Approach to acute vision loss in children
- Sabah Iqbal, MD
Sabah Iqbal, MD
- Assistant Professor of Pediatrics and Emergency Medicine
- The George Washington University School of Medicine and Health Sciences
- Bruce L Klein, MD
Bruce L Klein, MD
- Visiting Associate Professor of Pediatrics
- Johns Hopkins University School of Medicine
- Section Editor
- Stephen J Teach, MD, MPH
Stephen J Teach, MD, MPH
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics and Emergency Medicine
- George Washington University School of Medicine and Health Sciences
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
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".)
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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- Visual media
- - Open globe
- - Chemical burn
- - Conjunctivitis
- - Keratitis
- - Hyphema
- - Iritis
- - Glaucoma
- - Lens abnormality
- - Vitreous hemorrhage
- - Endophthalmitis
- Neuro-visual pathway
- Other conditions
- - Functional visual loss
- - Toxins
- - Other primary ocular tumors
- Transient vision loss
- HISTORY AND PHYSICAL FINDINGS
- Physical examination
- Diagnostic studies
- Monocular vision loss
- Binocular vision loss