Drop of Vision

Causes :

1. Errors of Refraction (uncorrected):

2. Organic Lesions in the Eye = Media opacities (cataract, cornea opacity, vitreous hemorrhage,…..)
3. Organic lesions in the Visual System {sensory} = retinal and optic nerve diseases, visual pathway affection
4. Functional Impairment EG. Amblyopia, Hysterical blindness {diagnosis of exclusion for sudden drop of vision}

Workup Approach to a patient with drop of vision

 History :
- Onset
- Pain ?
- Associated symptoms and signs
 Examination :
- Retinoscopy {autorefractometer} = For errors
- PINHOLE = organic lesions worsen by pinhole
- Slit lamp = cataract, corneal opacity, iridocyclitis ….
- Pupil = For optic nerve
- Fundus = For vitreous hemorrhage and retinal pathologies
 Investigations :
- visual field
- electrophysiology
- neuro-imaging

Sudden Drop of Vision Rapid Drop of vision Gradual Drop of vision

1. Vascular: 1. Corneal Ulcer : stitching pain 1. Errors

 CRAO 2. Acute Iridocyclitis: dull aching pain 2. Keratoconus
 Fuch’s Spot 3. Endophthalmitis 3. Chronic Iridocyclitis
 Vitreous Haemorrhage 4. Acute Attack of PACG: bursting pain 4. Senile Cataract
2. Neurological (Amaurosis Fugax) : 5. Acute Optic neuropathy: pain on moving the 5. Primary Open Angle Glaucoma
 Papilledema : for seconds eye in retrobulbar neuritis 6. Diabetic Maculopathy
 Prodroma of CRAO : for minutes 6. CRVO 7. Macular Degenerations {AMD}
 Postural Hypotension 7. Retinal Detachment 8. Optic Atrophy
3. Hysterical 8. Commottio Retinae 9. Retinitis Pigmentosa
10. Amblyopia