Today we discussed the concerning symptom of acute visual loss. Some points:
Monocular visual loss:
1) TIA (i.e. amaurosis fugax; curtain-like classically) - if not transient, represents branch or central retinal artery occlusion. These pts are at high risk for stroke. May see cherry red fovea and Hollenhorst plaques (cholesterol)
2) Central retinal vein (or branch) occlusion- can be transient or permanent, sometimes associated with hypercoagulability. May see engorged veins, hemorrhage.
3) Anterior Ischemic Optic Neuropathy (AION).
This is divided into "arteritic" and "non-arteritic".
Arteritic essentially means temporal arteritis.
Non-arteritic means no specific cause; HTN and DM2 are risk factors
4) Optic neuritis- demyelination, compression (abscess, tumor), hereditary causes
5) Primary ophthalmologic causes: Retinal detachment, vitreous hemorrhage or detachment, closed angle glaucoma, maculopathy,
Acute binocular blindness suggests a toxic cause (e.g. methanol, carbon monoxide, ethabutol, others). Stroke (cortical blindness from visual cortex involvement) and migraine are also on the differential.
Link:
Click here for a BMJ website outlining approach to visual loss
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