“Other” Eye Conditions My Opinion Retina

"Top Ten" Retinal Eye Emergencies: Part II

5.  Surgical Complications from cataract surgery can be a relative emergency.  On occasion, a portion of the cataract may dislodge during cataract surgery and slip into the vitreous.  Patients usually do not see well and may have trouble with high intraocular pressure.

  • Cause – variations in anatomy, surgical complications
  • Concerns – the biggest medical concern is the high eye pressure, it may cause permanent damage and be very painful.
  • Comments – this is one of the biggest “nightmares” of a cataract surgeon, yet it really is not a big deal to rectify as long as referral to a retina specialist is done early.

4.  Posterior Vitreous Detachment – while usually benign, a PVD can cause a retinal tear and possibly a retinal detachment.  With time, the vitreous (the gel inside the eye) separates from the surface of the retina.  This is a normal event as we get older, but it puts us at the highest risk of developing a retinal tear.

  • Cause – the separating/degenerating vitreous changes forces inside the eye causing flashes and floaters.
  • Concerns – there is no way to tell, without examination, if a tear has developed.
  • Comments – same approach as with new “floaters,” can’t tell if there is a tear.

3.  Retinal Tears cause retinal detachments.  The usual cause of a tear is from a Posterior Vitreous Detachment and rarely trauma.  Retinal holes, usually from a condition called Lattice Degeneration, may cause a retinal detachment, too.  Retinal tears may be treated to prevent a retinal detachment, hence, the “emergency.”

  • Cause – either a hole or tear allows fluid to accumulate underneath the retina.
  • Concerns – permanent loss of vision may occur if the macula becomes detached.  Blindness is possible.
  • Comments – progressive loss of peripheral vision should be communicated to your eye doctor immediately.

2.  Endophthalmitis is a true medical emergency and is usually caused by infection of the inside of the eye.  There is usually a history of recent eye surgery.

  • Cause – usually bacterial infection after eye surgery.  Rarely, severely immuno-compromised patients can acquire this infection from an “endogenous” source.
  • Concerns – Blindness can occur within 24 hours.
  • Comments – common signs of infection following eye surgery include decreased vision and usually, pain.

1.  Retinal Detachmentretinal detachments can cause permanent loss of vision or blindness.  The critical aspect of a retinal detachment is the state of the macula, that portion of the retina serving central vision.  If the macula is detached, central vision is already compromised.  While reattachment will likely improve vision, the prognosis is not as good as if surgery were performed before macular detachment.

  • Cause – retinal tears or holes.  Usually preceded by flashes or floaters, but may be asymptomatic.
  • Concerns – state of the macula, is it attached?
  • Comments – the most emergent retinal detachment is where the macula is “on,” or attached, but the portion of the detachment is above the macula.  Gravity will most likely act quickly to detach the macula.  Every effort is made to operate before the macula becomes affected!
How I Practice

"Top Ten" Eye Emergencies: Part 1

Any vision loss can be scary.  Sudden vision loss is even more frightening.  There are really only a couple of “true” retinal eye emergencies.  I’ve listed the “top ten,”  remember that there are many ways to define an emergency.  All involve loss of vision, or at least a change in vision, and that alone probably qualifies as an “emergency.”  By the way, if you have sustained any of these symptoms, please call your doctor.  This article, and web site, is not intended to replace medical advice.

So here goes;  my “Top Ten” Retinal Emergencies;

10.  Vitreous hemorrhage – the symptoms of a vitreous hemorrhage can range from the onset of sudden floaters to rather impressive loss of vision, depending upon the amount of bleeding into the vitreous.

9.  Vascular Occlusions – either vein occlusions or artery occlusions.  Patients experience sudden loss of vision.

  • Causes
  • Vein Occlusions – may be associated with hypertension or diabetes, often healthy individual
  • Artery Occlusions – look for cardiovascular disease/stroke
  • Concerns – may develop “neovascular” glaucoma
  • Comments – treatments include laser treatment, Ozurdex (vein).

8.  Submacular Hemorrhage – sudden bleeding underneath the macula/retina.  Causes a dark area in the vision.  Usually the peripheral vision is normal.

  • Causes – valsalva, trauma, macular degeneration
  • Concerns – source of the bleeding
  • Comments – valsalva (aka straining) has the best prognosis, remember blood underneath the retina is not toxic

7.  “Wet” Macular Degeneration – rapidly (days to weeks) decreasing vision, distortion.

  • Causes – fluid/blood accumulating in the macula
  • Concerns – look for abnormal blood vessels (neovascularization)
  • Comment – fluorescein angiography is helpful

6.  Uveitis/Iritis – this is inflammation inside the eye, not unlike arthritis.  Patients may experience pain, sensitivity to light, decreased vision.  Eye may turn red.

  • Causes – endogenous, some rheumatologic diseases, trauma
  • Concerns – relief of pain, may look for associated systemic disease
  • Comment – usually steroids play a big role in controlling this

To Be Continued…

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