From the Guidelines
Sudden vision loss requires immediate medical attention as it could indicate serious conditions like retinal detachment, stroke, or glaucoma.
Assessment and Diagnosis
First, assess the extent and nature of vision loss—whether it's complete or partial, in one or both eyes, and if it occurred gradually or suddenly.
- Seek emergency care immediately rather than attempting self-diagnosis.
- At the hospital, healthcare providers will conduct a comprehensive eye examination including:
- Visual acuity testing
- Pupillary response assessment
- Intraocular pressure measurement
- Examination of the retina and optic nerve They may also order imaging studies like CT or MRI scans, blood tests to check for inflammatory conditions, and possibly a fluorescein angiography to evaluate blood flow in the retina 1.
Treatment and Management
Treatment depends on the underlying cause—for example:
- Acute angle-closure glaucoma requires immediate pressure-lowering medications like timolol 0.5% eye drops and oral acetazolamide 500mg
- Giant cell arteritis might need high-dose corticosteroids like prednisone 60-100mg daily The prognosis varies significantly based on the cause and how quickly treatment begins, which is why immediate medical attention is crucial—delay can result in permanent vision loss 1. Immediate referral to a stroke center or emergency department is necessary for patients with suspected central retinal artery occlusion (CRAO) or other acute retinal ischemic events. Multidisciplinary collaboration among a neurologist, an ophthalmologist, and a primary care physician or an internist is essential for optimal management of these patients 1.
From the Research
Assessing Sudden Vision Loss in the Eye
To assess sudden vision loss in the eye, several key factors and conditions must be considered:
- The presence of pain or discomfort in the eye
- Inflammation or redness of the eye
- The extent and characteristics of vision loss (e.g., transient, prolonged, curtain-like visual field defect)
- Patient's medical history, including vascular risk factors and age
Common Causes of Sudden Vision Loss
Some common and dangerous conditions that can cause sudden vision loss include:
- Acute angle-closure glaucoma, characterized by ocular pain, headache, and nausea 2
- Retinal detachment, presenting with a curtain-like visual field defect 2
- Retinal artery occlusion, causing painless vision loss in patients with vascular risk factors 2, 3
- Giant cell arteritis, suspected in patients older than 50 years with scalp tenderness, jaw claudication, and elevated inflammatory markers 2
- Optic neuritis, a demyelinating condition featuring color desaturation, relative afferent pupillary defect, and pain with extraocular muscle movements 2
Diagnostic Approach
A diagnostic approach to sudden vision loss involves:
- History and examination, particularly ophthalmoscopy, to assist in diagnosing the cause 4
- Judicious use of serological and imaging investigations to guide appropriate treatment and referral 5
- Consideration of the need for urgent ophthalmic assessment and timely investigation pathway or referral 5
Management of Sudden Vision Loss
Management of sudden vision loss depends on the underlying cause and may involve:
- Treatment with pilocarpine eye drops, oral or intravenous acetazolamide, and intravenous mannitol for acute angle-closure glaucoma 2
- Surgical intervention for retinal detachment 2
- Prevention of vision loss in the other eye for retinal artery occlusion 2, 3
- Empiric steroids and referral for a temporal artery biopsy for giant cell arteritis 2
- High-dose steroids and evaluation for multiple sclerosis for optic neuritis 2
- Intra-arterial thrombolysis for central retinal artery occlusion, although its efficacy and safety are still being investigated 6