SUDDEN PAINLESS LOSS OF VISION Case 7 solution and reference

Painless loss of vision: Contents | Cases

Case 7

Problem

A 34 y/o male with AIDS on AZT and a sulfa drug presents with painless loss of vision in his right eye. This has worsened over the last several days.

Solution

Approximately 50% of AIDS patients will have some form of ocular involvement during the course of their disease. Remain highly suspicious of any such patient complaining of a vision change. They may be harboring CMV retinitis, Toxoplasmosis or even candidiasis to name but a few. A fundus exam followed by a referral is strongly recommended.

Reference

12. 13.

CMV retinitis initially involves the retina around the posterior pole, i.e.. near the macula. As it is neurotrophic the retina itself is gradually destroyed leaving an atrophic scar. Initiation of systemic antivirals such as Ganciclovir or Foscarnet is mandatory to preserve any vision. As well the patient will require lifelong maintenance treatment to prevent a recurrence. When the retina becomes separated from the underlying retinal pigment epithelium a Retinal Detachment is said to exist. The retinal pigment epithelium (RPE) supports the photoreceptors and if separated from them for a short period of time atrophy of the photoreceptors will ensue which is irreversible. There are several types of retinal detachments but the most common are rhegmatogenous. That is they arise from a tear in the retina usually produced from vitreous traction. This tear allows liquid vitreous to percolate under the retina lifting it away from the RPE. This type of detachment is more common in myopic patients, those with a history of trauma and patients with a strong family history.

Painless loss of vision: Contents | Cases

12.	13.

CMV retinitis initially involves the retina around the posterior pole, i.e.. near the macula. As it is neurotrophic the retina itself is gradually destroyed leaving an atrophic scar. Initiation of systemic antivirals such as Ganciclovir or Foscarnet is mandatory to preserve any vision. As well the patient will require lifelong maintenance treatment to prevent a recurrence.	When the retina becomes separated from the underlying retinal pigment epithelium a Retinal Detachment is said to exist. The retinal pigment epithelium (RPE) supports the photoreceptors and if separated from them for a short period of time atrophy of the photoreceptors will ensue which is irreversible. There are several types of retinal detachments but the most common are rhegmatogenous. That is they arise from a tear in the retina usually produced from vitreous traction. This tear allows liquid vitreous to percolate under the retina lifting it away from the RPE. This type of detachment is more common in myopic patients, those with a history of trauma and patients with a strong family history.