II. Differential Diagnosis: Acute Vision Loss based on pain
- Painful Vision Loss or Blurred Vision
- Eye Injury
- Corneal Ulcer
- Acute Angle-Closure Glaucoma (esp. if Intraocular Pressure >60 mmHg)
- Iritis and Uveitis (anterior chamber exudates)
- Endophthalmitis (vitreous exudates)
- Painless (or Minimal or variable pain) Vision Loss or Blurred Vision
- Optic Neuritis, retrobulbar Optic Neuritis or Papillitis (associated with Multiple Sclerosis)
- Eye movement may be painful
- Retinal Detachment
- Ocular tumor
- Central Retinal Artery Occlusion (pale fundus with cherry red Macula)
- Acute Maculopathy
- Pseudotumor Cerebri (or other cause of Increased Intracranial Pressure)
- Associated with Headache
- Transient Monocular Blindness (Amaurosis Fugax)
- Retinal Hemorrhage
- Optic Neuritis, retrobulbar Optic Neuritis or Papillitis (associated with Multiple Sclerosis)
III. Differential Diagnosis: Acute Unilateral Vision Loss
- Transient
- Persistent
- Acute Angle-Closure Glaucoma
- Central Retinal Artery Occlusion
- Central Retinal Vein Occlusion
- Retinal Detachment (later)
- Optic Neuritis (Multiple Sclerosis)
- Ischemic Optic Neuropathy
- Nonarteritic anterior optic Neuropathy (see Medications with Adverse Ocular Effects)
- Eye Trauma
- Tumor
- Vitreous Hemorrhage
- Occipital cortex infarction (vertebrobasilar thromboembolic event)
- Endophthalmitis
- Keratopathy
- Acute Maculopathy
- Psychogenic visual loss
IV. Differential Diagnosis: Acute Bilateral Vision Loss or Blurred Vision
- Transient
- Migraine Headache aura
- Congestive Heart Failure
- Hypertensive Emergency
- Severe bilateral Carotid Artery Stenosis
- Transient Ischemic Attack involving visual cortex (Hemianopsia)
- Pseudotumor Cerebri (or other cause of Increased Intracranial Pressure)
- Persistent
- Cerebrovascular Accident involving visual cortex (Hemianopsia)
- Bilateral Occipital Lobe ischemia
- Temporal Arteritis (Giant Cell Arteritis)
- Lymphoma
- Posterior ischemic Neuropathy
V. Risk Factors: Acute Vision Loss predisposing factors
- Diabetes Mellitus
- Hypertension
- Hyperlipidemia
- Hypercoagulable States
- Cardiac Arrhythmias (esp. Atrial Fibrillation, risk of embolic Retinal Artery Occlusion or CVA)
- Carotid Insufficiency
- Glaucoma
- Migraine Headaches
- Severe Myopia or Nearsightedness (Retinal Detachment)
- Recent intraocular procedures (including injections)
- Endophthalmitis
- Hypotony Maculopathy
- Choroidal effusion
VI. History
- Timing: Red flags for urgent referral
- Very recent onset of Vision Loss (hours)
- Progressive symptoms
- First episode
- Sudden onset (Hemorrhage, ischemia)
- Lesion localization
- Monocular or binocular?
- Monocular: Ocular or Optic Nerve lesion
- Binocular: Optic Chiasm and posterior back to Occipital Lobe lesion
- Focal Visual Field Deficit?
- Retina and posterior back through Optic Nerve and Occipital Lobe (post-chiasm)
- Retinal Detachment (unilateral progressive loss peripheral to central)
- Amaurosis Fugax (Temporal Arteritis with transient curtain-like closure
- Branch Retinal Artery Occlusion (BRAO)
- Cerebrovascular Accident (bilateral field deficit, Hemianopia)
- Periocular pain?
- Anterior eye or Optic Nerve lesion (requires Trigeminal Nerve sensitization)
- Acute Angle-Closure Glaucoma
- Uveitis
- Endophthalmitis
- Optic Neuritis (pain with eye movement, painless at rest)
- Disproportionate change in color Perception
- Optic Neuritis (red color desaturation)
- Monocular or binocular?
