Note: I copy the "definition" of something straight from the book. I find it's best to have an all-encompassing definition in order to better orient myself when I am studying.
Also I could not find one source for this topic but felt it was necessary to cover. Merged sources from multiple topics...so it may be a little incomplete.
Acute Vision Loss (from UptoDate): Acute persistent visual loss is defined as lasting at least 24 hours and is typically not caused by transient ischemia. Acute transient visual loss is defined as a sudden deficit in visual function in one or both eyes lasting less than 24 hours. It is caused by a temporary vascular occlusion in the circulation to the eye or visual cortex, or by neuronal depression after a seizure or migraine.
Note: Otherwise all else is chronic, this note attempts to cover at least superficially chronic vs. acute vision loss.
Likely not important for the NAC OSCE Exam:
(If you're a keener click here)
- 1 in 28 U.S adults over age 40 have vision impairment
- Adults > age 70 compromise 8% of U.S population but ~70% of cases of visual impairment.
- Medications: Sulfa drugs, diuretics, cholinergics.
The cornea and the lens account for the refraction of light coming into the eye onto the retina. The cornea accounts for more (~2/3) of the total load, but pathogenesis may involve either structure.
- Vision loss, peripheral or central.
- May have limitations of ADLs
Other Signs and Symptoms
- Need to rule out temporal arteritis: Headache, double vision, jaw pain, fatigue, weight loss, night sweats, fever.
- Need to rule out central retinal artery occlusion (CRAO): Acute onset, loss is limited to one area of the visual field, thrombosis risk (e.g. Afib, CAD, prev. hx of stroke, carotid artery occulsion), almost always uniocular.
- Need to rule out retinal detachment: Acute onset, floaters/sparks, flashes of light, recent trauma, previous hx of retinal disease
- If Diabetic retinopathy, other complications of diabetes: peripheral neuropathy, CKD, ACS/CAD, skin changes.
- HPI: onset and severity of symptoms, Is night time vision impaired? Are there flashes of light? Is there floaters or sparks in the vision?
- ALL/MEDS/HIITS: (What are HIITS? - Click to expand), Rx history
- PMH/FAMHx/OBGYN: especially peripheral vascular disease, diabetes.
- CBC w/ ESR, CRP if suspecting temporal arteritis.
- Hemoglobin A1c, OGTT if suspecting diabetic retinopathy.
- Vascular studies (CTA neck, CT head w/o contrast, Doppler US) if suspecting vascular.
- Macular degeneration
- Temporal Arteritis
- Retinal artery, retinal vein occlusion
- Diabetic Retinopathy
- Retinal detachment
- General: If age-related, likely referral to optometrist for eye exam.
- Steroids if temporal arteritis
- Surgery/medical management if vascular occlusion
- Rx: In some pathologies, medication to lower IOP may help alleviate symptoms.
Opthalmology for acute emergency.