Differential Diagnosis for Acute Painless Loss of Vision in Top Half of Visual Field
Single Most Likely Diagnosis
- Altitudinal Hemianopia due to Ischemic Optic Neuropathy: This condition is characterized by the sudden loss of vision in the upper or lower half of the visual field, often painless, and is commonly associated with ischemic optic neuropathy, particularly in older adults.
Other Likely Diagnoses
- Retinal Detachment: Although typically associated with symptoms like flashes and floaters, a retinal detachment can cause acute loss of vision, which might initially be perceived as affecting one half of the visual field.
- Branch Retinal Artery Occlusion: This condition leads to sudden, painless loss of vision, which can be limited to one half of the visual field, depending on the branch of the retinal artery affected.
- Optic Neuritis: While often associated with pain, some cases can be painless, and it can cause a variety of visual field defects, including altitudinal hemianopia.
Do Not Miss Diagnoses
- Giant Cell Arteritis: This is a critical diagnosis to consider because it can lead to permanent vision loss if not promptly treated. It often presents with sudden, painless loss of vision, but jaw claudication, scalp tenderness, and other systemic symptoms may also be present.
- Pituitary Apoplexy: Although less common, this condition can cause sudden visual loss, including defects in the visual field, and is a medical emergency due to potential hormonal deficiencies and mass effect.
Rare Diagnoses
- Chiasmal Syndrome due to Sellar or Suprasellar Mass: Lesions affecting the optic chiasm can cause a variety of visual field defects, including bitemporal hemianopia, but less commonly altitudinal defects. However, certain masses or lesions could potentially cause such a presentation.
- Migraine with Aura: While migraines are common, they rarely cause persistent, acute loss of vision in one half of the visual field without other symptoms like headache or typical aura phenomena.
- Inherited or Acquired Retinal Disorders: Certain retinal disorders can cause visual field defects, but these are less likely to present acutely and painlessly in one half of the visual field without prior symptoms or family history.