Acute Loss of Vision: Non-Traumatic (chart)

Acute PAINLESS Loss of Vision

Condition	Time Course	Notes
Migraine	Transient	Associated headache, but no globe pain
Amaurosis fugax	Transient	Monocular symptoms
Cerebral TIA	Transient	Bilateral symptoms
Cerebral Stroke	Persistent	Bilateral symptoms
Central retinal artery occlusion	Persistent	Characteristic fundoscopy
Central retinal vein occlusion	Persistent	Characteristic fundoscopy
Vitreous haemorrhage	Persistent	Fundoscopy may be characteristic or completely obscured
Retinal detachment	Persistent	Often preceded by floaters/flashes
Pituitary apoplexy	Persistent	Acute headache, but no globe pain
Acute maculopathy	Persistent	Characteristic fundoscopy
Hyphema (spontaneous)	Persistent	Characteristic ocular exam
Optic neuritis (papillitis)	Persistent	Papilloedema
Retinal poisons	Persistent	History of exposure: quinine, methanol
Psychogenic (usually painless)	Transient	Bizarre history or examination findings

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Acute PAINFUL Loss of Vision

Condition	Time Course	Notes
Acute glaucoma	Persistent	Characteristic ocular exam
Orbital cellulitis	Persistent	Signs of periorbital/orbital infection
Hypopyon	Persistent	Pus level in anterior chamber
Endophthalmitis	Persistent	Infection in vitreous/aqueous; consider retained foreign body
Giant cell arteritis	Persistent	Tender temporal arteries, elevated CRP
Optic neuritis (retrobulbar)	Persistent	Papilloedema (if disc involved), pain worse on eye movement

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References

FOAMed

• Nickson C. Ophthalmology Befuddler. Clinical Cases. LITFL
• Hayes J. Acute Loss of Vision: Non-Traumatic. FFS

Publications

• The Eye Emergency Manual, NSW Department of Health, 2nd ed. 2009