GuidelinesOther guideline
Sudden Painless Loss of Vision
Sudden Painless Loss of Vision
Key history:
- Unilateral or bilateral
- Rapidity of onset – seconds, hours or days
- Associated symptoms
- Systemic symptoms
- Illnesses – e.g. hypertension, diabetes
Key examination:
- VA in affected and fellow eye
- Visual field
- Pupil reaction
- Fundus examination
| History | Associated factors | Examination | Diagnosis | Investigations/referral |
| Unilateral, rapid onset | Usually unilateral, over 50 with some cardiovascular risk factors | Extensive widely scattered retinal haemorrhages | Central retinal vein occlusion | Non urgent. Discuss by phone during the day unless does not meet “usual” criteria i.e. under 50, bilateral etc. |
| Unilateral or bilateral, rapid | floaters | Red haze obscuring view of fundus | Vitreous haemorrhage | Semi urgent By phone during the day |
| Unilateral, rapid, severe loss of vision | Systemic symptoms – headache, jaw claudication, weight loss | Swollen pale optic disc | Temporal arteritis with ischaemic optic neuropathy | Urgent, administer IV steroid (250mg of methyl prednisolone) to prevent visual loss in other eye, FBC, CRP, ESR |
| Unilateral, rapid, severe | CVS risk factors | Pale retina with macula cherry red spot | Central retinal artery occlusion | Urgent discuss with registrar. |
| Visual loss progressive over days to weeks | Flashes of light, floaters, field defect. More common in myopic patients | Field defect, RAPD, pale, wrinkled retina | Retinal detachment | Semi urgent referral (the next day if during the night) |
| Visual loss progressive over days | May have pain, worse with eye movement, may have focal neurology, typically under 45 years old | Reduced vision and colour vision (red target), disc may be swollen or normal | Optic neuritis | Semi urgent |
| Sudden loss of vision with return within 1-2 hours | May be normal, may see retinal artery embolus. | Amaurosis fugax | Exclude temporal arteritis, semi urgent referral | |
| Various visual disturbances – blurred vision, field defect, zigzagging lights | Unilateral headache, may have aura, nausea | Usually normal | Migraine | Not required |
| Brief (seconds) visual loss | May have Headache, focal neurology | Papilloedema | Visual obscurations | BP, CT head scan to rule out mass |