Sudden Vision Loss

Abstract

Sudden visual loss, whether unilateral or bilateral, is an ophthalmic emergency that necessitates a history including the patient’s age, time course, laterality, character of the symptoms, associated symptoms, prior ocular history, and concurrent medical conditions. Age is a critical component of the history – one of the most important entities, GCA (giant cell arteritis), is extremely rare under age 50, while optic neuritis associated with demyelinating disease usually presents before age 35. Clarifying the time course is of paramount importance: the meaning of the word “sudden” can vary greatly – from fractions of a second to weeks. The more acute the presentation, the greater the urgency of potential intervention that can prevent progression of disease and/or restore vision. Persistent severe sudden visual loss most commonly results from retinal or optic nerve infarction, retinal detachment (RD), or intraocular hemorrhage. Monocular and transient visual loss is most commonly caused by carotid artery and cardiac disease, migraine auras, intermittent angle closure with resultant intraocular pressure increase, and GCA.