Gradual loss of vision (opthalmology)
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Transcript of Gradual loss of vision (opthalmology)
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Prepared by:Muhd Ariff b Mahdzub
GRADUAL LOSS OF VISION
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Introduction
• Patients with gradual loss of vision present with chronic, slowly progressive loss of vision which is generally painless.
• Visual loss is usually bilateral, but may occur asymmetrically, and happens over weeks to years.
• Poor vision in one eye may only be noticed when the patient closes the other eye, and thus may be reported to be sudden in onset in some cases.
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General History TakingGradual Loss Vision
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• Patient age(younger/older)• The nature of the problemI. Unilateral OR bilateralII. Painfull or painlessIII. Blurred vision? (whole field, close,
distance or both).IV. Restricted visual field? (often noted
following difficulties in driving/ daily activity
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• Progression: 1. Ask whether there has been a slow and steady decline or whether there have been step-wise drops in visual acuity, or
• Any associated symptoms. (eg: pain, redness, or visual phenomena - eg, haloes or flashes of light).
• Any precipitating factors (Specifically ask about whether vision is better in the day or at night).
• Hx trauma
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Medical history
Ask for systemic conditions/duration/compliance to medI. Endocrine/metabolic (Diabetes mellitus)II. HTNIII. HyperthyriodismIV. hyperlipidimia
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Cont.
• Medication - some drugs may be toxic to the eye or precipitate acute angle-closure glaucoma.
• Family history - it is helpful to know about atopy, diabetes, thyroid disease, certain malignancies and any hereditary syndromes.
• Social history -; eg, a metal worker
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Physical examination
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1. Visual acuity. (Note whether this improves using a pinhole)
2. Red reflex using opthalmoscope. - Media opacity (appears black against the red reflex) suggests a corneal, lens or vitreous problem. - Media clear, it is more likely to be a retinal or optic nerve disorder.Do a functional testing of visual field, pupils (RAPD), optic nerve and macula
3. Use an Amsler grid to look for distortion of straight lines - if present, this indicates serious macular pathology and needs urgent referral.
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Primary care assessment of patients with gradual loss of vision
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CAUSES
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The common causes of gradual loss of vision
Glaucoma Cystoid mascular oedema
Refractive error Diabetic retinopathy
Cataract Retinitis pigmentosa
ARMD (Age-Related Macular degeneration)
Drug
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Treatment
It is treated by prescribing suitable correcting spherical convex lenses.
From: Basic opthalmology 4th edition, page 51