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Chronic Vision Uni-Bilateral loss (Blindness)

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Version Jan 2023

Related Subjects: |Brain tumours |Astrocytomas |Brain Metastases

Cause	Details
Cataracts	A very common cause pain free progressive vision loss. Usually elderly. Often bilateral but one worse than the other. Loss of red reflex. Patients describe a reduce in visual quality. Treatment is cataract extraction.
Diabetes	Commonest cause of blindness in < 50. May be associated with fundal changes in diabetes. Fundus shows dot-blot haemorrhages, microaneurysms, and neovascularization. Proliferative diabetic retinopathy with neovascularization present) needs pan-retinal photocoagulation. Surgical or medical vitrectomy is used in some cases. Focal laser treatment is common for nonproliferative (background) retinopathy when macular oedema is present; the laser is applied only to the affected area. In severe cases, pan-retinal photocoagulation may be used.
Brain Pathology affecting Optic Tracts/Occipital lobes	Tumour, trauma, stroke or meningitis. Usually causes a progressive homonymous hemianopia. Needs CT/MRI
Eye infection	Cornea (herpes keratitis, corneal ulcer), retina (CMV in AIDS), orbital cellulitis
Open angle glaucoma	See specific topic. Age > 40, Black, Family history. Common cause of blindness in blacks.
Macular degeneration	Adults > 55 years. Often bilateral. Progressive loss of central vision. Fundal appearance is diagnostic. macular drusen; makes the diagnosis. Most are dry type (high doses of vitamins A, C, and E and mineral zinc can slow progression). Wet type treated with VEGF inhibitors (e.g., pegaptanib) and laser therapy with or without verteporfin (a photosensitizing dye
Optic neuritis	MS, Congenital, Autoimmune-type conditions, infections (Lyme disease), or drugs (ethambutol)
Papilloedema	Increased ICP (brain tumour, pseudotumour
Presbyopia	Seen in those > 50 as lens loses its ability to accommodate. Needs help for near vision. This is a normal part of aging and not a disease.
Uveitis	Autoimmune-type diseases. e.g. rheumatoid and juvenile rheumatoid arthritis regularly to detect uveitis. Treated with steroids.

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