How is sudden visual loss treated?

Updated: Dec 11, 2019
  • Author: Jean Deschênes, MD, FRCSC; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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Treatment is directed at the underlying cause of vision loss.

If GCA is suspected, prednisone 1 mg/kg should be initiated before the temporal artery biopsy is performed in order to prevent involvement of the fellow eye. Similarly, if optic neuritis is suspected, acute steroid management may hasten recovery but has not been found to affect visual acuity outcomes. [30]

Treatment of papilledema is directed at the underlying cause and consists of medical and surgical management.

For cases of suspected CRAO or BRAO, treatment is directed at prevention of future ischemic events. Patients with CRAO and BRAO should be referred for urgent stroke workup and a carotid and cardiac examination. Although acute treatments have been described in the literature, none has proven beneficial in improving visual outcome beyond the expected vision based on the natural history of ischemia. [4] Thrombolytics have been used in an attempt to dissolve clots in suspected arterial occlusions, although there are no guidelines on their use owing to mixed results from conducted studies, as well as the risks associated with administration of thrombolytics. [4]

In patients with CRVO, systemic risk factors such as hypertension, diabetes, and hyperlipidemia should be treated. Patients should be monitored for macular edema and iris neovascularization. The ophthalmic complications can be treated with anti-VEGF injections, steroids, or retinal photocoagulation. [9, 33]

For ophthalmic causes of vision loss, treatment should be aimed at the underlying etiology.

Angle-closure glaucoma should be treated with topical intraocular pressure–lowering agents, and the underlying cause of the angle closure should be addressed.

Retinal detachment is treated in conjunction with retinal specialists. Treatment can include pneumatic retinopexy or surgical treatment with scleral buckle or vitrectomy.

Globe ruptures should be repaired surgically.

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