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SUDDEN VISUAL LOSS

Dr. dr. Habibah S. Muhiddin, Sp.M(K)

BAGIAN ILMU KESEHATAN MATA


FAKULTAS KEDOKTERAN
UNIVERSITAS HASANUDDIN
• LOSS OF VISION WITHOUT RED EYE

• NEED EARLY DIAGNOSIS AND PROMT


TREATMENT
• VITREOUS HAEMORRHAGE

• Vitreous hemorrhage usually occurs from the


retinal vessels and may present as pre-retinal
(sub-hyaloid) or an intragel hemorrhage.
• The intragel hemorrhage may involve
anterior, middle, posterior or the whole
vitreous body.
`
CAUSES
• SPONTANE
• RUPTUR OF NEOVACULARIZATION (DR, CRVO,
BRVO, VASCULITIS)
• BLEEDING DISORDERS (HAEMOPHILIA, ITP)
• IDIOPATHIC
VH due to choroidal malignancy
TREATMENT
• Conservative treatment consists of bed rest,
elevation of patient’s head and bilateral eye
patches.
• Treatment of the cause.
• VITRECTOMY
COMPLICATIONS

• like vitreous liquefaction,


• Ghost cell glaucoma
• Retinitis proliferans may occur which may be
• complicated by tractional retinal detachment.
Retinal detachment
• Really need early treatment to reattach retina

To prevent : ischemia loss of retina cell


loss of function

develope of vitreoretinal
proliferation (fibrosis proliferation)
Retinal arterie /vein occlusion
• Central retina arterie occlusion
• Branch retina arterie occluision

• Early treatment :
improve visual impairment
limitation of further comlications
diagnosis and treatment of background
diseases
BRAO
CRAO
CRVO
BRVO
• Complications :
permanent loss of vision
retina neovascularization vitreous
hemorrhage

rubeiosis iridis neovascular


glaucoma
Hipertensive retinopathy
• Acute hypertension
such as : preeclampsia
acute renal failure

important for indication to make decision for


backgroun diseases
• Malignant hypertession
warning for more severe complications of
hypertension , considertaion for management
Optic neuritis
• Anterior optic neuritis
• Posterior optic neuritis (retrobulbar optic
neuritis)
Papillitis (AON)
• RETROBULBAR OPTIC NEURITIS

• REDUCE OF VISION WITHOUT CHANGES


WITHIN THE EYES

• PATIENT SEES NOTHING AND DOCTOR SEES


NOTHING
• VA reduced
• Field of vision impaired
• Color vision impaired
• RAPD relative afferent pupillaty defect

NEED FURTHER INVESTIGATION


• DIFFERENTIAL DIAGNOSIS
papilloedema (increase intracranial pressure
: brain tumor ext)
pseudo-papilloedema (hypermetropia)
• malingering, hysterical blindness,
• cortical blindness and indirect optic
neuropathy.
• PAPILLITIS WITHOUT BRAIN DISORDERS :

STEROID TREATMENT IS INDICATED AS SOON


AS POSSIBLE