Etiologies of Vision Loss

Ranges of vision loss

Various scales have been developed to describe the extent of vision and vision loss based on visual acuity.[1] Early editions of the World Health Organization's ICD described a simple distinction between "legally sighted" and "legally blind". The ICD-9 released in 1979 introduced the smallest continuous scale which consisted of three tiers: normal vision, low vision, and blindness.

Acute visual loss

Acute visual loss may be dramatic in presentation, and is almost always alarming to the person experiencing the loss. It may be caused by media opacities, retinal disease, optic nerve disease, visual pathway disorders, or functional disorders, or it may be in fact an acute discovery of chronic visual loss.

Media opacity

Opacities of the clear refractive media of the eye such as the cornea, anterior chamber, lens, and vitreous humor may cause acute visual loss as manifested by blurry vision or reduced visual acuity. While pupillary reflexes may be affected, these conditions generally do not cause a relative afferent pupillary defect.

Causes of media opacity include corneal edema, hyphema, cataract and vitreous hemorrhage.

Retinal disease

Retinal diseases may cause sudden visual loss. Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect. Conditions that affect or destroy the retina include retinal detachment; macular disease (e.g., macular degeneration); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

Optic nerve disease

Diseases which affect the optic nerve may cause acute visual loss. Signs include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.

The optic nerve can be affected by optic neuritis, retrobulbar neuritis, papillitis, papilledema, ischemic optic neuropathy, and giant cell arteritis.

Hypoxia

The eye is very sensitive to restriction of its supply of oxygen. A dimming of vision (a brownout or greyout) accompanied by loss of peripheral perception may result from low blood pressure, shock, g-LOC (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm. Vision usually returns readily once the conditions restricting blood flow are lifted.

Visual pathway disorder

Visual pathway disorders are any problems that may impede the visual pathway. Rarely, acute visual loss is caused by homonymous hemianopia and, more rarely, cortical blindness.

Functional disorder

The term functional disorder is now used where hysterical and malingering were historically used. This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).