Sudden Loss of Vision in the Uninflamed Eye
422 Ophthalmic Emergencies
MANAGEMENT
1 Refer the patient to the ophthalmology team for definitive treatment, includ-
ing steroid eye drops.Acute glaucoma
DIAGNOSIS
1 Acute angle closure glaucoma causes a unilateral red painful eye, associated
with a narrowed anterior chamber with obstruction to the outf low of
aqueous humour.
2 It is more common in middle-aged or elderly hypermetropes (long-sighted
people), and may be precipitated by pupillary dilation including drug related.
3 There is severe throbbing, boring pain accompanied by headache, nausea,
vomiting and prostration.
(i) Vision is reduced with haloes around lights, and the cornea
becomes hazy with a fixed, semi-dilated oval pupil. On gentle
palpation the eye feels hard.MANAGEMENT
This is an ocular emergency requiring urgent referral to the ophthalmology team.
On their advice commence:
1 Miotic drops such as pilocarpine every 5 min for up to 1 h.
2 Acetazolamide 500 mg slowly i.v. then 250 mg i.v. or orally t.d.s. – but
contraindicated in sulphonamide allergy.
3 An antiemetic such as metoclopramide 10 mg i.v. and analgesia such as
morphine up to 2.5 mg i.v. for severe pain.SUDDEN LOSS OF VISION IN THE UNINFLAMED EYE
Conditions to be considered include:
● Central retinal artery occlusion.
● Central retinal vein occlusion.
● Vitreous haemorrhage.
● Retinal detachment.
● Optic neuritis.Central retinal artery occlusion
DIAGNOSIS
1 This condition is most common in the elderly arteriosclerotic patient, but it
may occur due to emboli or in association with temporal arteritis.