Acute vision loss (noninflamed) - Revision history

Danbot: Add peer-reviewed references with PMIDs

2026-03-22T09:57:59Z

Add peer-reviewed references with PMIDs

← Older revision		Revision as of 09:57, 22 March 2026
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	*This page describes a general approach to the complaint of acute vision loss with a quiet (noninflamed) eye		*This page describes a general approach to the complaint of acute vision loss with a quiet (noninflamed) eye
	*Acute painless vision loss is an ophthalmologic emergency — several causes are time-sensitive		*Acute painless vision loss is an ophthalmologic emergency — several causes are time-sensitive
	*Central retinal artery occlusion (CRAO) is a stroke equivalent with a narrow treatment window (<4.5-6 hours)		*Central retinal artery occlusion (CRAO) is a stroke equivalent with a narrow treatment window (<ref>Hayreh SS. Acute retinal arterial occlusive disorders. Prog Retin Eye Res. 2011;30(5):359-394. PMID 21620994</ref><4.5-6 hours)
	*Key distinguishing feature: painless vision loss in a quiet eye narrows the differential to primarily vascular and retinal etiologies		*Key distinguishing feature: painless vision loss in a quiet eye narrows the differential to primarily vascular and retinal etiologies
	*Always check visual acuity in both eyes as a baseline		*Always check visual acuity in both eyes as a baseline
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	*Transient vs. persistent: amaurosis fugax (transient monocular vision loss) suggests TIA/carotid disease		*Transient vs. persistent: amaurosis fugax (transient monocular vision loss) suggests TIA/carotid disease
	*Visual field deficit pattern: central (macular), peripheral (retinal detachment), altitudinal (branch artery/vein occlusion)		*Visual field deficit pattern: central (macular), peripheral (retinal detachment), altitudinal (branch artery/vein occlusion)
	*Associated symptoms: headache, jaw claudication, scalp tenderness (giant cell arteritis), floaters/flashes (retinal detachment)		*Associated symptoms: headache, jaw claudication, scalp tenderness (giant cell arteritis), floaters/flashes (retinal detachment)<ref>Hunder GG, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum. 1990;33(8):1122-1128. PMID 2202311</ref>
	*Pain with eye movement (optic neuritis)		*Pain with eye movement (optic neuritis)

Danbot: Strip excess bold

2026-03-22T09:35:41Z

Strip excess bold

Danbot: Expanded with EM-focused content: time-sensitive emergencies, CRAO management, GCA, evaluation strategy, disposition

2026-03-20T23:27:05Z

Expanded with EM-focused content: time-sensitive emergencies, CRAO management, GCA, evaluation strategy, disposition

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 ==Background==
 [[File:Schematic diagram of the human eye en.png|thumb|Eye anatomy.]]
-*This page describes a general approach to the complaint of acute vision loss.
+*This page describes a general approach to the complaint of acute vision loss with a quiet (noninflamed) eye
 ==Clinical Features==
-{{Retinal images}}
+===Key Historical Features===
 ==Differential Diagnosis==
 {{Acute vision loss noninflamed DDX}}
 ==Evaluation==
 ==Management==
 ==Disposition==
 ==See Also==
 {{Eye algorithms}}
 ==External Links==

Rossdonaldson1: /* Background */

2026-02-04T17:53:48Z

Background

← Older revision		Revision as of 17:53, 4 February 2026
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	==Background==		==Background==
	[[File:Schematic diagram of the human eye en.png\|thumb\|Eye anatomy.]]		[[File:Schematic diagram of the human eye en.png\|thumb\|Eye anatomy.]]
			*This page describes a general approach to the complaint of acute vision loss.

	==Clinical Features==		==Clinical Features==

Rossdonaldson1 at 17:52, 4 February 2026

2026-02-04T17:52:46Z

← Older revision		Revision as of 17:52, 4 February 2026
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	==Clinical Features==		==Clinical Features==
			{{Retinal images}}

	==Differential Diagnosis==		==Differential Diagnosis==
			{{Acute vision loss noninflamed DDX}}

	==Evaluation==		==Evaluation==
	~~{{Acute vision loss noninflamed DDX}}~~
	~~{{Retinal images}}~~

	==Management==		==Management==

Rossdonaldson1 at 17:51, 4 February 2026

2026-02-04T17:51:58Z

← Older revision		Revision as of 17:51, 4 February 2026
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			==Background==
			[[File:Schematic diagram of the human eye en.png\|thumb\|Eye anatomy.]]

			==Clinical Features==

			==Differential Diagnosis==

	==Evaluation==		==Evaluation==
	{{Acute vision loss noninflamed DDX}}		{{Acute vision loss noninflamed DDX}}
			{{Retinal images}}

	~~{{Retinal images}}~~		==Management==

			==Disposition==

	==See Also==		==See Also==
	{{Eye algorithms}}		{{Eye algorithms}}

			==External Links==

	==References==		==References==

Rossdonaldson1: /* See Also */

2019-04-03T04:40:09Z

Neil.m.young at 19:53, 21 November 2016

2016-11-21T19:53:20Z

← Older revision		Revision as of 19:53, 21 November 2016
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	[[Category:Ophthalmology]]		[[Category:Ophthalmology]]
			[[Category:Symptoms]]

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-23T02:22:39Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 02:22, 23 July 2016
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	==~~Diagnosis~~==		==Evaluation==
	{{Acute vision loss noninflamed DDX}}		{{Acute vision loss noninflamed DDX}}

Neil.m.young: Text replacement - " ==" to "=="

2016-07-05T21:03:05Z

Text replacement - " ==" to "=="

