Differential Diagnosis for Unilateral Vision Loss with Loss of Color Perception

• Single Most Likely Diagnosis
  • Optic Neuritis: This condition is a common cause of unilateral vision loss and can lead to a decrease in color perception due to inflammation of the optic nerve. It often presents with pain on eye movement and can be associated with multiple sclerosis.
• Other Likely Diagnoses
  • Central Retinal Artery Occlusion (CRAO): This condition leads to sudden, painless loss of vision in one eye and can affect color perception. It is caused by an embolus or thrombus blocking the central retinal artery.
  • Retinal Detachment: While not always associated with loss of color perception, a retinal detachment can cause unilateral vision loss and may affect color vision if the macula is involved.
  • Ischemic Optic Neuropathy: This condition, often seen in older adults, can cause sudden vision loss in one eye and may affect color perception due to ischemia of the optic nerve head.
• Do Not Miss Diagnoses
  • Giant Cell Arteritis: Although less common, this condition can cause sudden, unilateral vision loss and is a medical emergency. It requires prompt treatment with corticosteroids to prevent further vision loss in the other eye.
  • Orbital Cellulitis or Abscess: Infections in the orbit can cause vision loss, including loss of color perception, and are medical emergencies requiring prompt antibiotic treatment and possibly surgical intervention.
• Rare Diagnoses
  • Leber's Hereditary Optic Neuropathy: A rare, inherited condition that primarily affects young men, leading to subacute, unilateral vision loss, including loss of color perception, due to mitochondrial DNA mutations.
  • Toxic or Nutritional Optic Neuropathy: Certain toxins (e.g., methanol, ethambutol) or nutritional deficiencies (e.g., vitamin B12 deficiency) can cause bilateral or unilateral optic neuropathy, affecting color vision.
  • Compressive Optic Neuropathy: Tumors or other masses compressing the optic nerve can cause gradual, unilateral vision loss, including changes in color perception.