Neurovascular Causes of Acute Monocular Visual Loss
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(2020) 22:27
Cerebrovascular Disease and Stroke (S Silverman, Section Editor)
Neurovascular Causes of Acute Monocular Visual Loss Melanie Truong-Le, DO, OD1,2 Robert M. Mallery, MD1,2,3,* Address *,1 Department of Neurology, Brigham and Women’s Hospital, 60 Fenwood Rd, Boston, MA, 02115, USA Email: [email protected] 2 Department of Ophthalmology, Mass. Eye and Ear, Boston, MA, USA 3 Harvard Medical School, Boston, MA, USA
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Cerebrovascular Disease and Stroke Keywords Central Retinal Artery Occlusion (CRAO) I Amaurosis fugax I Ischemic optic neuropathy I Giant cell arteritis I Paracentral Acute Middle Maculopathy (PAMM) I Benign retinal vasospasm
Abstract Purpose of review Acute monocular visual loss may result from a diverse set of neurovascular and systemic disorders and requires urgent evaluation. The goal of this review is to describe the most current understanding of the clinical features, pathophysiology, diagnosis, and treatment of these disorders. Recent findings 1. Acute central retinal artery occlusion (CRAO) should be treated as an equivalent to acute ischemic stroke. 2. Several recent clinical trials are evaluating the treatment of non-arteritic anterior ischemic optic neuropathy (NAION). 3. Tocilizumab is emerging as a first-line steroid-sparing immunomodulatory therapy for the treatment of giant cell arteritis (GCA). 4. Optical coherence tomography (OCT) imaging of the retina has led to the appreciation that retinal capillary ischemia in the form of paracentral acute middle maculopathy (PAMM) is a distinct form of acute monocular visual loss with relatively normalappearing fundus examination and good prognosis for recovery. Summary Accurate diagnosis and timely treatment of disorders resulting in acute monocular visual loss may reduce the likelihood of additional visual and neurologic complications.
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Curr Treat Options Cardio Med
(2020) 22:27
Introduction Acute monocular vision loss is vision loss in one eye that occurs suddenly or develops within hours and progresses significantly within a few days. It results from pathology affecting the optic nerve, retina, or structures of the eye including the cornea or vitreous. Amongst the causes of acute monocular visual loss, vascular causes have important implications due to their association with neurologic and systemic disorders including stroke and giant cell arteritis. A complete history and ophthalmic examination should be performed urgently to guide further evaluations. Ophthalmic causes such as retinal detachment, vitreous hemorrhage, or corneal opacities are excluded by the anterior and posterior segment ophthalmic examination. Retinal or optic nerve abnormalities may be evident on fundus exam, and ancillary testing including visual field assessment, ophthalmic imaging modalities such as optical coherence tomography (OCT) or fluorescein angiography (FA),
neurophysiologic testing such as electroretinography
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