Visual loss

The central fossa of the retina is the only part of the eye with a vision equal to 6/6. With its defeat, in most cases, lightning loss of vision occurs.

• In such cases, the patient is always waiting for the answer to the question: "I'm blind?".
• Each such patient requires the attention of a specialist, unless, of course, the cause of vision loss is not migraine.
• Always in such cases, determine ESR, because in this way it is possible to identify the temporal arteritis, and this can save the eyesight with the other eye.

Intermittent blindness (amaurosis fugax) is a temporary loss of vision. The patient in such cases says that the curtain fell before his eyes. With temporal arteritis, this sometimes precedes an irreversible loss of vision. The cause may be embolism of the corresponding artery, so that a correct diagnosis can save eyesight.

The main causes of vision loss:

Ischemic optic neuropathy. If blood flow in the ciliary arteries is disturbed (occlusion due to inflammatory infiltration or arteriosclerosis), then the visual eye is damaged. In fundoscopy, a pale and swollen optic disc is detected.

Temporal arteritis (giantant arteritis). This disease is important to recognize because there is a high risk of vision loss and another eye if the treatment is not started in a timely manner. The condition may be accompanied by general weakness, sudden transient pain during chewing (mandibular intermittent claudication), and sensitivity during scalp palpation in the temporal arteries (when checking their pulsation). Often this disease is combined with rheumatic polymyalgia. ESR can exceed 40 mm / h, which allows you to suspect this disease, with a biopsy of the temporal artery, you can get a false-negative result if a biopsy site gets a site of the unaffected artery. In such cases, prednisolone should be given rapidly at 80 mg / day orally. The gradual decrease in the dose of steroids as the clinical picture stabilizes and the ESR decreases, can last more than a year.

Arteriosclerotic ischemic optic neuropathy. To this disease may predispose hypertension, lipid metabolism and diabetes mellitus, and this can be observed in relatively young people. Appropriate treatment will help to keep sight with another eye.

Occlusion of the central artery of the retina. In this case, the eye does not perceive light and an afferent pupil defect is noted. The retina is very pale (almost white), but in the area of the macula, a cherry-red dot can be seen. The disc of the optic nerve is swollen. Occlusion of the artery usually occurs due to a thrombus or embolus (in such cases it is necessary to auscultate the carotid arteries in order to detect noise). I can try with this to forcefully press on the eyeball to displace what has occluded the artery, but if the occlusion lasts more than an hour, then there is an atrophy of the optic nerve with subsequent blindness. If one branch of the artery of the retina is occluded, then accordingly retinal and visual changes will concern only that part of the retina where the blood supply has been disturbed.

Hemorrhage in the vitreous. This is particularly often the cause of loss of vision in diabetic patients, in whom new vessels are formed. Such a hemorrhage can occur with hemorrhagic diathesis, with retinal detachment. If the hemorrhage is large enough and a loss of vision occurs, the red reflex disappears, and the retina can not be seen. Hemorrhages in the vitreous are subject to spontaneous resorption, so treatment for the actual hemorrhage is expectant, but in general it should be directed to the causes that caused it (for example, photocoagulation of newly formed vessels). Small extravasates of blood lead to the formation in the vitreous body of floating bodies, which can not violate the essential vision.

Occlusion of the central vein of the retina. The frequency of this disease increases with age. It occurs more often than the occlusion of the central artery of the retina. Predisposing factors include chronic simple glaucoma, arteriosclerosis, hypertension and polycythemia. If the entire central vein of the retina is thrombosed, then a sudden loss of vision occurs and its severity drops to the "finger count". The eye bottom has the form of "sunset before the storm," it is hyperemic, the veins are sharply curved, with hemorrhages on their way. The long-term prognosis is variable, it is possible to improve in the period from 6 months to 1 year, mainly peripheral vision improves, and macular vision remains impaired. The formation of new vessels with a high risk of hemorrhage into the eye may start (in 10-15% of cases). If only the branches of the central vein are affected, changes in the fundus can be traced only in the corresponding quadrant. Certain treatment does not exist.

