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Approach to acute vision loss in children

Authors
Sabah Iqbal, MD
Bruce L Klein, MD
Section Editor
Stephen J Teach, MD, MPH
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

Acute vision loss in children is frightening, not only for the patient and family, but also for the clinician. Blindness, especially if bilateral and permanent, represents a serious loss of function. Unfortunately, children may not present until they have significant loss of vision; very young children will not perceive declining vision until there is significant compromise and even school-age children compensate well. By the time vision loss is appreciated, the chance for recovery may be low.

The approach to acute vision loss in children will be reviewed here. The approach to vision loss in adults is discussed separately. (See "Approach to the adult with acute persistent visual loss".)

ETIOLOGY

To achieve clear vision, light must follow an unhindered path from the front to the back of the eye, traveling through the cornea, aqueous humor, lens, and vitreous humor to the retina (figure 1). Refracted by the cornea and lens (and perhaps also by glasses or contact lenses), light is focused onto the retina where it is transformed into an electrochemical signal by photoreceptors and supporting cells. The signal is transmitted via the optic nerve through the visual pathways to the occipital lobes.

Alterations in function of any of the structures along the visual pathway may cause vision loss. Pathology can be broadly divided into three major anatomic categories (table 1):

Visual media problems – Disorders of the cornea, anterior chamber, lens, and vitreous (figure 1)

                          