- Associated symptoms
- Nausea or Vomiting with Eye Pain
- Acute angle closure Glaucoma
- Flashes or Floaters
- Associated neurologic deficits
- Cerebrovascular Accident or other systemic cause
- Headache
- Optic Neuritis
- Migraine Headache with aura
- Pseudotumor Cerebri (Idiopathic Intracranial Hypertension)
- Temporal Arteritis (temporal Headache, Jaw Claudication, scalp tenderness)
- Nausea or Vomiting with Eye Pain
VII. Exam
-
Visual Acuity (perform with prescription lenses for distance)
- Snellen Chart
- Consider Pinhole Test for Visual Acuity in a patient who did not bring their glasses to evaluation
- Finger Counting (CF) at 1 foot and at 6 inches
- Hand Movements (HM)
- Light Perception (LP)
- No light Perception (NLP): total blindness
- Snellen Chart
-
Ciliary Flush
- Diffuse Corneal haze
- Acute angle closure Glaucoma
- Corneal opacities (especially with Fluorescein uptake)
- Diffuse Corneal haze
-
Visual Field Deficit
-
- Monocular Blindness
-
Homonymous Hemianopia (field cut affects both eyes in same region)
- Occipital lesion
-
Bitemporal Hemianopia
- Bilateral peripheral Vision Loss suggests Optic Chiasm lesion
-
-
Pupil abnormality
- Mid-dilated non-reactive pupil
- Relative Afferent Pupillary Defect (sluggish or absent pupil response to light, but consensual reflex)
-
Funduscopic Exam
-
Retinal Detachment
- Affected Retina will have the pale billowing appearance of a parachute
- In non-dilated Eye Exam, Ocular Ultrasound has better sensitivity
- Red Reflex absent or dulled
- Cherry red spot (red Macula)
- Retinal Hemorrhage
- Optic Disc swelling
-
Retinal Detachment
VIII. Management
- Rapid assessment and management if acute CNS event is suspected
- Indications for emergent referral to ophthalmology
- Keratitis
- Endophthalmitis
- Retinal Detachment
- Retinal Hemorrhage or Vitreous Hemorrhage
- Optic Neuritis
- Occipital infarction
- Central Retinal Artery Occlusion
- Acute angle closure Glaucoma
- Ischemic Optic Neuropathy
- Conditions with specific immediate temporizing measures by emergency provider
- Central Retinal Artery Occlusion
- Acute angle closure Glaucoma
- Ischemic Optic Neuropathy
IX. References
- Hartmann (2016) Crit Dec Emerg Med 30(6): 3-11
- Trobe (2012) Physician Guide to Eye Care, p. 31-35
- Fraser (2025) Am Fam Physician 111(1): 54-61 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Sign or Symptom (T184) |
| ICD9 | 368.11 |
| ICD10 | H53.13 , H53.139 |
| SnomedCT | 155140002, 267724006, 282611000009101, 15203004 |
| Spanish | Pérdida visual repentina, pérdida visual súbita (trastorno), pérdida visual súbita |
| Italian | Perdita visiva improvvisa |
| French | Perte subite de la vision |
| Dutch | plots gezichtsverlies, plotseling; blindheid, plotseling; verlies gezichtsvermogen, verlies; gezichtsvermogen, plotseling, visus; verlies, plotseling |
| German | ploetzlicher Sehverlust |
| Portuguese | Défice visual súbito |
| Japanese | 突然視力消失, ﾄﾂｾﾞﾝｼﾘｮｸｼｮｳｼﾂ |
| Czech | Náhlá ztráta zraku |
| English | Sudden visual loss, unspecified eye, sudden visual loss, acute vision loss, blindness sudden, sudden vision loss, sudden blindness, sudden loss of vision, acute loss vision, Acute blindness, Sudden blindness (disorder), Sudden blindness, Sudden visual loss, Sudden visual loss (disorder), loss; vision, sudden, sudden; blindness, sudden; visual loss, vision; loss, sudden |
| Hungarian | Hirtelen látásvesztés |
Ontology: Blindness of one eye (disorder) (C0271240)
