Eye Pain and Visual Change Answers 505459.The answer is b.(Tintinalli, pp 1460-1462.)The differential diagnosis
for acute painless loss of vision includes retinal detachment, central retinal
artery and vein occlusions, vitreous hemorrhage, and transient ischemic
attack. An ophthalmologist should be called immediately when entertaining
these diagnoses because a thorough funduscopic examination and prompt
treatment is essential. On funduscopic examination, the patient has a
macular cherry-red spotwith a pale retinaand less pronounced arteries.
This is diagnostic of central retinal artery occlusion.Occlusion of the cen-
tral retinal blood supply is commonly caused by emboli, thrombi, vasculitis,
or trauma. Treatment aims to dislodge the clot from the main artery to one of
its branches and includes digital massage, vasodilation, and lowering IOP.
Acute angle-closure glaucoma (e)usually causes painful loss of vision.
Central retinal vein occlusion (c)presents similarly to retinal artery occlusion
but is caused by thrombosis of the central retinal vein from stasis, edema, and
hemorrhage. Funduscopic examination shows diffuse retinal hemorrhages
and optic disc edema, also called the “blood and thunder” fundus. Treatment
involves aspirin and prompt ophthalmology referral. Retinal detachment (a)
occurs when vitreous fluid accumulates behind a retinal tear displacing the
retina. On funduscopy, the retina will be hanging in the vitreous. Clinically,
retinal detachment may be heralded by blurry vision or floaters followed by
painless vision loss. Vitreous hemorrhage (d)is bleeding within the posterior
chamber. On funduscopic examination, these patients have blood obstruct-
ing the view of the fundus. There are many causes of vitreous hemorrhage,
including diabetic retinopathy, retinal detachment, trauma, and age-related
macular degeneration.