Unilateral blindness: etiology

Physiology - Neurologic

Post-operative visual loss typically occurs as an ischemic sequelae of external compression of the globe, hypotension, anemia or embolism (Miller 2010). The causes of post-operative unilateral blindness and their possible mechanisms include :

2. Central Retinal Artery Occlusion (CRAO): may occur as a result of external compression on the eye causing raised intraocular pressure that blocks blood flow through the central retinal artery, retrobulbar hemorrhage from vasuclar injury or from an emboism. Clinical findings include “painless blindness,” “cherry red macula” and narrowed retinal arteries on fundoscopic exam. Causes of CRAO include 1) raised intraocular pressure, 2) embolism, 3) decreased venous outflow. (Miller 2010)

4. Acute angle glaucoma: results in raised intraocular pressure from blockade of the aqueous humor outflow tract from obliteration of the space between the iris and lens. Clinical findings include a painful and red globe, blurry vision, headache, nausea and vomiting. (Miller 2010) Although a cause of unilateral blindness, case reports have described bilateral acute angle closure glaucoma after spine surgery. (Ref. 3, Ref. 4)


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