Unexplained Vision Loss

2019 ◽  
pp. 89-92
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak
Keyword(s):  
Clinical Features ◽  
Refractive Error ◽  
Visual Function ◽  
Vision Loss ◽  
Diagnostic Evaluation ◽  
Cone Dystrophy ◽  
Autoimmune Retinopathy ◽  
Clinical Strategies ◽  
Cancer Associated Retinopathy ◽  
Visual Complaints

When visual complaints are out of proportion to examination findings, nonorganic vision loss or a disorder of higher visual function may be suspected. However, certain ophthalmic causes of vision loss should also be considered. In this chapter, we begin by reviewing potential causes of unexplained vision loss, including refractive error, corneal disorders (e.g., keratoconus), optic neuropathy, and occult retinopathy. We next discuss clinical strategies and investigations that can help to identify certain causes of unexplained vision loss. Lastly, we discuss the clinical features, causes, and diagnostic evaluation of occult retinopathy, with a focus on conditions that cause cone photoreceptor dysfunction, such as cone dystrophy, cancer-associated retinopathy, and autoimmune retinopathy.

Disorders of Higher Visual Function

2019 ◽  
pp. 71-76
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak
Keyword(s):  
Alzheimer Disease ◽  
Clinical Features ◽  
Visual Function ◽  
Diagnostic Evaluation ◽  
Imaging Findings ◽  
Optic Ataxia ◽  
Common Causes ◽  
Motor Apraxia ◽  
Occipital Lobes ◽  
Visual Complaints

A disorder of higher visual function should be considered when visual complaints are out of proportion to examination findings. Such disorders can remain undiagnosed until other cognitive deficits develop. In this chapter, we begin by reviewing the various disorders of higher visual function, which include visual agnosias, simultanagnosia, ocular motor apraxia, and optic ataxia. We next discuss practical strategies to detect these disorders. We then discuss common causes of these disorders and their diagnostic evaluation. We focus our discussion on the clinical features and imaging findings in the visual variant of Alzheimer disease, where the parieto-occipital lobes are preferentially affected in the early stages of the disease.

Progressive, Symmetrical, Painless Visual Loss

2021 ◽  
pp. 77-79
Author(s):  
Eric R. Eggenberger ◽  
Marie D. Acierno ◽  
M. Tariq Bhatti ◽  
John J. Chen
Keyword(s):  
Optical Coherence Tomography ◽  
Vision Loss ◽  
Fundus Autofluorescence ◽  
Retinal Pigment ◽  
Light Sensitivity ◽  
Normal Serum ◽  
Breast Adenocarcinoma ◽  
Optical Coherence ◽  
Autoimmune Retinopathy ◽  
Cancer Associated Retinopathy

A 75-year-old woman with a medical history of mixed connective tissue disease and breast adenocarcinoma sought care for subacute visual “haze” in both eyes characterized by light sensitivity, particularly with commercial fluorescent lighting, progressing over weeks. Visual acuity was 20/40 in each eye. The pupils were equal in size with no relative afferent pupillary defect but were sluggishly reactive to light. Automated perimetry documented peripheral constriction in both eyes. Ocular motility was normal. Ophthalmoscopy showed mild retinal pigment epithelial changes in both maculae with normal optic nerves. Optical coherence tomography showed macular thinning in both eyes. Findings of fundus autofluorescence were normal. Serum testing documented the presence of 3 retinal antibodies, against 30-, 36-, and 46-kDa proteins. A paraneoplastic panel was negative except for low-level ganglionic (alpha 3) acetylcholine receptor autoantibody positivity, which was interpreted as nonspecific autoimmunity. Electroretinography indicated severely decreased scotopic and photopic a and b waves. A diagnosis of paraneoplastic or nonparaneoplastic autoimmune retinopathy was made, consistent with the clinical presentation, optical coherence tomography and electroretinography findings, and the presence of retinal antibodies. There are no established evidence-based guidelines to assist treatment decisions in autoimmune retinopathy, although several lines of therapy have been advocated. No specific immunosuppressive therapy was undertaken in this case. However, if her vision had continued to rapidly worsen over time, empiric immunotherapy would have been instituted. Autoimmune retinopathy includes paraneoplastic and nonparaneoplastic forms. The best-characterized autoimmune retinopathy phenotype is cancer-associated retinopathy. Cancer-associated retinopathy typically presents with subacute, painless, bilateral (although asymmetry has been described) vision loss that is progressive over weeks to months, reflecting both rod and cone dysfunction in most patients. Visual symptoms precede recognition of an underlying cancer in approximately 50% of cases.

