From the Guidelines
Light-induced vision loss is a serious condition that can be caused by various factors, including certain porphyrias, and patients should seek immediate medical attention if they experience any symptoms of vision loss after exposure to light. When considering light-induced vision loss, it is essential to understand the underlying causes, such as the accumulation of phototoxic porphyrins in the skin, which can occur in cutaneous porphyrias [ 1 ]. These porphyrias can be divided into two groups: those that present with acute photosensitivity and those that present mainly with bullae, fragility of the skin, and/or scarring.
Key Considerations
- Cutaneous porphyrias, such as EPP and XLEPP, can cause skin damage and vision loss due to photoactivation of porphyrins and generation of singlet oxygen in the dermis [ 1 ].
- Patients with current cutaneous symptoms can be expected to have increased plasma porphyrins, which is the rationale for using plasma fluorescence scanning as a first-line analysis [ 1 ].
- Fractionation of porphyrins in urine, faeces, and erythrocytes is required to differentiate between the various types of porphyrias [ 1 ].
Recommendations
- Patients with suspected light-induced vision loss should undergo a comprehensive diagnostic evaluation, including plasma fluorescence scanning and fractionation of porphyrins in urine, faeces, and erythrocytes [ 1 ].
- Treatment should be individualized based on the underlying cause of the vision loss and may include anti-inflammatory medications, antioxidant supplements, and proper eye protection [ 1 ].
- It is crucial to seek immediate medical attention if symptoms of vision loss occur after exposure to light, as prompt treatment can help prevent permanent damage [ 1 ].
From the Research
Light-Induced Vision Loss
- Light-induced vision loss can be caused by various factors, including solar retinopathy, which occurs when the retina is damaged by direct exposure to sunlight 2.
- Solar retinopathy can cause significant foveal pathology, including disruption of the photoreceptor ellipsoid zone and the interdigitation zone, even in cases where visual acuity is normal 2.
- The condition can be diagnosed through a combination of visual acuity testing, dilated fundus examination, and spectral domain optical coherence tomography (SD-OCT) imaging 2.
- Other studies have focused on the evaluation of screening schemes for eye disease in primary care settings, which may help identify patients at risk of vision loss due to various causes, including light-induced damage 3.
- However, there is limited research specifically addressing light-induced vision loss, and more studies are needed to fully understand the condition and its effects on vision.
Diagnosis and Evaluation
- A thorough eye examination, including visual acuity testing, pupil examination, external examination, and dilated fundus examination, is essential for evaluating patients with suspected vision loss 4.
- Additional tests, such as SD-OCT imaging and fundus fluorescein angiography, may be necessary to confirm the diagnosis and assess the extent of retinal damage 2, 5.
- A comprehensive approach to vision loss evaluation, including a thorough history and examination, can help guide further tests and referrals to specialists 6.