Acute vision loss can have many etiologies with a large differential. Many of these are time-sensitive, and the emergency physician may improve patient outcome through the consideration of several acute conditions.
We three doctors—an optometrist, an ophthalmologist and an emergency medicine physician—are involved in different stages of the care such patients require. Here, we’ve pooled our collective expertise to outline a few of these conditions from the perspective of the entire management team to give you a quick reference guide to the workup, diagnostic clues and management course likely to occur for each.
This review addresses the elements of the history and examination that are useful in evaluating a patient with visual loss, with the goals of correctly localizing the lesion and constructing a likely differential diagnosis.
The most common cause of monocular transient vision loss is amaurosis fugax, usually resulting from an embolic complication of an ulcerated plaque of the carotid artery. In contrast, the most common cause of transient binocular vision loss is migraine.
Vision loss can be a challenging ED chief complaint to diagnose and manage because of the difficulty determining which causes are neurological and which are related to intrinsic ocular pathology.
An “eye stroke” is a term used to describe several different conditions that lead to vision loss because of poor blood flow to the eye.
When a patient presents with vision loss it can be terrifying not only for the patient but for you as an eye care provider too! While there are seemingly innumerable causes of vision loss, simply breaking down a patient’s signs and symptoms can help the practitioner make a diagnosis. This flowchart and accompanying article serve as a guide for the practitioner regarding common causes of vision loss.
A good pathway to deal with eye/vision problems is to try to determine if there are issues of trauma, exposure, or infection involved. Painless vision loss rarely involves these elements. Next, is the vision loss partial, full, blurry, monocular, or binocular. Binocular vision loss is usually cerebral, thus a neurologic, rather than an ophthalmic pathology. Was it sudden, or gradual, constant or intermittent? Is the eye red, or normal appearing?
Chemical alkali burns to the eye can result in liquefactive necrosis and should be irrigated until the eye pH is between 6 and 8.
Decrease of visual acuity due to a non-traumatic cause. Transient vision loss defined as vision loss <24 hours. Persistent vision loss defined as loss of vision >24 hours. (Bagheri 2015). Causes: There are multitude of causes of vision loss...
Dr. George Porfiris and Dr. Simon Kingsley discuss four non-traumatic eye emergency presentations. The painful red eye, the painless red eye, acute painful loss of vision and acute painless loss of vision.
It is important to distinguish sudden painLESS loss of vision from sudden painFUL loss of vision, gradual loss of vision and transient loss of vision, as these have different underlying pathology.
Sudden vision loss is a common complaint in eye care practices. Often, such a situation requires urgent attention. It can represent something relatively benign such as dry eye, or be a warning sign of a stroke. Depending on the etiology, vision loss can be permanent. Other times, however, it is transient--lasting for seconds to hours.