Nonorganic Vision Loss

2019 ◽  
pp. 93-96
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Visual System ◽  
Clinical Features ◽  
Visual Function ◽  
Vision Loss ◽  
Good Prognosis ◽  
Management Approach ◽  
Permanent Damage ◽  
Visual Field Constriction

Nonorganic vision loss is common but can be challenging to diagnose and treat. In this chapter, we begin by reviewing the clinical features that suggest nonorganic vision loss. We next describe the maneuvers that can be used to demonstrate intact visual function in the patient who reports decreased visual acuity in one or both eyes. We then describe strategies to evaluate the patient who has visual field constriction. We describe the features that help to distinguish organic visual field constriction from nonorganic visual field constriction. Lastly, we discuss the management approach, which includes reassuring the patient that there is no evidence of permanent damage to the visual system and a good prognosis for spontaneous recovery.

Pituitary Apoplexy and Its Effect on Vision

Neurosurgery ◽  
1991 ◽  
Vol 29 (5) ◽  
pp. 669-675 ◽  
Author(s):  
Robert M. McFadzean ◽  
David Doyle ◽  
Roy Rampling ◽  
Evelyn Teasdale ◽  
Graham Teasdale
Keyword(s):  
Pituitary Adenoma ◽  
Clinical Diagnosis ◽  
Clinical Features ◽  
Visual Function ◽  
Pituitary Apoplexy ◽  
Diagnostic Errors ◽  
Large Series ◽  
Ocular Motility ◽  
Pathological Findings ◽  
Results Of Treatment

Abstract A series of 15 patients with a clinical diagnosis of pituitary apoplexy is reviewed. Clinical features are highlighted, with stress on the defects of visual function and ocular motility, and the associated endocrine abnormalities are described. Potential diagnostic errors and their significance are considered. The incidence of this complication in a large series of pituitary adenoma patients is measured, and the radiological and pathological findings are recorded. The results of treatment by surgery and/or radiotherapy and/or bromocriptine are assessed, particularly in relation to visual consequences, and compared with previous reports in the literature, which are reviewed.

Clinical Features of Japanese Patients With Anti-α-enolase Antibody–Positive Autoimmune Retinopathy: Novel Subtype of Multiple Drusen

2018 ◽  
Vol 196 ◽  
pp. 181-196 ◽  
Author(s):  
Ryo Ando ◽  
Wataru Saito ◽  
Atsuhiro Kanda ◽  
Satoru Kase ◽  
Kaoru Fujinami ◽  
...  
Keyword(s):  
Clinical Features ◽  
Japanese Patients ◽  
Autoimmune Retinopathy

scholarly journals Prevalence and causes of vision loss in North Africa and Middle East in 2015: magnitude, temporal trends and projections

2018 ◽  
Vol 103 (7) ◽  
pp. 863-870 ◽  
Author(s):  
Rim Kahloun ◽  
Moncef Khairallah ◽  
Serge Resnikoff ◽  
Maria Vittoria Cicinelli ◽  
Seth R Flaxman ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Middle East ◽  
North Africa ◽  
Refractive Error ◽  
Vision Loss ◽  
Corneal Opacity ◽  
Vision Impairment ◽  
Age Related Macular Degeneration ◽  
Age Related ◽  
Uncorrected Refractive Error

