Approach to the patient with visual loss

Visual loss a primary complaint varies depending one or both eyes are
affected. Is the visual loss abrupt in onset, gradul or is it suddenly discovered long
after onset ? Is the visual loss complete or partial ? finally , does the visual loss
include visual hallucinations or illusions ? the cause of visual loss rapidly narrow
down to a very small number of possibilities based on the temporal sequence of the
patients sympoms, age, and sex, and the presumed anatomic location of the lesion.
(table 10.1)
Patients visual complaints usully first seek an ophthalmologist or optometrist.
Referral to a neurologist from the ophthalmologist usully includes a CT or MRI
already in hand. If the problem appears to be a tumor, the eye specialist will most
often refer the patient directly to a neurosurgeon.
The visual pathway provides a number of diagnostic constellations of easily
examined elements that can be carried out at the bedside. The pupils, the retina, and
the optic disc can be objectively examined. Subjective visual tests include color,
visual acuity, and visual fields, and these help to direct localization to the retina optic
nerve, chiasm, optic tract, lateral geniculate, geniculocalcarine tract, and visual cortex.
Damage to visual association cortices, especially parietal and inferior temporal, will
produce higher function distrurbances such as central achromatopsia, alxia without
agraphia, prosopagnosia and Antons syndromes.

I. BEDSIDE OR OFFICE CLINICAL EXAMINATION OF THE VISUAL SYSTEM