Impact of Blindness on the Patient

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The loss of sight is a terrifying experience. The sighted person lives mostly in a visual and auditory world illuminated by lights and colors. When blindness occurs, the person loses not only the ability to see but the perceptual center of the world. This center must now be replaced by hearing and touch. Because light is often equated with life, the inability to see light is associated with death. The newly blinded patient must take a new place in society. He or she can no longer read ordinary books, can no longer receive visual stimuli, and is unable to appreciate the world of visual communication. This can result in a reactive depression. The clinician must show genuine care for blind patients and try to understand their feelings of discouragement and despair.

The person who is blind from birth or early childhood has little or no conception of the visual world. Having never been able to see, this patient has no visual frame of reference.

On occasion, a blind individual recovers sight as a result of a surgical procedure later in life. Many difficulties may arise owing to the reorganization of the patient's perception. His or her frame of reference has been shifted from touch to sight. Surprisingly, many of these patients become depressed after attaining vision. Facial expressions mean nothing because only with experience can people understand them. The following quote from a case history by Gregory and Wallace illustrates the response of such an individual:

He suffered one of the greatest hardships (blindness) and yet he lived with energy and enthusiasm. When his handicap was apparently swept away, as by a miracle, he lost his peace and self-respect.

Similarly, the patient with normal vision may develop psychosomatic eye problems as a result of anxiety. Loss of vision also can accompany panic disorders. Such individuals can have either

Table 10-2 Differential Diagnosis for Red Eye*

Manifestation

Acute Conjunctivitis{

Acute Iritis{

Narrow-Angle Glaucoma

Corneal Abrasion

History

Sudden onset Exposure to conjunctivitis

Fairly sudden onset Often recurrent

Rapid onset

Sometimes history of attack Highest incidence among Jews, Swedes, and the Inuit

Trauma Pain

Vision

Normal

Impaired if untreated

Rapidly lost if untreated§

Can be affected if central

Pain

Gritty feeling

Photophobia

Severe

Exquisite

Bilaterality

Frequent

Occasional

Occasional

Usually unilateral

Vomiting

Absent

Absent

Common

Absent

Cornea

Clear (epidemic keratoconjunctivitis has corneal deposits)

Variable

''Steamy'' (like looking through a steamy window)

Irregular light reflex

Pupil

Normal, reactive

Sluggishly reactive Sometimes irregular in shape

Partially dilated, oval, nonreactive

Normal, reactive

Iris

Normal

Normal11

Difficult to see, owing to corneal edema

Shadow of corneal defect may be projected on the iris with penlight

Ocular discharge

Mucopurulent or watery

Watery

Watery

Watery or mucopurulent

Systemic effect

None

Few

Many

None

Prognosis

Self-limited

Poor if untreated

Poor if untreated

*See Figure 10-88.

{Can be viral, bacterial, or allergic.

{See Figure 10-63.

§Seeing "rainbow" can be an early symptom during an acute attack. }Slit-lamp examination revealing cells in anterior chamber is diagnostic.

infected

*See Figure 10-88.

{Can be viral, bacterial, or allergic.

{See Figure 10-63.

§Seeing "rainbow" can be an early symptom during an acute attack. }Slit-lamp examination revealing cells in anterior chamber is diagnostic.

partial or complete vision loss in one or both eyes. Supportive care of the primary problem usually results in the return of vision.

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