Merck Manual

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Some Causes and Features of Sudden Loss of Vision

Some Causes and Features of Sudden Loss of Vision

Cause

Common Features*

Diagnosis †

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 MRI or CT

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)

Measurement of ESR (a blood test), C-reactive protein, and platelets

Sometimes MRI or CT

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)

A doctor's examination

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)

A doctor's examination

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

Sometimes MRI or CT

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

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

Often MRI

* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present.

† Although a doctor's examination is always done, it is only mentioned in this column if the diagnosis can sometimes be made only by the doctor's examination, without any testing. In other words, additional tests may not be needed.

CT = computed tomography; ECG = electrocardiography; ESR = erythrocyte sedimentation rate; MRI = magnetic resonance imaging.