) – A more persistent vision loss that lasts minutes or longer
Transient bilateral visual loss (TBVL) – Episodes affecting one or both eyes or both cerebral hemispheres and causing visual loss
Ocular infarction – Persistent ischemic damage to the eye, resulting in permanent vision loss
Sudden visual loss is uncommon.
Transient monocular visual loss (TMVL) in a person younger than 45 years may be benign; many attacks are probably vasospastic or due to migraine.
Transient bilateral visual loss (TBVL) is almost always associated with severe occlusive disease of the internal carotid artery (ICA), aortic arch, or bilateral occipital lobe ischemia.
Patients with ICA disease often have other systemic evidence of atherosclerosis, such as coronary and peripheral vascular disease. Other risk factors include smoking, hypercholesterolemia, and hypertension.
Whites, especially men, have a high incidence of ICA-origin atherosclerosis.
Blacks and Chinese and Japanese persons have a higher incidence of intracranial occlusive disease.
A strong male predominance (2:1) exists among patients with severe ICA disease.
Hedges TR. The terminology of transient visual loss due to vascular insufficiency. Stroke. 1984 Sep-Oct. 15(5):907-8. [Medline].
Shinar Z, Chan L, Orlinsky M. Use of ocular ultrasound for the evaluation of retinal detachment. J Emerg Med. 2011 Jan. 40(1):53-7. [Medline].
Wray SH. Visual aspects of extracranial internal carotid artery disease. Bernstein EF, ed. Amaurosis Fugax. New York: Springer-Verlag; 1988. 72-80.
Hayreh SS. Intra-arterial thrombolysis for central retinal artery occlusion. Br J Ophthalmol. 2008 May. 92(5):585-7. [Medline].
Braithwaite T, Nanji AA, Greenberg PB. Anti-vascular endothelial growth factor for macular edema secondary to central retinal vein occlusion. Cochrane Database Syst Rev. 2010 Oct 6. CD007325. [Medline].
Berker N, Batman C. Surgical treatment of central retinal vein occlusion. Acta Ophthalmol. 2008 May. 86(3):245-52. [Medline].
Morley MG, Heier JS. Venous obstructive diseases of the retina. Yanoff M, Duker Js. Ophthalmology. 3rd. place unknown: Mosby; Dec 2008. 10/6.17. [Full Text].
Newman NJ, Scherer R, Langenberg P, et al. The fellow eye in NAION: report from the ischemic optic neuropathy decompression trial follow-up study. Am J Ophthalmol. 2002 Sep. 134(3):317-28. [Medline].
Varma R, Bressler NM, Suñer I, et al. Improved vision-related function after ranibizumab for macular edema after retinal vein occlusion: results from the BRAVO and CRUISE trials. Ophthalmology. 2012 Oct. 119(10):2108-18. [Medline].
Ng WS, Ang GS, Azuara-Blanco A. Laser peripheral iridoplasty for angle-closure. Cochrane Database Syst Rev. 2012 Feb 15. 2:CD006746. [Medline].
Gal RL, Vedula SS, Beck R. Corticosteroids for treating optic neuritis. Cochrane Database Syst Rev. 2012 Apr 18. 4:CD001430. [Medline].
Biousse V, Calvetti O, Bruce BB, Newman NJ. Thrombolysis for central retinal artery occlusion. J Neuroophthalmol. 2007 Sep. 27(3):215-30. [Medline].
Schumacher M, Schmidt D, Jurklies B, et al. Central retinal artery occlusion: local intra-arterial fibrinolysis versus conservative treatment, a multicenter randomized trial. Ophthalmology. 2010 Jul. 117(7):1367-75.e1. [Medline].
McAllister IL, Gillies ME, Smithies LA, et al. The Central Retinal Vein Bypass Study: a trial of laser-induced chorioretinal venous anastomosis for central retinal vein occlusion. Ophthalmology. 2010 May. 117(5):954-65. [Medline].
Ferrara DC, Koizumi H, Spaide RF. Early bevacizumab treatment of central retinal vein occlusion. Am J Ophthalmol. 2007 Dec. 144(6):864-71. [Medline].
Wroblewski JJ, Wells JA 3rd, Adamis AP, et al. Pegaptanib sodium for macular edema secondary to central retinal vein occlusion. Arch Ophthalmol. 2009 Apr. 127(4):374-80. [Medline].
D.M. Brown, P.A. Campochiaro, et al. Ranibizumab for macular edema following central retinal vein occlusion: six-month primary end point results of a phase III study. Ophthalmology. 2010. 117:1124-1133. [Medline].
