Out of Sight

Common causes of non-traumatic transient visual loss include:

• amaurosis fugax (usually minutes) — usually embolic or thrombotic; can occur secondary to hypoperfusion states, hyperviscosity or vasospasm.
• migraine (can be without headache)
• one eye closed!

Uncommon causes include:

• papilloedema (may be associated with visual loss lasting seconds)
• other causes of ischemic optic neuropathy, e.g. giant cell arteritis
• impending central retinal vein occlusion (CRVO)
• glaucoma
• posterior reversible encephalopathy syndrome (PRES)
• large vessel occlusion or dissection, e.g. ocular ischemic syndrome (carotid occlusive disease), vertebrobasilar insufficiency, and carotid or vertebral artery dissection
• functional visual loss, e.g. hysteria, malingering

Painless acute persistent loss of vision:

• central retinal artery occlusion (CRAO)
• central retinal vein occlusion (CRVO)
• retinal detachment or hemorrhage
• vitreous hemorrhage
• optic or retrobulbar neuritis
• internal carotid artery occlusion

Painful acute loss of vision:

• acute glaucoma
• endophalmitis
• uveitis
• keratoconus (vision can deteriroate rapidly and is associated with photophobia)

Transient

• migraine
• VBI (transient)

Prolonged

• CVA
• poisons/ toxic optic neuropathy (e.g. methanol, quinine, ethambutol, ergot alkaloids, salicylates)
• posterior reversible encephalopathy (PRES)
• optic or retrobulbar neuritis
• hysteria
• malingering

From ‘front to back‘:

• lid injury
• corneal irregularity or laceration
• hyphema
• ruptured globe
• traumatic cataract
• lens dislocation
• commotio retinae
• retinal detachment
• retinial or vitreous hemorrhage
• intra-ocular foreign body
• traumatic optic neuropathy or optic nerve avulsion
• CNS injury

central loss of vision

visual loss that respects the horizontal midline (‘altitudinal’)

visual loss that respects the vertical midline

Loss of vision in one eye

Loss of vision in both eyes

Sudden onset of painless loss of vision

Patient does not complain of visual loss, but bumps into objects when ambulating

Cloudy vision with floaters

Flashing lights experience

Curtain-like veil obscuring vision

Curtain coming across vision like a shutter from above or below

Vague central vision obscurations — “fluffy ball” or “puff of smoke”, or complaint of a sensation of “looking through ground glass”, or a claim that vision would be normal if he could only “see around it”

Transient visual obscurations during any movement or change of position such as bending, straining or getting up suddenly

Previous transient visual obscurations lasting seconds

Previous transient visual obscurations lasting minutes

Photopsias (positive visual phenomena — spontaneous flashing squares, flashes of light, showers of sparks) precipitated by eye movements

Visual blurring made worse by hot weather or hot shower

Visual distortions such as metamorphosia (straight lines are bent) or micropsia (objects appear smaller)

Eye pain at rest

Eye pain with eye movements

Diffuse or localised headache, pain on combing the hair, temporal area pain especially when laying the head down on a pillow, jaw claudication, prolonged unexplained fever, malaise, weight loss, proximal myalgias, age > 50

Visual loss with diplopia

Visual loss with focal neurological symptoms or signs

Recent trauma

HIV

• Ehlers JP, Shah CP, Fenton GL, Hoskins EN. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease Lippincott Williams & Wilkins
• NSW Statewide Opthalmology Service. Eye Emergency Manual — An illustrated Guide. [Free PDF]