| Concepts | Disease or Syndrome (T047) |
| ICD10 | H54.4 |
| SnomedCT | 22950006, 155149001, 193733003, 267728009 |
| English | Blindness, one eye, unspecified, Blindness,one eye, unspecified, Blindness, one eye, Blind/low vision -one eye only, Blindness of one eye (disorder), Blindness unilateral, blindness one eye, unilateral blindness, Blindness;one eye, blinding eye, one eye blindness, blind eye, Blindness, unilateral, Blindness, one eye, unspecified (disorder), Unilateral blindness, Blind eye, Blind or low vision - one eye only, Blind or low vision - one eye only (disorder), Blindness of one eye, blindness; one eye, one eye; blindness, Blindness of one eye, NOS |
| Italian | Cecità monolaterale, Cecità in un occhio |
| Dutch | blindheid een oog, unilaterale blindheid, blindheid; één oog, één oog; blindheid, Blindheid van n oog p, blindheid unilateraal |
| French | Cécité d'un oeil, Cécité unilatérale |
| German | Blindheit, ein Auge, einseitige Blindheit, Blindheit eines Auges, Blindheit ein Auge |
| Portuguese | Cegueira de um olho, Cegueira unilateral |
| Spanish | Ceguera de un ojo, ceguera unilateral, ceguera, un ojo, no especificada (trastorno), ceguera, un ojo, no especificada, ceguera de un ojo (trastorno), ceguera de un ojo, ceguera o visión escasa - sólo un ojo (trastorno), ceguera o visión escasa - sólo un ojo, Ceguera unilateral |
| Japanese | 片側失明, 失明、片眼, ﾍﾝｿｸｼﾂﾒｲ, ｼﾂﾒｲﾍﾝｶﾞﾝ |
| Czech | Jednostranná slepota, Unilaterální slepota, Nevidomost, jedno oko |
| Korean | 편안 실명 |
| Hungarian | Vakság, egy szemen, Egyoldali amaurosis |
Ontology: Blurred vision (C0344232)
| Definition (CHV) | finding |
| Definition (CHV) | finding |
| Definition (CHV) | finding |
| Definition (CHV) | finding |
| Definition (CHV) | finding |
| Definition (CHV) | finding |
| Definition (CHV) | finding |
| Definition (CHV) | finding |
| Definition (CHV) | finding |
| Definition (CHV) | finding |
| Definition (CHV) | finding |
| Definition (CHV) | finding |
| Definition (NCI_CTCAE) | A disorder characterized by visual perception of unclear or fuzzy images. |
| Definition (NCI) | Blurred vision is the loss of visual acuity (sharpness of vision) resulting in a loss of ability to see small details. (from MedlinePlus Medical Encyclopedia) |
| Concepts | Sign or Symptom (T184) |
| SnomedCT | 111516008, 267629007, 193695001, 155145007, 267726008, 246636008, 111517004 |
| LNC | LA15105-2 |
| English | VISION BLURRED, blurred vision, blurry vision (symptom), blurry vision, foggy vision (symptom), foggy vision, Blurring of eyes, Blurring of vision, Vision blurred, Blurry vision, cloudy vision, blurred eyes, blurring vision, Blurred;vision, vision blurry, hazy vision, blur vision, blurred eye, blur eyes, eye blur, blurring of vision, vision blur, vision blurred, Blurred vision NOS (disorder), Dull vision NOS, Cloudy vision NOS, VISION, BLURRING OF, BLURRING, BLURRED VISION, Filmy vision, Blurred vision - hazy, Cloudy vision, Foggy vision, Hazy vision, Misty vision, Blurring of visual image, Mist over eyes, Blurring of visual image (finding), Hazy vision (disorder), blurred; vision, vision; blurred, Blurred vision, NOS, Blurred Vision, Blurred vision, Blurred vision NOS |
| Italian | Visione offuscata, Annebbiamento della vista, Visione appannata, Occhi annebbiati, Visione annebbiata, Offuscamento della vista |
