NORMAL EYES WITH SUDDEN PAINLESS

LOSS OF VISION

Izzatul Yazidah
I11112024
TOPIC
Vitreous haemmorhage
Retinal Dettachment
Rhegmatogenous
Tractional
Exudative
Retinal venous/arterial occlusion
Neuritis Optik
VITREOUS HAEMORRHAGE
VITREOUS BODY
• The gelatinous vitreous body
consists of 98% water , 2%
collagen and hyaluronic acid.
• It is attached to adjacent
structures at the following
locations
VITREOUS HEMORRHAGE
Symptoms
• Sudden appearance of black
spots, cobwebs, or haze in the
vision.
• Sudden Painless loss of vision
Signs
• Red blood cells may be seen in
the anterior vitreous
• In severe VH the red fundus
reflex may be absent
ETIOLOGY
1. Bleeding from normal retinal
vessels
2. Bleeding from retinal vessels
with abnormal changes
3. Influx of blood from the
retina or other sources
Mild vitreous haemorrhage seen
against the red reflex

Severe diffuse vitreous

haemorrhage
TREATMENT
• Bed rest with the head of the bed elevated 2 to 3
days.
• Eliminate aspirin, NSAIDs, and other
anticlotting agents unless they are medically
necessary.
• The underlying etiology is treated as soon as
possible
• Surgical removal of the blood (vitrectomy)
RETINAL DETACHMENT
DEFINITION
• RD refers to separation of the neurosensory
retina (NSR) from the retinal pigment
epithelium (RPE).
CLASSIFICATION
 Rhegmatogenous » retinal detachment results from a tear
 Round breaks: A portion of the retina has been completely
torn out due to a posterior vitreous detachment.
 Horse shoe tears: The retina is only slightly torn.
 Tractional » retinal detachment results from traction
 Exudative » retinal detachment is caused by fluid
SYMPTOMS
Rhegmatogenous Tractional Exudative

Flashes of light, Visual loss or visual Minimal to severe

floaters, a curtain, or field defect; may be visual loss or a visual
asymptomatic. field defect; visual
shadow moving over
changes may vary with
the field of vision,
changes in head
peripheral or
position.
central visual loss, or
both
 Rhegmatogenous Tractional
The image shows a typical reddish Tensile forces exerted on the retina
horseshoe tear in the retina by preretinal fibrovascular strands

Exudative
Subretinal fluid accumulates
between the neurosensory
retina and the retinal pigment
epithelium.
TREATMENT
Argon laser photocoagulation
Circular white laser burns are visible
around the break.

Retinal tamponade with an

elastic silicone sponge
The ocular muscles are
retracted , The globe is
indented
at the site of the tamponade,
The retina is again in contact
with the underlying
tissue.
TREATMENT
Pars Plana Vitrectomy
The three instruments
(infusion cannula, light
source, and vitrectome).
Cutting and aspiration of
the vitreous body is
performed with the aid of
simultaneous infusion to
prevent the globe from
collapsing
RETINAL VENOUS OCCLUSION
Retinal Venous Occlusion
Definition Classification

Vein occlusion occurs as a • Central Retinal Vein Occlusion

result of circulatory (CRVO)
• Branch Retinal Vein Occlusion
dysfunction in the central
(BRVO)
vein or one of its branches.
ETIOLOGY
CRVO BRVO
• Atherosclerosis of the adjacent • Disease of the adjacent arterial
central retinal artery wall (usually the result of
• Optic disc edema Hypertensive Retinopathy,
• Hipertensive Retinopathy arteriosclerosis, or diabetes)
• Glaucoma compresses the venous wall
• Vasculitis : syphilis, SLE
• Drug : Oral contraceptives,
diuretics, and others
• Abnormal platelet function
Retinal Venous Occlusion
Symptoms Sign
CRVO BRVO
• Painless loss of
vision
• usually unilateral

Diffuse retinal hemorrhages Superficial hemorrhages in a

in all four quadrants of the sector of the retina along a
retina; dilated, tortuous retinal vein. The hemorrhages
retinal veins. usually do not cross the
horizontal raphe (midline).
TREATMENT
• In the acute stage of vein occlusion,
hematocrit should be reduced to 35–38% by
hemodilution.
• Laser treatment
• Focal laser treatment is performed in branch
retinal vein occlusion with macular
edema when visual acuity is reduced to 20/40
or less within three months of occlusion.
RETINAL ARTERIAL OCCLUSION
RETINAL ARTERIAL OCCLUSION
Definition Etiology
• Retinal infarction due to • Emboli are frequently the
occlusion of an artery In cause of retinal artery and
the lamina cribrosa or a branch retinal artery
branch retinal artery occlusions. Less frequent
occlusion. causes include inflammatory
processes
SYMPTOMS
• central retinal artery occlusion, the patient
generally complains of sudden, painless
unilateral blindness.
• branch retinal artery occlusion, the patient
will notice a loss of visual acuity or visual field
defects
Central retinal artery
occlusion
The paper-thin vessels and
extensive retinal edema in which
the retina loses
its transparency are typical signs.
Only the fovea is spared, which
appears as a cherry red spot.

Branch retinal artery

occlusion
Multiple emboli are visible in the
affected arterial branches
TREATMENT
• Ocular massage, medications that reduce
intraocular pressure, or paracentesis are applied
in an attempt to drain the embolus in a
peripheral retinal vessel.
• Calcium antagonists or hemodilution are applied
in an attempt to improve vascular supply.
OPTIC NEURITIS
DEFINITION
Optic neuritis is an inflammation of the optic
nerve that may occur within the globe (papillitis)
or posterior to it (retrobulbar optic neuritis).
ETIOLOGY
• Demyelinating. This is by far the most common
cause.
• Parainfectious, following a viral infection or
immunization.
• Infectious. This may be sinus-related, or
associated with conditions such as cat-scratch
disease, syphilis, Lyme disease, cryptococcal
meningitis and herpes zoster.
• Non-infectious causes include sarcoidosis and
systemic autoimmune diseases such as systemic
lupus erythematosus, polyarteritis nodosa and other
vasculitides.
SYMPTOMS
• Sudden loss of vision, which may occasionally be
accompanied by fever (Uhthoff symptom).
• Blind spot, and wedge-shaped visual field
defects up to and including complete blindness.
• Pain that increases in extreme positions of gaze
and reduced perception of color intensity.
Papilitis
characterized by hyperaemia and
oedema of the optic disc, which may be
associated with peripapillary flame-
shaped haemorrhages

Retrobulbar Neuritis
which the optic disc appears normal,
at least initially, because the optic
nerve head is not involved. It is the
most common type in adults and is
frequently associated with multiple
sclerosis (MS).
TREATMENT
• Methylprednisolone 1 g/day i.v. for 3 days,
• Prednisone 1 mg/kg/day p.o. for 11 days
• Taper prednisone over 4 days (20 mg on day 1,
10 mg on days 2 and 4).
• Antiulcer medication (ranitidine 150 mg)
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