Differential Diagnosis for Painless Sudden Change in Vision

Described as Wax Paper Over Eye

• Single Most Likely Diagnosis

  • Vitreous Detachment: This condition is characterized by the separation of the vitreous gel from the retina, which can cause sudden, painless visual disturbances, including a sensation like looking through wax paper or a veil. It's a common condition, especially in older adults or those who are nearsighted.

• Other Likely Diagnoses

  • Retinal Vein Occlusion: This condition involves blockage of the small veins that carry blood away from the retina, leading to sudden vision loss in one eye, which might be described as a curtain or veil over the vision.
  • Macular Edema: Fluid accumulation in the macula (the part of the retina responsible for central vision) can cause sudden, painless vision changes, including blurred or distorted vision.
  • Posterior Vitreous Detachment (PVD) with Floaters: While often asymptomatic, some individuals may notice a sudden increase in floaters or a shadow in their vision, which could be described similarly to looking through wax paper.

• Do Not Miss Diagnoses

  • Retinal Detachment: A medical emergency where the retina separates from the back of the eye. Symptoms can include sudden flashes of light, a significant increase in eye floaters, and a shadow or curtain descending over the field of vision. Missing this diagnosis can lead to permanent vision loss.
  • Central Retinal Artery Occlusion (CRAO): A blockage of the central retinal artery, leading to sudden, painless loss of vision in one eye. Prompt treatment is necessary to attempt to restore vision.
  • Giant Cell Arteritis: An inflammation of the arteries that can lead to sudden vision loss if the arteries supplying the optic nerve or retina are affected. It's crucial to diagnose and treat promptly to prevent further vision loss.

• Rare Diagnoses

  • Ocular Migraine: Also known as retinal migraine, this condition can cause temporary, painless vision loss or disturbances in one eye, which might be described as looking through a veil or wax paper.
  • Optic Neuritis: Inflammation of the optic nerve, which can cause painless vision loss, though it's more commonly associated with pain on eye movement. It's less common but should be considered, especially in younger patients or those with a history of demyelinating diseases like multiple sclerosis.