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Sudden Vision Loss

Primary Care CME on Sudden Vision Loss.

A broad view and summary of a scary, sudden and seemingly complex disorder.

Ophthalmology CME

Eligible for FibonacciCME Credit

Members: Log into APP for Online CME Test

Continuing Medical Education


OBJECTIVE:

  • To recognize the possible causes of sudden vision loss

  • To determine the initial diagnostic evaluation of sudden vision loss

  • To determine when to refer sudden vision loss urgently to the appropriate specialist(s) for treatment


An Approach to Acute Vision Loss CME


by Eleni Florakis and George J. Florakis, MD


Acute vision loss can be very distressing to both patients and physicians and extremely important to diagnose in a timely manner. There are many different causes of acute vision loss which can occur anywhere along the visual tract, from the cornea to the occipital lobe [1]. Acute vision loss may be benign and reversible, but it may also represent a more malignant, irreversible process. Prompt diagnosis is necessary to treat and potentially save the patient’s vision and/or life.


As with any new presenting symptom, the first step is to obtain a thorough history and physical. Acute vision loss can be caused by many different etiologies including ocular, vascular, and neurological pathologies. A detailed medical history may help determine whether one of these categories of pathology should be considered.


The Conclusion to An Approach to Acute Vision Loss which covers the following topics:


Hints from the Past Medical History Consider:

  • Primary ocular pathology

  • Vascular etiology (retinal artery or vein occlusion, cardiac emboli, carotid occlusive disease or vertebrobasilar disease)

  • Hyperviscosity syndrome and vascular etiology

  • Optic neuritis

  • Methanol toxicity

  • Neurologic pathology

  • Medication related


Hints from the History of Present Illness

  • Blurry vision

  • Dimming of the vision

  • Reduction in the visual field

  • Showering of black dots

  • Floating, moving scotoma

  • Sudden vision loss that only lasts a few seconds

  • Binocular vision loss

  • Flashes of lights or floating shadows

  • Headache

  • Ocular pain with eye movement

  • Localized ocular pain

  • Painful visual impairment


Hints from the Physical Exam

  • Ptosis

  • Proptosis

  • Injection or chemosis

  • Relative afferent pupillary defect (RAPD)

  • Topical fluorescein application

  • Color vision testing

  • Abnormal red reflex exam

  • Fundus examination

  • retinal hemorrhaging and/or retinal whitening

  • cotton-wool spots

  • optic disc pallor

  • increase in the cup-to-disc ratio

  • macula cherry-red spot

  • deficits of the optic nerve, oculomotor nerve, trochlear nerve, and the ophthalmic branch of the trigeminal and abducens nerves

  • deficits in the maxillary branches of the trigeminal nerve along with central retinal vein occlusion


Two Diseases You Shouldn’t Forget

  • Giant cell arteritis

  • Pituitary apoplexy


Download the full Sudden Vision Loss article PDF or take the CME test. The article includes more about:

  • Medical History

  • History of Present Illness

  • Physical Exam

  • Treatment

 

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ABOUT THE AUTHORS


Eleni Florakis

Eleni Florakis is currently a fourth-year medical student at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, PA. She is interested in pursuing a residency in Internal Medicine and possibly practicing as a Primary Care Physician or Gastroenterologist in the future. She enjoys volleyball, and she continues to play flute for her medical school orchestra.


George J. Florakis, M.D.

George J. Florakis, M.D. is currently a Clinical Professor of Ophthalmology at the Columbia University Medical Center. Dr. Florakis attended medical school at Columbia’s College of Physicians and Surgeons. He completed his residency training at the Edward S. Harkness Eye Institute at the Columbia Presbyterian Medical Center. His fellowship in Corneal and External Eye Diseases was conducted with Dr. Jay Krachmer at the University of Iowa.


References

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