← Older revision		Revision as of 21:03, 5 July 2016
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	==Diagnosis ==		==Diagnosis==
	{{Acute vision loss noninflamed DDX}}		{{Acute vision loss noninflamed DDX}}

← Older revision		Revision as of 09:35, 22 March 2026
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	*This page describes a general approach to the complaint of acute vision loss with a quiet (noninflamed) eye		*This page describes a general approach to the complaint of acute vision loss with a quiet (noninflamed) eye
	*Acute painless vision loss is an ophthalmologic emergency — several causes are time-sensitive		*Acute painless vision loss is an ophthalmologic emergency — several causes are time-sensitive
	*~~'''~~Central retinal artery occlusion (CRAO)~~'''~~ is a stroke equivalent with a narrow treatment window (<4.5-6 hours)		*Central retinal artery occlusion (CRAO) is a stroke equivalent with a narrow treatment window (<4.5-6 hours)
	*Key distinguishing feature: painless vision loss in a quiet eye narrows the differential to primarily vascular and retinal etiologies		*Key distinguishing feature: painless vision loss in a quiet eye narrows the differential to primarily vascular and retinal etiologies
	*Always check visual acuity in both eyes as a baseline		*Always check visual acuity in both eyes as a baseline
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	===Physical Exam===		===Physical Exam===
	*Visual acuity (each eye independently) — document with Snellen chart or near card		*Visual acuity (each eye independently) — document with Snellen chart or near card
	*Pupillary exam: ~~'''~~relative afferent pupillary defect (RAPD/Marcus Gunn pupil)~~'''~~ present in optic nerve or extensive retinal pathology		*Pupillary exam: relative afferent pupillary defect (RAPD/Marcus Gunn pupil) present in optic nerve or extensive retinal pathology
	*Visual field testing by confrontation		*Visual field testing by confrontation
	*Extraocular movements		*Extraocular movements
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	===Vascular===		===Vascular===
	*~~'''~~[[Central retinal artery occlusion]]~~'''~~ (CRAO): painless sudden monocular vision loss, pale retina with cherry-red spot		*[[Central retinal artery occlusion]] (CRAO): painless sudden monocular vision loss, pale retina with cherry-red spot
	*~~'''~~[[Central retinal vein occlusion]]~~'''~~ (CRVO): painless monocular vision loss, "blood and thunder" fundus		*[[Central retinal vein occlusion]] (CRVO): painless monocular vision loss, "blood and thunder" fundus
	*~~'''~~[[Amaurosis fugax]]~~'''~~: transient monocular vision loss, carotid embolic source		*[[Amaurosis fugax]]: transient monocular vision loss, carotid embolic source
	*~~'''~~[[Giant cell arteritis]]~~'''~~ (GCA/temporal arteritis): vision loss (may be bilateral), headache, jaw claudication, elevated ESR/CRP		*[[Giant cell arteritis]] (GCA/temporal arteritis): vision loss (may be bilateral), headache, jaw claudication, elevated ESR/CRP
	*Ischemic optic neuropathy (anterior or posterior)		*Ischemic optic neuropathy (anterior or posterior)

	===Retinal===		===Retinal===
	*~~'''~~[[Retinal detachment]]~~'''~~: flashes, floaters, "curtain" over visual field, pigmented cells in vitreous		*[[Retinal detachment]]: flashes, floaters, "curtain" over visual field, pigmented cells in vitreous
	*~~'''~~[[Vitreous hemorrhage]]~~'''~~: sudden painless vision loss, absent red reflex, history of diabetes/trauma		*[[Vitreous hemorrhage]]: sudden painless vision loss, absent red reflex, history of diabetes/trauma

	===Neurologic===		===Neurologic===
	*~~'''~~[[Optic neuritis]]~~'''~~: painful eye movements, central vision loss, RAPD, associated with MS		*[[Optic neuritis]]: painful eye movements, central vision loss, RAPD, associated with MS
	*Stroke affecting visual cortex: binocular homonymous hemianopsia		*Stroke affecting visual cortex: binocular homonymous hemianopsia
	*Papilledema from elevated [[ICP]]: bilateral vision changes, headache		*Papilledema from elevated [[ICP]]: bilateral vision changes, headache
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	*'''Giant cell arteritis''': start high-dose IV [[methylprednisolone]] (1g/day) immediately if clinical suspicion high — do NOT wait for biopsy results		*'''Giant cell arteritis''': start high-dose IV [[methylprednisolone]] (1g/day) immediately if clinical suspicion high — do NOT wait for biopsy results
	**Temporal artery biopsy within 1-2 weeks (steroids do not affect biopsy for several days)		**Temporal artery biopsy within 1-2 weeks (steroids do not affect biopsy for several days)
	*~~'''~~Retinal detachment~~'''~~: emergent ophthalmology consultation for surgical repair		*Retinal detachment: emergent ophthalmology consultation for surgical repair
	**Macula-on detachments are more urgent (better visual outcomes with earlier repair)		**Macula-on detachments are more urgent (better visual outcomes with earlier repair)
	*~~'''~~Optic neuritis~~'''~~: neurology and ophthalmology consultation; high-dose IV corticosteroids may hasten recovery		*Optic neuritis: neurology and ophthalmology consultation; high-dose IV corticosteroids may hasten recovery

	===Non-Emergent===		===Non-Emergent===

← Older revision		Revision as of 04:40, 3 April 2019
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	==See Also==		==See Also==
	*[[Acute Onset Flashers and Floaters]]		{{Eye algorithms}}
	*[[Eye ~~Algorithms (Main)]]~~

	==References==		==References==