Acute visual disturbance

Arterial occlusion

2 main arterial system that may occlude at posterior segment of the eye:
-central /branch retinal artery- occlusion lead to retinal infarction.
-posterior ciliary artery- occluson cause optic nerve head infarction (arteritic or non arteritic anterior ischaemic optic neuropathy)

Giant cell arteritis is an emergency and it can rapidly affect the second eye. Treatment is high dose intravenous steroid.


Venous occlusion

Causes:
Extraluminal- compression from mass /arterioes (which harden due to arterosclerosis)
Luminal- hyperviscocity syndrome- multiple myeloma, DM

Common cause of CRVO is chronic glaucoma , if pt presented with CRVO have to look for glaucomatous changes of he other eye.

Optic /retrobulbar neuritis - usu in women age 20 to 40, presented with unilateral disturbance of vision , usu with eye pain anggravated by movement.
Despite that visual acuity maybe normal, pt may have RAPD with desaturation of contrast sensitivity (check with red object and compare with the other eye). Patient may also have central scotoma.
If assoc with weakness, pin and needle sensation or other neurological symp, may be assoc with multiple sclerosis, MRI indicated and referral to neurologist may be needed.
Systemic steroid does not alter visual prognosis but may hasten recovery and reduce the incidence of multiple sclerosis.


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