BackgroundTo assess the prevalence and causes of vision impairment in North Africa and the Middle East (NAME) from 1990 to 2015 and to forecast projections for 2020.MethodsBased on a systematic review of medical literature, the prevalence of blindness (presenting visual acuity (PVA) <3/60 in the better eye), moderate and severe vision impairment (MSVI; PVA <6/18 but ≥3/60) and mild vision impairment (PVA <6/12 but ≥6/18) was estimated for 2015 and 2020.ResultsThe age-standardised prevalence of blindness and MSVI for all ages and genders decreased from 1990 to 2015, from 1.72 (0.53–3.13) to 0.95% (0.32%–1.71%), and from 6.66 (3.09–10.69) to 4.62% (2.21%–7.33%), respectively, with slightly higher figures for women than men. Cataract was the most common cause of blindness in 1990 and 2015, followed by uncorrected refractive error. Uncorrected refractive error was the leading cause of MSVI in the NAME region in 1990 and 2015, followed by cataract. A reduction in the proportions of blindness and MSVI due to cataract, corneal opacity and trachoma is predicted by 2020. Conversely, an increase in the proportion of blindness attributable to uncorrected refractive error, glaucoma, age-related macular degeneration and diabetic retinopathy is expected.ConclusionsIn 2015 cataract and uncorrected refractive error were the major causes of vision loss in the NAME region. Proportions of vision impairment from cataract, corneal opacity and trachoma are expected to decrease by 2020, and those from uncorrected refractive error, glaucoma, diabetic retinopathy and age-related macular degeneration are predicted to increase by 2020.

Horner Syndrome

2019 ◽  
pp. 193-198
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Clinical Features ◽  
Internal Carotid ◽  
Carotid Artery Dissection ◽  
Diagnostic Evaluation ◽  
Artery Dissection ◽  
Internal Carotid Artery Dissection ◽  
Horner Syndrome

Horner syndrome can be caused by a lesion anywhere along the oculosympathetic pathway. Although there may be other signs that help with localization of the lesion, the syndrome often occurs in isolation. In this chapter, we begin by reviewing the anatomy of the oculosympathetic pathway. We next describe the clinical features of Horner syndrome, which include ipsilateral miosis and eyelid ptosis. We then discuss the role and potential pitfalls of pharmacologic pupil testing in the diagnostic evaluation of Horner syndrome. We review the potential causes for Horner syndrome, with a focus on causes for acute isolated painful Horner syndrome, such as internal carotid artery dissection. Lastly, we discuss the workup, management, and potential complications of internal carotid artery dissection.

Common age-related eye diseases and visual impairment

2017 ◽  
pp. 1165-1170
Author(s):  
Jacqueline Chua ◽  
Ching-Yu Cheng ◽  
Tien Yin Wong
Keyword(s):  
Diabetic Retinopathy ◽  
Visual Impairment ◽  
Macular Degeneration ◽  
Refractive Error ◽  
Vision Loss ◽  
Age Related Macular Degeneration ◽  
Age Related ◽  
Eye Disorders ◽  
Appropriate Treatment ◽  
Uncorrected Refractive Error

General physicians have an essential role in preventing vision loss in older people. However, most vision-threatening eye disorders are initially asymptomatic and often go underdiagnosed. Therefore screening, early detection, and timely intervention are important in their management. The most common cause of visual impairment is uncorrected or undercorrected refractive error, followed by cataract, age-related macular degeneration, glaucoma, and diabetic retinopathy. Spectacles and cataract surgery can successfully restore sight for uncorrected refractive error and cataract, respectively. Visual impairment as a result of age-related macular degeneration, glaucoma, and diabetic retinopathy can be prevented with appropriate treatment if they are identified early enough. This chapter provides an overview of common age-related eye disease and visual impairment.

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