Albert Y. Wu, MD, PhD
Assistant Professor
Division of Ophthalmic Plastic and Reconstructive Surgery
Departments of Ophthalmology and Medical Education
Icahn School of Medicine at Mount Sinai
When Quick Care Could Save Your Vision
When I was an ophthalmology resident in training, several of my patients experienced visual symptoms that they ignored and didn't seek care until it was too late. They had serious eye conditions that required swift treatment. Some patients became visually impaired, while others went blind altogether. If they had just recognized how critical their symptoms were and come to the clinic earlier, we might have been able to save their vision.
Fortunately, you can prevent this happening to you. If you have any of the following symptoms, you should seek medical attention immediately, preferably from an ophthalmologist (eye MD). If one is unavailable, see an optometrist or primary care physician, or go to the emergency room. Be sure to let them know you need urgent attention.
Symptoms of Emergency Eye Problems
•Blurry vision that does not go away within five or 10 minutes.
•Partial or complete vision loss in one eye that does not resolve within five or 10 minutes; may initially appear as a "curtain" of darkness moving across the visual field.
•A sudden graying or blacking out of all vision to one eye.
•A sudden increase in floaters (specks or thread-like squiggles randomly moving through your vision) that persist longer than a half-hour.
•A sudden increase in flashes (little scintillations of light) that last longer than a half-hour.
•Sudden, sharp eye pain or sharp headache in the eye area that becomes a dull ache and lasts longer than 10 minutes or is continual; often strikes in low- to mid-light situations (for example, dusk or dawn), and may be accompanied by eye redness, as well as slight changes in vision.
•Persistent pain around the eye or in the temple area that may be exacerbated by chewing.
If you didn't know these symptoms were that serious, you are not alone. In a recent survey conducted at The Mount Sinai Hospital in New York City, fellow researchers and I found most people to be unaware of four rare eye diseases that underlie one or more of the above symptoms and are considered eye emergencies. Even fewer were knowledgeable about the diseases' pathophysiology, symptoms, and treatment.
The Four Eye Diseases
1. Retinal detachment. The retina is the light-sensitive tissue that sends visual signals to the brain, allowing us to see. Retinal detachment occurs when that tissue pulls away (detaches) from the back of the eye. The detached retina needs to be put back in place in a matter of hours to days; otherwise it will die, causing permanent vision loss. This disease is more common in patients who are very nearsighted.
Treatments for retinal detachment include applying heat with a laser to "glue" the retina back onto the eye; inserting a small gas bubble into the eye to press the retina back into place; and surgically reattaching the retina.
2. Acute angle-closure glaucoma. In acute angle-closure glaucoma, the iris (the colored part of the eye that opens and closes with the pupil) abnormally bends toward the front of the eyeball near the eye's drainage system. When the iris gets too close to the front periphery, it gets sucked into the drain, clogging it. Fluid then builds up, causing an intense spike in pressure inside the eye. This can compress the optic nerve and cause partial loss of vision or complete blindness in one eye if you don't seek care immediately.
It is usually treated with eyedrops and other medications to lower the intraocular pressure and help release the iris from the drain, but surgery may be necessary in some cases.
3. Central retinal artery occlusion. Individuals with cardiovascular risk factors, such as diabetes, high blood pressure, and high cholesterol, are at increased risk for this disease. It can be thought of as an eye "stroke," where a small clot or cholesterol plaque travels from a blood vessel (usually in the neck) and sticks in the retinal artery, blocking the flow of blood and oxygen to the eye. Without these, the retina will eventually die, resulting in irreversible blindness in that eye.
As with a brain stroke, you have no time to lose. In my experience, immediate medical attention -- ideally within an hour -- gives patients the best chance of saving their vision. Although there are no scientifically proven treatments, anecdotal evidence suggests that therapies to restore the retina, including blood thinners and hyperbaric oxygen therapy (breathing pure oxygen in a pressurized chamber), help some people.
4. Giant cell arteritis. Also known as temporal arteritis, this disease causes pain in the temple area due to an inflammation of blood vessels around the eye. It typically strikes patients older than age 50. Unlike the other diseases, which affect only one eye at a time, this is a systemic disease affecting the whole body. Symptoms usually occur first on one side, then continue on the other. Untreated, it can result in blindness in one or both eyes.
Oral steroid medication is an effective treatment for giant cell arteritis.
Quick Care is Crucial
As these diseases are rare, our survey results finding low awareness were unsurprising. But if you happen to be that one in 1,000 persons affected, recognizing the symptoms and getting quick care can mean the difference between saving your vision and suffering permanent visual impairment or blindness.