| Dutch | wazigzien, wazig gezichtsvermogen, vaag zien, troebel gezichtsvermogen, wazig voor de ogen, wazig zien, visus; wazig, wazig; visus, gezichtsvermogen wazig |
| French | Vision floue, Vision brouillée, Trouble de la vision, Yeux troubles, BAISSE DE VISION, Vision trouble |
| German | verschwommenes Sehen, verschwommener Seheindruck, Sehen durch einen Film, dunstiges Sehen, nebelhaftes Sehen, SEHEN VERSCHWOMMEN, Sehen verschwommen |
| Portuguese | Turvação da vista, Visão enevoada, Visão velada, VISAO TURVA, Visão turva |
| Spanish | Visión confusa, Borrosidad de ojos, Visión nebulosa, Visión ensombrecida, visión nebulosa, VISION BORROSA, visión borrosa, SAI (trastorno), visión borrosa, SAI, Visión borrosa, visión borrosa (hallazgo), visión borrosa, visión nebulosa (trastorno), imagen visual borrosa (hallazgo), imagen visual borrosa, visión borrosa (trastorno) |
| Japanese | 霧視, かすみ目, ｶｽﾐﾒ, ﾑｼ |
| Czech | Zamlžené vidění, Mlhavé vidění, Zastření zraku, Rozmazané vidění, Pocit mlhy před očima |
| Hungarian | Homályos látás, Életlen látás, Fátyolos látás, Ködös látás, Látás, homályos, Homályos szemek, Látás homályosodása |
Ontology: Blind Vision (C0456909)
| Definition (NCI) | The lack of vision. It is caused by neurological or physiological factors. |
| Definition (MSH) | The inability to see or the loss or absence of perception of visual stimuli. This condition may be the result of EYE DISEASES; OPTIC NERVE DISEASES; OPTIC CHIASM diseases; or BRAIN DISEASES affecting the VISUAL PATHWAYS or OCCIPITAL LOBE. |
| Definition (CSP) | inability to see or the loss or absence of perception of visual stimuli; condition may be the result of eye, optic nerve, optic chiasm or brain diseases effecting the visual pathways or occipital lobe. |
| Concepts | Finding (T033) |
| MSH | D001766 , D015354, D014786 |
| SnomedCT | 40031005, 139548004, 277675000, 397540003 |
| LNC | LA17710-7 |
| English | Blindness, BLINDNESS, Cannot see, Loss of vision, Unable to see, UTS - Unable to see, Blind Vision, Blindness [Disease/Finding], blindness, blind, blind vision, Blindness NOS, Blindness (finding), Blind (finding), Blind, Blindness, NOS |
| French | CECITE, Cécité SAI, Aveugle, Déficience de la vision, Déficience visuelle, Cécité, Vision basse, Non-voyance, Vision diminuée, Vision faible, Vision réduite |
| Portuguese | CEGUEIRA, Cegueira NE, Cego, Cegueira |
| Spanish | CEGUERA, Ceguera NEOM, Ciego, ciego, ciego (hallazgo), ceguera (trastorno), ceguera, Ceguera |
| German | BLINDHEIT, Blindheit NNB, blind, Blindheit, Sehverlust, Sehschwäche, Sehvermögen, herabgesetztes, Sehvermögen, vermindertes |
| Dutch | blindheid NAO, blind, Blindheid, laag; visus, blindheid, Amaurose |
| Italian | Cieco, Cecità NAS, Visione ridotta, Ipovisione, Cecità |
| Japanese | 失明ＮＯＳ, ｼﾂﾒｲ, ｼﾂﾒｲNOS, 視覚消失症, 盲, 亜正常視覚, 黒内障, 失明, 低視力, 低視覚, ロービジョン, 視覚-亜正常, 視覚-低 |
| Swedish | Blindhet |
| Czech | slabozrakost, zrak subnormální, slepota, vidění snížené, Nevidomý, Slepota, Nevidomost NOS |
| Finnish | Sokeus, Heikentynyt näkö |
| Russian | AMAVROZ, SLEPOTA, ZRENIE PONIZHENNOE, ZRENIE SUBNORMAL'NOE, SLEPOTA TSENTRAL'NOGO PROISKHOZHDENIIA, АМАВРОЗ, ЗРЕНИЕ СУБНОРМАЛЬНОЕ, СЛЕПОТА, СЛЕПОТА ЦЕНТРАЛЬНОГО ПРОИСХОЖДЕНИЯ |
| Croatian | SLJEPOĆA |
| Polish | Ślepota, Obniżenie jakości widzenia, Wzrok słaby, Wzrok subnormalny, Widzenie obniżone |
| Hungarian | Vakság, Amaurosis k.m.n., Vak |
| Norwegian | Redusert synsevne, Blindhet, Synshemning, Svekket syn, Nedsatt syn, Synssvekkelse, Svakt syn, Synsnedsettelse |
