What's the Prognosis for this patient??

[Connie31079]

Had a call the other day, 33 y/o female had sudden onset of blindness in left eye for approx 15 minutes, before vision returned, but has remained blurry.

This onset of blindness happened @ 0530 hrs in the morning, but according to the patient, she didn't feel the need to go to the ER to have this checked out because there was no pain when the blindness occured, and it returned "fairly quickly" according to her.

When we picked her up approx. 14 hours after initial onset, she was experiencing a "burning sensation" in the affected eye, the vision remained blurry, and it was quite red in appearance.

Pt. has hx of migraines for which she takes imitrex, nexium for GERD, ventolin for asthma, and metformin for type 2 diabetes. She's also on Depo Provera birth control shot q 3 months. She does not smoke.

Was talking to her the other day, she was diagnosed with having a TIA, and was told she continues to have a blood clot in the back of her left eye, although it is not completely occluding blood flow to the eye, thus the reason for her continuing blurry vision. Does this make sense??

Was told to take ASA everyday, and is due to go see a neurologist next week for a full workup.

What do you think is this patient's prognosis? She's a good friend of mine! Was wondering what y'all think, if she'll regain full vision in that eye?? What about that blood clot that she continues to have in behind her left eye? Should she worry about it??

[craig]

prognosis for this patient?

isnt that what she is going to the specialist for? and taking the meds?

if it was a tia then prognosis will probably be god a long as she remembers to carry out what the doctor tells her to do.

hope all goes well

stay safe

[Mediclcems]

I don't know if the clot was in the eye, but seeing an opthomologist might be a good idea. Neurology can't help her vision, just her brain.

[Connie31079]

I do believe she initially was seen by an optamologist, who found the blood clot behind her eye.

Now, she's being sent to a neurologist for a full workup.

[Ridryder 911]

Yes, retinal occlusion is very common. Acute sudden blindness.. sometimes painless as well. Prognosis is poor, with only 21-35% of eyes retaining useful vision.

From e-med: http://www.emedicine.com/emerg/topic777.htm (full text with pathophysiology & etiology)

Frequency:

In the US: Recent estimates put the incidence of RAO at 0.85 per 100,000 per year, with a 10-year cumulative incidence of 1.5%.

Mortality/Morbidity:

Patients with visualized retinal artery emboli, whether or not obstruction is present, have 56% mortality over 9 years, compared to 27% for an age-matched population without retinal artery emboli.

Life expectancy of patients with central RAO (CRAO) is 5.5 years, compared to 15.4 years for an age-matched population without CRAO.

RAO is associated with smoking and cardiovascular disease, with an increased incidence of stroke in patients who have suffered RAO.

Both eyes have an equal incidence of disease, with bilateral involvement in 1-2%.

Sex: Men are affected slightly more frequently than women.

Age:

The mean age of presentation is early in the seventh decade of life, although a few cases have been reported in patients younger than 30 years.

The etiology of occlusion changes, depending on the age at presentation

Some serious stuff huh ?.. I have seen 3 cases already this year..one was on a 33 year old male..

R/r 911

[1EMT-P]

It sounds like she has a serious condition that needs to be addressed ASAP. Has she been evaluated by an Ophthalmologist and a Neurologist?