Campochiaro PA, Heier JS, Feiner L, Gray S, Saroj N, Rundle AC, et al. Ranibizumab for macular edema following branch retinal vein occlusion: six-month primary end point results of a phase III study. Ophthalmology. 2010. 117(6):1102-12. [Medline].
Campochiaro PA, Brown DM, Awh CC, et al. Sustained benefits from ranibizumab for macular edema following central retinal vein occlusion: twelve-month outcomes of a phase III study. Ophthalmology. 2011 Oct. 118(10):2041-9. [Medline].
Brown DM, Campochiaro PA, Bhisitkul RB, Ho AC, Gray S, Saroj N, et al. Sustained benefits from ranibizumab for macular edema following branch retinal vein occlusion: 12-month outcomes of a phase III study. Ophthalmology. 2011. 117(6):1594-602. [Medline].
Heier JS, Campochiaro PA, Yau L, Li Z, Saroj N, Rubio RG, et al. Ranibizumab for macular edema due to retinal vein occlusions: long-term follow-up in the HORIZON trial. Ophthalmology. 2012. 119(4):802-9. [Medline].
Mitry D, Bunce C, Charteris D. Anti-vascular endothelial growth factor for macular oedema secondary to branch retinal vein occlusion. Cochrane Database Syst Rev. 2013 Jan 31. 1:CD009510. [Medline].
Aldrich EM, Lee AW, Chen CS, et al. Local intra-arterial fibrinolysis administered in aliquots for the treatment of central retinal artery occlusion: the Johns Hopkins Hospital experience. Stroke. 2008 Jun. 39(6):1746-50. [Medline].
Rootman DB, Gill HS, Margolin EA. Intravitreal bevacizumab for the treatment of nonarteritic anterior ischemic optic neuropathy: a prospective trial. Eye (Lond). 2013 Feb 1. [Medline].
Dickersin K, Manheimer E, Li T. Surgery for nonarteritic anterior ischemic optic neuropathy. Cochrane Database Syst Rev. 2012 Jan 18. 1:CD001538. [Medline].
Carter JE. Chronic ocular ischemia and carotid vascular disease. Bernestein EF, ed. Amaurosis Fugax. New York: Springer-Verlag; 1988. 118-134.
FDA. US Food and Drug Administration Center for Drug Evaluation and Research [Web site]. Available at http://www.fda.gov/cder/. Accessed: November 2008.
Fisher CM. Observations of the fundus oculi in transient monocular blindness. Neurology. 1959 May. 9(5):333-47. [Medline].
Gino A Farina, MD, FACEP, FAAEM Professor of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine at Hofstra University; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center
Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
Ellen M Menocal, MD Resident Physician, Department of Emergency Medicine, Long Island Jewish Medical Center
Disclosure: Nothing to disclose.
Nicholas Lorenzo, MD, MHA, CPE Co-Founder and Former Chief Publishing Officer, eMedicine and eMedicine Health, Founding Editor-in-Chief, eMedicine Neurology; Founder and Former Chairman and CEO, Pearlsreview; Founder and CEO/CMO, PHLT Consultants; Chief Medical Officer, MeMD Inc
Nicholas Lorenzo, MD, MHA, CPE is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Association for Physician Leadership
Disclosure: Nothing to disclose.
Lien Hong Lam, MD Resident Physician, Department of Emergency Medicine, North Shore Long Island Jewish Hospital
Lien Hong Lam, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, Emergency Medicine Residents’ Association
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
J James Rowsey, MD Former Director of Corneal Services, St Luke’s Cataract and Laser Institute
J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Sigma Xi, Southern Medical Association, Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.
Edsel Ing, MD, MPH, FRCSC Associate Professor, Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine; Active Staff, Michael Garron Hospital (Toronto East Health Network); Consulting Staff, Hospital for Sick Children and Sunnybrook Hospital, Canada
Edsel Ing, MD, MPH, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Ophthalmic Plastic and Reconstructive Surgery, Canadian Medical Association, Canadian Ophthalmological Society, Canadian Society of Oculoplastic Surgery, Chinese Canadian Medical Society, European Society of Ophthalmic Plastic and Reconstructive Surgery, North American Neuro-Ophthalmology Society, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Statistical Society of Canada
Disclosure: Nothing to disclose.
Kilbourn Gordon, III, MD, FACEP Urgent Care Physician
Kilbourn Gordon, III, MD, FACEP is a member of the following medical societies: American Academy of Ophthalmology, Wilderness Medical Society
Disclosure: Nothing to disclose.
The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Angel Feliciano, MD, to the development and writing of this article.
Sudden Visual Loss
Research & References of Sudden Visual Loss|A&C Accounting And Tax Services
Source
0 Comments