Sudden Vision Loss: Possible Causes and Treatments

One eye suddenly lost vision?

I do not expect an immediate answer to the following question, as I understand that diagnosing such diseases and determining treatment can be challenging.
Based on my second-year anatomy knowledge, I know that ophthalmic diseases that cannot be seen with an ophthalmoscope are usually serious.
In any case, I hope to use this case as a teaching material for discussion.
If you cannot provide an answer, please recommend relevant physicians in Taichung or elsewhere in Taiwan.
A relative in my family suddenly lost vision in one eye without any other symptoms, except for a slight pain.
According to him, one day he just couldn't see anything at all.
Both Tzu Chi Dalin Hospital and the ophthalmology department in the Madou area could not find any issues.
The ophthalmoscope examination was normal, and the CT scan showed no problems.
It wasn't until he went to Cheng Kung University Hospital that a contrast agent was used, suggesting it might be inflammation.
They believe that a large dose of corticosteroids might be the only possible treatment.
My father is skeptical, so he searched online and found a very similar condition: http://www.love-eye.cn/shtml/aywd12.htm#C11 (acute retrobulbar neuritis).
I am unsure if my understanding is incorrect, but I do not think that "corticosteroids" mentioned there refers to "antihistamines" among steroids.
(Actually, corticosteroids are a type of steroid, right? I was too assertive in my previous response to my father and forgot that steroids can refer to many types of medications.)
I hope the responding physician can clarify this point.
Additionally, please advise if there are stronger hospitals and doctors in this area.
That relative refuses any treatment involving corticosteroids.
In summary, I do not want a vague answer like "steroids." I am a second-year dental student and am planning to research this issue further.
I hope to gain a more comprehensive understanding of corticosteroid medications, as this is also relevant to my biochemistry and microbiology exams, isn't it? XDDDD I hope this misunderstanding does not occur again.

Sincerely, a child who had a disagreement with their father over the efficacy mentioned on the website.

JJLi, 20~29 year old female. Ask Date: 2005/12/14

Dr. Cai Jingyao reply Ophthalmology

There are many causes of acute vision loss.
If, as you mentioned, the fundus appears completely normal, it is possible that the issue lies with the retrobulbar optic nerve.
If it is retrobulbar optic neuritis, corticosteroids such as methylprednisolone may be administered via injection, and oral prednisolone may also be used.
However, it is not possible to assess the condition accurately with limited information.
Therefore, it is advisable to consult a specialized hospital for further examination, including doctors such as Dr.
Chou Chieh-Jen from National Taiwan University, Dr.
Yen Mei-Yuan from Veterans General Hospital, and Dr.
Weng Lin-Chung from Taipei City Hospital.
Thank you.

Reply Date: 2005/12/14

More Info

Sudden vision loss can be a distressing experience, and understanding its potential causes and treatments is crucial for both patients and their families. Based on the information provided, it seems that your relative experienced a sudden loss of vision in one eye, accompanied by slight pain, and despite various examinations, no clear diagnosis was made until a more advanced imaging technique was employed.

Possible Causes of Sudden Vision Loss
1. Retinal Detachment: This is a serious condition where the retina separates from the back of the eye, leading to sudden vision loss. Symptoms may include flashes of light, floaters, or a shadow in the peripheral vision.

2. Vitreous Hemorrhage: Bleeding into the vitreous cavity can cause sudden vision loss. This can occur due to various reasons, including diabetic retinopathy or trauma.

3. Central Retinal Artery Occlusion (CRAO): This is often described as a "stroke of the eye," where the blood supply to the retina is blocked, leading to sudden and painless vision loss.

4. Acute Inflammatory Conditions: Conditions such as acute optic neuritis or anterior ischemic optic neuropathy can cause sudden vision loss. These conditions may be associated with inflammation of the optic nerve.

5. Transient Ischemic Attack (TIA): Sometimes referred to as a "mini-stroke," a TIA can cause temporary vision loss, often resolving within minutes to hours.

6. Glaucoma: An acute angle-closure glaucoma can lead to sudden vision loss, accompanied by severe eye pain, headache, nausea, and vomiting.

7. Other Causes: Other potential causes include infections, tumors, or systemic diseases that affect the blood vessels supplying the eye.

Diagnostic Approaches
As you mentioned, traditional examinations such as fundoscopy may not always reveal underlying issues, especially in cases of inflammation or subtle changes. Advanced imaging techniques, such as Optical Coherence Tomography (OCT) or fluorescein angiography, can provide more detailed information about the retina and optic nerve.

Treatment Options
The treatment for sudden vision loss largely depends on the underlying cause:
- Steroids: In cases of inflammatory conditions such as optic neuritis or certain types of uveitis, corticosteroids may be prescribed to reduce inflammation. It's important to clarify that corticosteroids are a type of steroid, but they are not the same as anabolic steroids or other non-steroidal anti-inflammatory drugs (NSAIDs).

- Surgery: For conditions like retinal detachment or vitreous hemorrhage, surgical intervention may be necessary.

- Laser Therapy: In cases of diabetic retinopathy or other retinal issues, laser treatment can help stabilize vision.

- Observation: In some cases, particularly with transient issues, careful monitoring may be all that is required.

Importance of Early Intervention
Prompt evaluation by an ophthalmologist is crucial in cases of sudden vision loss. Delays in treatment can lead to irreversible vision loss, depending on the underlying condition. If your relative is hesitant about corticosteroid treatment, it may be beneficial to seek a second opinion or consult with a specialist in ocular inflammation or a retina specialist.

Recommendations for Further Care
Given the complexity of the situation, I recommend seeking care from a comprehensive eye care center or a university hospital with a strong ophthalmology department. Institutions like Chang Gung Memorial Hospital or National Taiwan University Hospital have specialists who can provide advanced diagnostic and treatment options.

Conclusion
Understanding the nuances of sudden vision loss and its treatment options is essential for patients and their families. While corticosteroids can be a contentious topic, they play a critical role in managing certain inflammatory conditions. It’s important to have open discussions with healthcare providers about the risks and benefits of any treatment plan. Your pursuit of knowledge in this area will not only aid your relative but also enhance your understanding as a dental student, as systemic health and ocular health are interconnected.

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