[SAMPLE] Table 1: Summary of Painless Vision Loss
Table 1: Summary of Painless Vision Loss
Disease | Cause(s) | Presentation | Physical Findings | ED Treatment/Management | Disposition |
---|---|---|---|---|---|
Optic neuritis |
Inflammatory, autoimmune demyelination of the optic nerve. Idiopathic vs. multiple sclerosis |
Subacute unilateral vision loss, alteration of color vision, eye discomfort |
|
IV methylprednisolone MRI to evaluate for multiple sclerosis |
Ophthalmology and neurology consultations in the ED Possible admission for IV steroids and work up |
Giant cell arteritis/ temporal arteritis |
Autoimmune, granulomatous vasculitis of the large vessels |
Sudden monocular vision loss in an older patient with a history of amaurosis fugax, jaw claudication, polymyalgia rheumatica, and headache |
|
Diagnosis based on clinical presentation and elevated ESR Treatment with PO or IV corticosteroids Consider low-dose aspirin |
Immediate ophthalmology evaluation Possible admission for IV steroids and work up If discharged, appropriate specialty follow-up for temporal artery biopsy |
Vitreous hemorrhage |
Vitreous detachment and rupture of retinal vessels, leading to hemorrhage |
Acute onset of vision loss or vision changes (flashing lights, floaters, cobwebs, etc.) |
|
Allow the blood to settle
Discontinuation of antiplatelet and/or anticoagulants if possible |
Ophthalmology evaluation in the ED or within 24 hours |
Retinal detachment |
Detachment of the neuroretina from the pigmented epithelial layer |
Acute onset of vision loss or vision changes (floaters, flashing lights, visual distortions) |
|
No specific ED management outside of diagnosis |
Immediate ophthalmology evaluation |
Central retinal artery occlusion |
Occlusion of the central retinal artery from a thrombus or embolus |
Sudden monocular vision loss in an older patient with cardiovascular risk factors |
|
General treatment involves dislodging the clot, improving retinal perfusion pressure, and vasodilating retinal vessels. This includes:
However, there is no evidence to support any specific treatment, and treatment should be guided by institutional protocols |
Immediate ophthalmology evaluation |