Protocolo diagnóstico-terapéutico del paciente con pérdida aguda de visión

Abstract

Recent vision loss is a common complaint, more often unilateral than bilateral. The temporal pattern of onset may be classified into transient, hyperacute, acute, and subacute-chronic losses, and the presence or absence of pain is also a relevant criterion. Among transient losses, amaurosis fugax is worth highlighting because it may herald an established ischemic stroke. Among hyperacute losses, urgent diagnosis of central retinal artery occlusion is imperative, given the possibility of reperfusion treatment with alteplase (off-label) in the first 4.5hours. In acute forms, the presence or absence of papillitis distinguishes between anterior and posterior (or retrobulbar) optic neuropathies, the latter being typical of demyelinating processes. In either transient, hyperacute and acute forms, and especially in the context of pain, identification of an arteritic process is mandatory as it would dictate the urgent initiation of corticosteroid therapy.