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Approach to “Visual Loss”
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Aastha Takkar Kapila, Monika Singla, Vivek Lal
Patients with monocular visual loss should be approached in a systematic way. Temporal profile of the visual loss, associations and vital information on examination may help in reaching a diagnosis. A simplified approach to a patient with persistent monocular visual loss is given in Algorithm 4.2.
Cranial Neuropathies II, III, IV, and VI
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Tanyatuth Padungkiatsagul, Heather E. Moss
The differential diagnosis of monocular vision loss is large, including optic neuropathies and pathology of other ophthalmic structures. Most of the ophthalmic causes are readily appreciated on ophthalmic examination. The exception is maculopathies, damage to the central retina, which shares symptomatic features with optic neuropathies and can be occult, even on dilated fundoscopic examination. Symptom of metamorphopsia (distortion of image) or photopsia (perception of flashing lights) are unusual for optic neuropathies but suggestive of maculopathies. On the contrary, perception of dimness, pain on eye movement, and heat-induced transient visual loss (Uhthoff's phenomenon) are well described in optic neuropathies.
When There Are Symptoms But it All Looks Totally Normal
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Stereopsis: Assessment of stereopsis can be particularly useful when the patient describes monocular vision loss. Stereopsis requires good vision in both eyes with good binocular fusion. Therefore if the patient can demonstrate good stereopsis, they must have good visual acuity. By describing the purpose of the test as being ‘seeing how the two eyes work together’, the true intention behind the test can be masked. During binocular tests it can be difficult to work out which eye is seeing and the patient may also try to close one eye during the test. The degree of stereopsis achieved can give some indication of the true visual acuity (see Table 25.1). Your orthoptist will hopefully assist you with this test.
Prevalence of vision conditions in children in a very remote Australian community
Published in Clinical and Experimental Optometry, 2023
Scott A Read, Shelley Hopkins, Alex A Black, Sharon A Bentley, John Scott, Joanne M Wood
The mean unaided monocular distance visual acuity was 0.01 ± 0.13 for the right eye and 0.02 ± 0.14 logMAR for the left eye (range: −0.16 to 1.34 logMAR). The mean unaided near visual acuity was similar at 0.00 ± 0.17 logMAR for the right eye and −0.01 ± 0.11 logMAR for the left eye (range −0.12 to 1.32). No children exhibited bilateral vision impairment. Four percent (n = 7) of children exhibited monocular distance vision impairment, and 4% (n = 7) exhibited monocular near vision impairment (visual acuity >0.3 logMAR). Monocular distance vision impairment that was not correctable with spectacles was evident in 3% (n = 6) of children. The causes of monocular vision impairment in these cases were either amblyopia (due to high refractive error, n = 3), or associated with past ocular trauma (n = 3).
Impact of visual impairment following stroke (IVIS study): a prospective clinical profile of central and peripheral visual deficits, eye movement abnormalities and visual perceptual deficits
Published in Disability and Rehabilitation, 2022
Fiona J. Rowe, Lauren R. Hepworth, Claire Howard, Kerry L. Hanna, Jim Currie
The profile of visual impairment following stroke has received little attention. Monocular or binocular vision loss can be an isolated presentation of stroke [9]. Reduced central vision has largely been attributed to spectacle need or eye disease but with less consideration to new onset low vision after stroke [3,10]. Homonymous hemianopia is the most common form of visual field loss due to stroke but less is reported on other types of visual field loss [11,12]. Strabismus is an ocular misalignment in which both eyes no longer coordinate as a pair and usually causes the symptoms of blurred/jumbled or double vision (diplopia). The misaligned eye may turn inwards, outwards, up, down or a combination [13]. Ocular motility abnormalities are varied following stroke and include ocular cranial nerve palsies, horizontal and vertical gaze palsies, nystagmus and deficits in saccadic, smooth pursuit and vergence eye movements. Resultant symptoms are often diplopia, oscillopsia, reading difficulty and altered vision [14].
Population-based Rate and Patterns of Diplopia in Giant Cell Arteritis
Published in Neuro-Ophthalmology, 2022
Clara M. Castillejo Becerra, Cynthia S. Crowson, Matthew J. Koster, Kenneth J. Warrington, M. Tariq Bhatti, John J. Chen
Medical records were reviewed to identify patients with binocular diplopia from GCA. Binocular diplopia was considered constant if an episode lasted more than 24 hours or transient if an episode lasted less than 24 hours, with or without recurrence. Neuro-ophthalmology reviewed and confirmed all cases of binocular diplopia. Cases of monocular diplopia were excluded. The type and pattern of diplopia, treatment, response to therapy and final outcomes were documented. Other ocular manifestations such as permanent or transient vision loss and systemic manifestations such as headache, jaw claudication, facial pain, scalp tenderness, fever, weakness, weight loss, polymyalgia rheumatica, and fatigue were recorded. Laboratory findings included haemoglobin, ESR, CRP, alkaline phosphatase, and albumin.