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practice updates

Acute Visual Loss in the Emergency Department: Pearls and Pitfalls

Acute vision loss has a wide differential, and some of these conditions can cause permanent visual deficit. Many of these are time-sensitive, and the emergency physician may improve patient outcome through the consideration of several acute conditions. This post seeks to provide an overview of the evaluation of vision loss in the ED and a summary of several common conditions.

EM Cases

Central Retinal Artery Occlusion

An 82 year-old man with a history of dyslipidemia, hypertension, and CAD s/p stenting was driving home from the grocery store when he experienced sudden vision loss in his right eye around 2:30 pm. He has no previous history of vision problems and is puzzled but eventually concerned. By the time he presents to the ED he has light perception only in his right eye. He cannot not recognize motion. Central retinal artery occlusion (CRAO) is first in the differential.

clinical cases

Endophthalmitis Highlights

Endophthalmitis is a rare, but clinically significant infection. It is often misdiagnosed due to the multitude of other ocular diseases that share similar presenting symptoms. It results from an infectious or non-infectious inflammatory process of the vitreous and aqueous humors. Missed or late diagnoses can have severe consequences, including permanent vision loss. The natural history of the disease thus necessitates a high degree of clinical suspicion in all patients, especially those at increased risk.