Differential Diagnosis for Bilateral Acute Painless Vision Loss
- Single most likely diagnosis
- Bilateral optic neuritis: This condition is characterized by inflammation of the optic nerves, leading to vision loss. It is often associated with multiple sclerosis but can occur independently. The painless nature of the vision loss and its bilateral presentation make optic neuritis a strong candidate.
- Other Likely diagnoses
- Ischemic optic neuropathy: This condition involves a sudden loss of blood flow to the optic nerves, which can cause painless vision loss. It is more common in older adults and those with vascular risk factors.
- Papilledema: Increased intracranial pressure can cause swelling of the optic discs (papilledema), leading to bilateral vision loss. This condition can be painless and is often associated with headaches.
- Toxic or nutritional optic neuropathy: Certain toxins (e.g., methanol, ethambutol) and nutritional deficiencies (e.g., vitamin B12 deficiency) can cause bilateral optic neuropathy, leading to painless vision loss.
- Do Not Miss diagnoses
- Giant cell arteritis: Although this condition often presents with headache and jaw claudication, it can cause sudden, painless vision loss in one or both eyes due to ischemia of the optic nerves. Missing this diagnosis can result in permanent vision loss.
- Stroke or cerebral vasculitis: These conditions can cause vision loss due to damage to the visual pathways in the brain. While they may present with other symptoms, the vision loss itself can be painless.
- Rare diagnoses
- Leber's hereditary optic neuropathy: A rare, inherited condition that causes progressive vision loss, often in young adults. While it typically starts in one eye, it can affect both eyes and may present acutely.
- Neuromyelitis optica: An autoimmune condition that can cause optic neuritis and vision loss, often accompanied by spinal cord inflammation. It is less common than multiple sclerosis but can have a more severe course.
- Sarcoidosis: A systemic inflammatory disease that can affect the optic nerves and cause vision loss. It is a rare cause of bilateral acute painless vision loss but should be considered in the appropriate clinical context.