Emergency Medicine

SUDDEN LOSS OF VISION IN THE UNINFLAMED EYE

424 Ophthalmic Emergencies

MANAGEMENT

1 There is no specific treatment, although predisposing conditions must be

looked for particularly diabetes and hypertension.

2 Refer the patient to the ophthalmology clinic to monitor for the development

of secondary acute glaucoma (some weeks later) from neovascularization.

Vitreous haemorrhage

DIAGNOSIS

1 This may be traumatic, or spontaneous associated with proliferative diabetic

retinopathy, posterior vitreous detachment ± a retinal tear particularly in

high myopia (short-sighted person), various blood disorders, and branch or

central retinal vein occlusion.

2 There is a reduced or absent red ref lex and diminution in vision, preceded by

a history of ‘cobwebs’ or ‘f loaters’.

MANAGEMENT

1 Refer the patient to the ophthalmology team to look for the predisposing

conditions, and to exclude a retinal tear or detachment.

2 Vitrectomy may be necessary if the haemorrhage fails to clear.

Retinal detachment

DIAGNOSIS

1 This may be traumatic, or spontaneous in myopes (short-sighted people), or

may follow a vitreous haemorrhage such as associated with proliferative

diabetic retinopathy.

2 There is peripheral visual loss, like a curtain, which may be profound if the

macula is affected. A preceding history of sudden f lashes of light or f loaters

is common.

3 The retina is dark, wrinkled and ballooned, and the choroid may appear as a

red tear, although peripheral detachments may not be seen.

(i) An RAPD (Marcus Gunn pupil) occurs only if the detachment is

large.

4 Request an ultrasound scan, but this must not delay ophthalmology referral.

MANAGEMENT

1 Refer the patient immediately to the ophthalmology team for a time-critical

repair technique.