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SomeCausesofAcuteVisionLoss

Cause

SuggestiveFindings

DiagnosticApproach

Cause

SuggestiveFindings

DiagnosticApproach

Cause

SuggestiveFindings

DiagnosticApproach

Acutelossofvisionwithouteyepain

Acutelossofvisionwithouteyepain

Considerationof
Carotidultrasonography

Amaurosisfugax

Monocularblindnesslastingminutestohours(typically<5minwhendueto
cerebrovasculardisease)

Echocardiography
MRIorCT
ECG
Continuousmonitoringofcardiac
rhythm

Arteriticischemicoptic
neuropathy(usuallyinpatients
withgiantcell[temporal]
arteritis)

Functionallossofvision
(uncommon)

Sometimesheadache,jawortongueclaudication,temporalarterytenderness
ESR,Creactiveprotein(CRP),
orswelling,paleandswollendiskwithsurroundinghemorrhages,occlusionof
plateletcount
retinalarteryoritsbranches
Sometimesproximalmyalgiaswithstiffness(duetopolymyalgiarheumatica)
Normalpupillarylightreflexes,positiveoptokineticnystagmus,noobjective
abnormalitiesoneyeexamination
Ofteninabilitytowritenameorbringoutstretchedhandstogether
Sometimesindifferentaffectdespiteseverityofclaimedlossofvision

Macularhemorrhagedueto
neovascularizationinagerelated Bloodwithinordeeptoretinainandaroundthemacula
maculardegeneration

Nonarteriticischemicoptic
neuropathy

Clinicalevaluation
Ifdiagnosisisindoubt,
ophthalmologicevaluationand
visualevokedresponses

Clinicalevaluation

Opticdiskedemaandhemorrhages

ESR,CRP,andplateletcount

Sometimeslossofinferiorandcentralvisualfields

Considerationoftemporalartery
biopsytoexcludegiantcell
arteritis

Riskfactors(eg,diabetes,hypertension,hypotensiveepisode)

Ocularmigraine

Temporalarterybiopsy

Scintillatingscotomata,mosaicpatterns,orcompletelossofvisionlasting
usually1060minandoftenfollowedbyheadache

Clinicalevaluation

Ofteninyoungpatients
ESR,CRP,andplateletcountto
excludegiantcellarteritis
Carotidultrasonography
Retinalarteryocclusion

Nearlyinstantaneousonset,paleretina,cherryredfovea,sometimes
Hollenhorstplaque(refractileobjectatthesiteofarterialocclusion)
Riskfactorsforvasculardisease

Echocardiography
ConsiderationofMRIorCT
ECG
Continuousmonitoringofcardiac
rhythm

Cause

SuggestiveFindings

DiagnosticApproach

Recentincreaseinfloaters,photopsias(flashinglights),orboth
Retinaldetachment

Visualfielddefect,retinalfolds

Clinicalevaluation

Riskfactors(eg,trauma,eyesurgery,severemyopiainmen,advancedage)
Frequent,multiple,widelydistributedretinalhemorrhages
Retinalveinocclusion

Riskfactors(eg,diabetes,hypertension,hyperviscositysyndrome,sicklecell
anemia)

Clinicalevaluation

Carotidultrasonography

Transientischemicattackor

Bilaterallysymmetric(homonymous)fielddefects,noeffectonvisualacuityin Echocardiography
theintactpartsofthevisualfield(bilateraloccipitallesionsaretheexception
ConsiderationofMRIorCT

Transientischemicattackor
stroke

theintactpartsofthevisualfield(bilateraloccipitallesionsaretheexception
andareuncommonbutcanoccurduetobasilararteryocclusion)

ConsiderationofMRIorCT
ECG

Riskfactorsforatherosclerosis

Continuousmonitoringofcardiac
rhythm

Vitreoushemorrhage

Previousfloatersorspiderwebinvision
Riskfactors(eg,diabetes,retinaltear,sicklecellanemia,trauma)

Possibleocularultrasonography
toassessretina

Acutelossofvisionwitheyepain

Acuteangleclosureglaucoma

Cornealulcer

Endophthalmitis

Halosaroundlights,nausea,headache,photophobia,conjunctivalinjection,
cornealedema,shallowanteriorchamber,intraocularpressureusually>40

Ulcervisiblewithfluoresceinstaining,slitlampexamination,orboth
Riskfactors(eg,injury,contactlensuse)
Floaters,conjunctivalinjection,decreasedredreflex,hypopyon,ora
combination
Riskfactors(infectionaftereyesurgerytraumaticrupturedglobe,intraocular
foreignbody[eg,afterhammeringmetalonmetal],fungemia,orbacteremia)

Immediateophthalmologic
evaluation
Gonioscopy

Ophthalmologicevaluation

Immediateophthalmologic
evaluationwithculturesof
anteriorchamberandvitreous
fluids

Mildpainwitheyemovement,afferentpupillarydefect(occursearly)
Opticneuritis(usuallypainful
butnotalways)

Visualfielddefects,typicallycentral
Abnormalcolorvisiontestingresults

GadoliniumenhancedMRIto
diagnosemultiplesclerosisand
relateddisorders

Sometimesopticdiskedema
2016 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA