sudden, painless, unilateral vision loss
CRAO = central retinal artery occlusion
GCA = giant cell arteritis
LHON = Leber hereditary optic neuropathy
NAION = nonarteritic ischemic optic neuropathy
NMO = neuromyelitis optica
RAPD = relative afferent pupillary defect.
(a) With marked retinal diseases, an afferent pupillary defect can be present.
(b) CRAO, BRAO, macular ischemia.
(c) Retinal abnormalities may not be present.
(d) Mild optic disc swelling may be present, typically without peripapillary hemorrhages.
(e) Vision loss can be bilateral, recurrent, and often severe.
(f) Optic disc pseudoswelling and peripapillary telangiectasias may be present.
(g) Some may have macular star.
Nontraumatic causes of transient (<24h) monocular vision loss
- amaurosis fugax (usually minutes) — usually embolic or thrombotic; can occur secondary to hypoperfusion states, hyperviscosity or vasospasm.
- migraine (can be without headache)
- one eye closed!
- Uncommon causes include:
- papilloedema (may be associated with visual loss lasting seconds)
- other causes of ischemic optic neuropathy, e.g. giant cell arteritis
- impending central retinal vein occlusion (CRVO)
- glaucoma
- posterior reversible encephalopathy syndrome (PRES)
- large vessel occlusion or dissection, e.g. ocular ischemic syndrome (carotid occlusive disease), vertebrobasilar insufficiency, and carotid or vertebral artery dissection
- functional visual loss, e.g. hysteria, malingering
Nontraumatic causes of acute persistent monocular vision loss
- Painless acute persistent loss of vision:
- central retinal artery occlusion (CRAO)
- central retinal vein occlusion (CRVO)
- retinal detachment or hemorrhage
- vitreous hemorrhage
- optic or retrobulbar neuritis
- internal carotid artery occlusion
- Painful acute loss of vision:
- acute glaucoma
- endophalmitis
- uveitis
- keratoconus (vision can deteriorate rapidly and is associated with photophobia)
Nontraumatic causes of acute binocular loss of vision
- Transient
- migraine
- vertebrobasilar insufficiency (transient)
- Prolonged
- Stroke
- poisons/ toxic optic neuropathy (e.g. methanol, quinine, ethambutol, ergot alkaloids, salicylates)
- posterior reversible encephalopathy (PRES)
- optic or retrobulbar neuritis
- hysteria
- malingering
Post-traumatic causes of loss of vision (From ‘front to back’):
- lid injury
- orbital blow-out fracture
- corneal abrasion, irregularity or laceration
- hyphema
- traumatic mydriasis
- traumatic iritis
- ruptured globe
- traumatic cataract
- lens dislocation
- commotio retinae
- retinal detachment
- retinal or vitreous hemorrhage
- intra-ocular foreign body
- traumatic optic neuropathy or optic nerve avulsion
- CNS injury
