Acute Loss of Vision: Non-Traumatic (chart)
Acute non-traumatic loss of vision is an ophthalmic emergency. All patients require urgent assessment, and persistent deficits mandate immediate ophthalmology referral.
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 | 
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 | 
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
Fellowship Notes
Educator, magister, munus exemplar, dicata in agro subitis medicina et discrimine cura | FFS |


