Makindo Medical Notes

Obtain a Detailed History and Examination

• Onset: Sudden or gradual? Exact timing is important in differentiating causes (e.g., central retinal artery occlusion is abrupt). Duration: Hours, days, or weeks.
• Associated Symptoms:
  • Pain: Painful conditions (e.g., acute angle-closure glaucoma, optic neuritis) vs. painless (e.g. retinal detachment, central retinal artery occlusion).
  • Photophobia, Redness: May indicate inflammation (e.g., uveitis, keratitis).
  • Systemic Symptoms: Headaches, jaw claudication (consider giant cell arteritis), fever, or neurological symptoms.
  • Trauma: Any recent eye injury.
• Visual Acuity: Measure using a Snellen chart or handheld chart. Document vision in both eyes.
• Pupil Examination: Look for a relative afferent pupillary defect (RAPD) which suggests optic nerve or severe retinal disease.
• Fundoscopy: Inspect for:
  • Pale retina and "cherry-red spot" (central retinal artery occlusion).
  • Reddish reflex obscured (vitreous haemorrhage).
  • Retinal tears or detachments.
• Intraocular Pressure (IOP) Measurement: Elevated IOP in acute angle-closure glaucoma.

Causes of Acute Loss of Vision over minutes

Investigations

• Fundoscopy or Slit-lamp Examination: Direct visualization of the retina.
• OCT (Optical Coherence Tomography): Used for retinal and macular diseases.
• B-scan Ultrasound: Helpful when the view is obscured (e.g., vitreous haemorrhage).
• MRI or CT: For suspected optic neuritis or brain pathology.

Management

• Emergent Referral: Immediate ophthalmologic evaluation for conditions like retinal detachment, central retinal artery occlusion, or acute angle-closure glaucoma.
• Retinal Detachment: Surgery (e.g., laser photocoagulation, scleral buckle).
• Acute Angle-Closure Glaucoma: Lower IOP with medications (e.g., acetazolamide), possible laser or surgery.
• Optic Neuritis: High-dose corticosteroids.