Monocular Painless Vision Loss

posted in Ophthalmology on by

Brief H&P:

A 29 year-old female with no known medical history presents with vision changes for two weeks. She describes blurring and darkening of her vision in the left eye without associated pain after which her vision returns to normal. She notes occasional headaches which she describes as her usual migraines.

Physical examination including a detailed neurological examination, visual acuity, and visual fields is normal with the exception of bilateral optic disc edema. A non-contrast head CT is performed and is similarly normal. The patient underwent uncomplicated lumbar puncture with identification of elevated opening pressure with otherwise unremarkable cerebrospinal fluid analyses.

The patient’s evaluation was consistent with idiopathic intracranial hypertension, she was started on acetazolamide 500mg p.o. b.i.d and was discharged with close neurology follow-up.

An Algorithm for the Evaluation of Painless Monocular Vision Loss

An algorithm for the evaluation of painless monocular vision loss

This algorithm was developed by Dr. Lara Samarneh. Lara is an emergency medicine resident at UTHealth Houston. She attended medical school at UTHealth Houston McGovern Medical School and graduated from The University of Texas at Austin with a Bachelor’s degree in Biomedical Engineering. She is passionate about education and is currently serving as Vice Chief of Education.
Special thanks to Dr. Ore-ofe O. Adesina, MD , Associate Professor, Department of Ophthalmology and Visual Science – McGovern Medical School, Medical Director, Cizik Eye Clinic for his expertise and review of this algorithm.

References

  1. Fundoscopy images in the algorithm are sourced from Ophthalmic Atlas Images by EyeRounds.org, The University of Iowa which are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
  2. Guluma, K, Lee, J. Ophthalmology. In Rosen’s Emergency Medicine: Concepts and Clinical Practice (10th ed., pp. 750-780). Philadelphia, PA: Elsevier.
  3. Sharma P, Sridhar J, Mehta S. Flashes and floaters. Prim Care. 2015;42(3):425-435.
  4. Bagheri N, Mehta S. Acute vision loss. Prim Care. 2015;42(3):347-361.
  5. Pula JH, Kwan K, Yuen CA, Kattah JC. Update on the evaluation of transient vision loss. Clin Ophthalmol. 2016;10:297-303.
  6. Dehghani A, Giti M, Akhlaghi MR, Karami M, Salehi F. Ultrasonography in distinguishing optic neuritis from nonarteritic anterior ischemic optic neuropathy. Adv Biomed Res. 2012;1:3.
  7. Prasad S, Galetta SL. Approach to the patient with acute monocular visual loss. Neurol Clin Pract. 2012;2(1):14-23.
  8. Abbatemarco JR, Patell R, Buccola J, Willis MA. Acute monocular vision loss: Don’t lose sight of the differential. Rutecki GW, ed. CCJM. 2017;84(10):779-787.
  9. Current management of amaurosis fugax. The amaurosis fugax study group. Stroke. 1990;21(2):201-208.