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Literature review current through: Nov 2016. | This topic last updated: Wed Mar 16 00:00:00 GMT+00:00 2016.
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References
Top
  1. Spector J, Fernandez WG. Chemical, thermal, and biological ocular exposures. Emerg Med Clin North Am 2008; 26:125.
  2. Duffy B. Managing chemical eye injuries. Emerg Nurse 2008; 16:25.
  3. Knoop K, Trott A. Ophthalmologic procedures in the emergency department--Part I: Immediate sight-saving procedures. Acad Emerg Med 1994; 1:408.
  4. Rozenbaum D, Baruchin AM, Dafna Z. Chemical burns of the eye with special reference to alkali burns. Burns 1991; 17:136.
  5. Naradzay J, Barish RA. Approach to ophthalmologic emergencies. Med Clin North Am 2006; 90:305.
  6. Sosne G, Christopherson PL, Barrett RP, Fridman R. Thymosin-beta4 modulates corneal matrix metalloproteinase levels and polymorphonuclear cell infiltration after alkali injury. Invest Ophthalmol Vis Sci 2005; 46:2388.
  7. Berman MB. Collagenase inhibitors: rationale for their use in treating corneal ulceration. Int Ophthalmol Clin 1975; 15:49.
  8. Levin AV. Retinal hemorrhage in abusive head trauma. Pediatrics 2010; 126:961.
  9. Naftchi S, la Cour M. A case of central visual loss in a child due to macular cavernous haemangioma of the retina. Acta Ophthalmol Scand 2002; 80:550.
  10. el-Sayed Y, al-Muhaimeid H. Acute visual loss in association with sinusitis. J Laryngol Otol 1993; 107:840.
  11. Postma GN, Chole RA, Nemzek WR. Reversible blindness secondary to acute sphenoid sinusitis. Otolaryngol Head Neck Surg 1995; 112:742.
  12. Casteels I, De Loof E, Brock P, et al. Sudden blindness in a child: presenting symptom of a sphenoid sinus mucocele. Br J Ophthalmol 1992; 76:502.
  13. Cannon ML, Antonio BL, McCloskey JJ, et al. Cavernous sinus thrombosis complicating sinusitis. Pediatr Crit Care Med 2004; 5:86.
  14. Quisling SV, Mawn LA, Larson TC 3rd. Blindness associated with enlarging mycotic aneurysm after cavernous sinus thrombosis. Ophthalmology 2003; 110:2036.
  15. Watkins LM, Pasternack MS, Banks M, et al. Bilateral cavernous sinus thromboses and intraorbital abscesses secondary to Streptococcus milleri. Ophthalmology 2003; 110:569.
  16. Belgaumi AF, Kauffman WM, Jenkins JJ, et al. Blindness in children with neuroblastoma. Cancer 1997; 80:1997.
  17. McGirt MJ, Cowan JA Jr, Gala V, et al. Surgical reversal of prolonged blindness from a metastatic neuroblastoma. Childs Nerv Syst 2005; 21:583.
  18. Varma D, George N, Livingston J, et al. Acute visual loss as an early manifestation of metastatic neuroblastoma. Eye (Lond) 2003; 17:250.
  19. Steenberge SP, Prayson RA. Pediatric cerebral ganglioneuroblastoma. J Clin Neurosci 2014; 21:2023.
  20. Sivakumar S, Poulik J, Sivaswamy L. Monocular Blindness as Presentation Manifestation of Neuroblastoma. Neurohospitalist 2016; 6:41.
  21. Maier W, Laubert A, Weinel P. Acute bilateral blindness in childhood caused by rhabdomyosarcoma and malignant lymphoma. J Laryngol Otol 1994; 108:873.
  22. Baig MN, Lubow M, Immesoete P, et al. Vision loss after spine surgery: review of the literature and recommendations. Neurosurg Focus 2007; 23:E15.
  23. de Fátima Soares M, Braga FT, da Rocha AJ, Lederman HM. Optic nerve infiltration by acute lymphoblastic leukemia: MRI contribution. Pediatr Radiol 2005; 35:799.
  24. Iqbal Y, Palkar V, Al-Sudairy R, et al. Papilledema, presenting as reversible loss of vision, in a child with acute lymphoblastic leukemia. Pediatr Blood Cancer 2005; 45:72.
  25. Güler E, Kutluk T, Akalan N, et al. Acute blindness as a presenting sign in childhood non-Hodgkin lymphoma. J Pediatr Hematol Oncol 2003; 25:69.
  26. Chaudhry IA, Shamsi FA, Al-Sharif A, et al. Optic nerve avulsion from door-handle trauma in children. Br J Ophthalmol 2006; 90:844.
  27. Mankhambo LA, Makwana NV, Carrol ED, et al. Persistent visual loss as a complication of meningococcal meningitis. Pediatr Infect Dis J 2006; 25:566.
  28. Hu WT, Leavitt JA, Moore EJ, Noseworthy JH. MRI findings of rapidly progressive ophthalmoplegia and blindness in mucormycosis. Neurology 2006; 66:E40.
  29. Lim SA, Siatkowski RM, Farris BK. Functional visual loss in adults and children patient characteristics, management, and outcomes. Ophthalmology 2005; 112:1821.
  30. Bangash IH, Worley G, Kandt RS. Hysterical conversion reactions mimicking neurological disease. Am J Dis Child 1988; 142:1203.
  31. Maloney MJ. Diagnosing hysterical conversion reactions in children. J Pediatr 1980; 97:1016.
  32. Leaverton DR, Rupp JW, Poff MG. Brief therapy for monocular hysterical blindness in childhood. Child Psychiatry Hum Dev 1977; 7:254.
  33. Gospe SM Jr. Transient cortical blindness in an infant exposed to methamphetamine. Ann Emerg Med 1995; 26:380.
  34. Brennan RC, Wilson MW, Kaste S, et al. US and MRI of pediatric ocular masses with histopathological correlation. Pediatr Radiol 2012; 42:738.
  35. Damasco VC, Dire DJ. A child with leukocoria. Pediatr Emerg Care 2011; 27:1170.
  36. Shokunbi T, Agbeja A. Ocular complications of head injury in children. Childs Nerv Syst 1991; 7:147.
  37. Olitsky SE, Hug D, Smith LP. Disorders of the eye. In: Nelson Textbook of Pediatrics, 18th, Kliegman RM, Behman RE, Jenson HB, Stanton BF. (Eds), Saunders Elsevier, Philadelphia 2007. p.2569.
  38. Sacchetti M, Lambiase A, Coassin M, et al. Toxic corneal ulcer: a frequent and sight-threatening disease. Eur J Ophthalmol 2009; 19:916.
  39. Handler JA, Ghezzi KT. General ophthalmologic examination. Emerg Med Clin North Am 1995; 13:521.
  40. Sit M, Levin AV. Direct ophthalmoscopy in pediatric emergency care. Pediatr Emerg Care 2001; 17:199.
  41. Levin AV. Eye emergencies: acute management in the pediatric ambulatory care setting. Pediatr Emerg Care 1991; 7:367.
  42. Jäger HR. Loss of vision: imaging the visual pathways. Eur Radiol 2005; 15:501.
  43. Davis PC, Hopkins KL. Imaging of the pediatric orbit and visual pathways: computed tomography and magnetic resonance imaging. Neuroimaging Clin N Am 1999; 9:93.
  44. Hamid RK, Newfield P. Pediatric eye emergencies. Anesthesiol Clin North America 2001; 19:257.
  45. Rothermel H, Hedges TR 3rd, Steere AC. Optic neuropathy in children with Lyme disease. Pediatrics 2001; 108:477.