Some Causes and Features of Sudden Loss of Vision
Cause | Common Features* | Diagnostic Approach |
|---|---|---|
Sudden loss of vision without eye pain | ||
Sudden, brief loss of vision in one eye resulting from a transient ischemic attack (called amaurosis fugax) | Blindness in one eye lasting minutes to hours Sometimes a normal eye examination | A doctor's examination MRI or CT of the brain Ultrasonography of the carotid arteries Echocardiogram (ultrasound of the heart) ECG Continuous monitoring of heart rhythm |
Blockage of the central retinal artery (the artery that carries blood to the retina) | Almost instantaneous, complete loss of vision in one eye In people with risk factors for atherosclerosis (such as high blood pressure, abnormal blood lipids, or cigarette smoking) | A doctor's examination Measurement of ESR (a blood test), C-reactive protein, and platelets Sometimes, MRI or CT of the brain Ultrasonography of the carotid arteries Echocardiogram (ultrasound of the heart) ECG Continuous monitoring of heart rhythm (Holter monitor) |
Blockage of the central retinal vein (the vein that carries blood away from the retina) | In people with risk factors for this disorder (such as diabetes, high blood pressure, a tendency for blood to clot excessively, or sickle cell disease) | A doctor's examination |
Vitreous hemorrhage (bleeding into the vitreous humor—the jellylike substance that fills the back of the eyeball) | In people who have had specks, strings, or cobwebs in their field of vision (floaters) or who have risk factors for vitreous hemorrhage (such as diabetes, a tear in the retina, sickle cell disease, or an eye injury) Usually loss of the entire field of vision (not in just one or more spots) | Examination by an ophthalmologist Sometimes, ultrasonography of the retina |
Giant cell (temporal) arteritis (inflammation of the large arteries of the head, neck, and upper body), which can block blood flow to the optic nerve | Sometimes headache, pain while combing the hair, or pain in the jaw or tongue when chewing Sometimes aches and stiffness in the large muscles of the arms or legs (polymyalgia rheumatica) | Measurement of ESR, C-reactive protein, and platelets Biopsy of the temporal artery |
Ischemic optic neuropathy (damage of the optic nerve caused by blockage of its blood supply) | In people with risk factors for this disorder (such as diabetes or high blood pressure) or in people who have had an episode of very low blood pressure, which sometimes causes fainting | A doctor's examination Measurement of ESR, C-reactive protein, and platelets Sometimes, biopsy of temporal artery Sometimes, carotid artery Doppler (ultrasound of the neck veins) and echocardiogram (ultrasound of the heart) |
Macular hemorrhage (bleeding around the macula—the most sensitive part of the retina) resulting from age-related macular degeneration | Usually in people known to have age-related macular degeneration or in people with risk factors for blood vessel disorders (such as high blood pressure, cigarette smoking, or abnormal blood lipids) | Examination by an ophthalmologist |
Ocular migraine (migraines that affect vision) | Shimmering, irregular spots that drift slowly across the field of vision of one eye for about 10 to 20 minutes Sometimes blurring of central vision (what a person is looking at directly) Sometimes a headache after the disturbances in vision Often in young people or in people known to have migraines | A doctor's examination |
Sudden, spontaneous flashes of light that can look like lightning, spots, or stars (photopsias) that occur repeatedly Loss of vision that affects one area, usually what is seen out of the corners of the eye (peripheral vision) Loss of vision that spreads across the field of vision like a curtain Sometimes in people with risk factors for detachment of the retina (such as a recent eye injury, recent eye surgery, or severe nearsightedness) | Examination by an ophthalmologist Sometimes, ultrasound of the eye | |
Usually loss of the same parts of the field of vision in both eyes In people with risk factors for these disorders (such as high blood pressure, atherosclerosis, diabetes, abnormal blood lipids, and cigarette smoking) Sometimes slurred speech, impaired eye movements, muscle weakness, and/or difficulty walking | A doctor's examination MRI or CT of the brain ECG Ultrasonography of the carotid arteries Echocardiogram (ultrasound of the heart) Continuous monitoring of heart rhythm | |
Sudden loss of vision with eye pain | ||
Severe eye ache and redness Headache, nausea, vomiting, and sensitivity to light Disturbances in vision such as seeing halos around lights | Measurement of pressure inside the eye (tonometry) Examination of eye's drainage channels with a special lens (gonioscopy), done by an ophthalmologist | |
Corneal ulcer (usually caused by bacterial or viral infection) | Often a grayish patch on the cornea that later becomes an open, painful sore Eye ache or a foreign object (body) sensation Eye redness and watering Sensitivity to light Sometimes in people who have an infection after an eye injury or who have slept with their contact lenses in | A doctor's examination Culture of a sample taken from the ulcer, done by an ophthalmologist |
Severe eye pain and redness Sensitivity to light Floaters Swollen eyelid Sometimes after eye surgery, recent injury to the eye, foreign object in the eye (for example, after hammering metal on metal), or fungal or bacterial infection of the eye surface | Immediate examination by an ophthalmologist Cultures of fluids from the eye by an ophthalmologist | |
Optic neuritis (inflammation of the optic nerve), which can be related to multiple sclerosis | Usually mild pain that may worsen when the eyes are moved Partial or complete loss of vision Eyelids and corneas that appear normal | A doctor's examination Often, MRI |
* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. CT = computed tomography; ECG = electrocardiography; ESR = erythrocyte sedimentation rate; MRI = magnetic resonance imaging. | ||