Loss of vision in one eye can occur due to retinal detachment, acute glaucoma (painful), and migraine. Patients with stroke sometimes complain of blindness in one eye, but the study of visual fields in such cases usually reveals homonymous hemianopsia. Sudden blindness to both eyes is extremely rare, for example, with cytomegalovirus infection in AIDS patients.

Subacute vision loss

Optic neuritis is an inflammation of the optic nerve. Unilateral reduction in visual acuity occurs on the clock or days. At the same time, the perception of color is violated: red seems less red; eyeball movements can be painful. The pupil shows an afferent defect. The disc of the optic nerve can be swollen (papillitis), if, finally, the inflammation is not localized more centrally (then they say about retrobulbar neuritis). There is almost no treatment, but young people usually recover, although some such patients later develop multiple sclerosis.

Gradual loss of vision

Possible causes of gradual loss of vision in one eye may be a choroiditis, a "sprawling" lower retinal detachment or a choroidal melanoma. If the loss of vision occurs in both eyes (usually it is asymmetric), its causes are often cataracts, chronic glaucoma, diabetic and hypertensive retinopathy, senile macular degeneration or atrophy of the optic nerve.

Choroiditis (chorioretinitis). Actually, the choroid of the eyeball (choroidea) is part of the vascular membrane of the eyeball (uvea). (In addition to the vascular envelope itself, the vascular shell of the eyeball includes the iris and the ciliary body.) Therefore, in the inflammatory processes affecting uvea, choroidea is also affected. The retina can be invaded by microorganisms, in response to which granulomatous reactions usually begin (which need to be differentiated from retinoblastoma). Currently, toxoplasmosis and toxocarosis are more common than tuberculosis. The cause of this reaction may be sarcoidosis. Examination of the patient - chest X-ray, Mantoux reaction, serological studies, Kveim reaction. In the acute phase, vision can be clouded, fuzzy; on the retina there are visible raised whitish-gray spots, there may be a clouding of the vitreous, cells are found in the anterior chamber of the eye. Later, a chorioretinal scar appears (a white spot with pigmentation around). It is not accompanied by any symptoms, unless, of course, the area of the macula is involved in the process. Treatment is etiologic.

Malignant melanoma proper of the choroid of the eyeball (choroidea). This is the most common malignant tumor of the eye. In the beginning, gray-black spots appear on the fundus, as retinal detachment occurs as they grow. The tumor is spreading hematogenically or by local invasion of the orbit. Treatment consists in enucleation of the affected eyeball, but in some cases, local treatment is also possible.

Senile macular degeneration. This is the most common cause of reported blindness in the UK. Senile degeneration begins in the elderly, who complain of a deterioration in central vision. At the same time, loss of visual acuity is observed, however, the fields of vision are not violated. The disc of the optic nerve is normal, but with the presence of pigment, minor exudate and hemorrhage in the area of the yellow spot. In some cases, the area of the yellow spot is edematic and as it were raised by a large amount of exudate - this is called disc-shaped degeneration. In most cases, there is no effective treatment. But sometimes laser therapy is used. The use of ancillary measures can bring symptomatic relief.

Tobacco amblyopia. This is an atrophy of the optic nerve due to smoking, or rather, cyanide poisoning. At the same time, a gradual loss of central vision occurs. An early and constant sign in this case is the loss of the ability to distinguish red and green colors.

Atrophy of the optic nerve. In this case, the optic nerve disc looks pale, but the degree of pallor does not always correspond to loss of vision. Atrophy of the optic nerve can be secondary in relation to increased intraocular pressure (with glaucoma), to damage to the retina (choroiditis, retinitis pigmentosa, cerebromacular degeneration), but it can also be associated with ischemia (retinal artery occlusion). In addition to tobacco, atrophy of the optic nerve can cause toxic substances such as methanol, lead, arsenic, quinine and carbon disulfide. Other causes: Leber's optic nerve atrophy, multiple sclerosis, syphilis, external pressure on the nerve (intraorbital or intracranial tumors, Paget's disease with localization in the skull).