Good Hope, Heartlands, and Solihull Eye Clinics

Unexplained visual loss

David Kinshuck, from lectures at Congress 2014

Some notes

  • Photopsia...is common, usually originates in retina.
  • Photophobia....retina.
  • Colour vision problems, optic nerve.
  • test the APD with a neutral density filter, move from one eye to another, a slight defect should increase and be more obvious when the filter is moved from one eye to the other
  • cataract does not cause APD
  • no APD..no optic neuropathy
  • photostress test...test sight, shine light in eye for 10 seconds, sight should return to normal in 10 seconds; takes much longer with macular disease
  • Visual fields...look at pattern deviation not grey scale, eg pituitary tumour
  • Understand symptoms, careful ophthalmoscopy, unilateral APD

Case 1

  • 55y patient, Crohns disease, saw white as green, erg reduced....vitamin A deficiency.

Case 2

  • normal fundus..enhanced S cone deficiency

Case 3

  • dengue fever, reduced vision...PERG reduced

Case 4

  • 7y, special school, PERG reduced

Case 5

  • night flashes, let sight reduced 6/12, slight colour vision defect, for 2 months,
    • erg reduced....autoimmune retinopathy

Case 6

  • blurred vision, spots, floaters, slowly progressive, difficult adjusting to light..suggests retinal problems. Differential includes
    • retinopathy: cancer related or autoimmune
    • toxic
    • inherited
    • vitamin a
    • AZOOR