SUDDEN VISUAL LOSS

• Central retinal artery occlusion (CRAO) - urgent treatment required
• Central retinal vein occlusion
• Optic neuritis - treatment with opthalmology/neurology consultaton
• Vitreous haemorrhage
• Amaurosis fugax
• Ophthalmic migraine

CRAO

Causes

• Hypertension
• Carotid artery stenosis
• Cardio-emboli - AF, valvular disease, post MI
• Temporal arteritis
• Connective tissue disease
• IV drug abuse

Signs

• Afferent pupillary defect
• Pale retina with cherry-red spot at fovea
• Retinal arteries thin and dark

Treatment (best commenced within 20 min to prevent permanent loss)

• Lie supine and massage orbit - intermittent firm compression/release (to fragment emboli)
• Medically decompress globe - 500mg acetazolamide
• Surgically decompress globe - anterior chamber paracentesis