Sudden Loss of Vision: Or something else? Differential Diagnosis

Eyes and ocular appendages (H00-H59).

  • Ablatio retinae* * (Amotio retinae; retinal detachment) – acute, painless, unilateral loss of visual acuity; especially in elderly patients, retinal detachment is then suspected. Note: A vitreous hemorrhage can also cause acute unilateral visual deterioration.In central retinal artery occlusion (CAD), the unilateral visual loss typically sets in abruptly – in contrast to retinal detachment.
  • Acute transient bilateral diabetic cataract (transient bilateral cataract due to diabetes; sorbitol cataract)* * [visual loss].
  • Acute glaucoma* (glaucoma; acute angle-closure glaucoma); symptomatology: eye pain, nausea (nausea)/vomiting, usually unilateral eye redness, extremely hard eyeball, sudden loss of vision (seeing fog; seeing veils), seeing colored rings (halos); clinical findings: red eye with moderately wide, light-rigid pupils; eyes often appear dull and cloudy
  • Acute keratoconus (thinning and cone-shaped deformation of the cornea of the eye)* [visual loss].
  • Amaurosis fugax* * (temporary absence of light perception, in children; extremely rare) [sudden loss of vision in child]
  • Erosio corneae (corneal abrasion)* * [decrease in visual acuity]
  • Vitreous hemorrhage* * – acute, painless, unilateral loss of visual acuity; often underlying diabetic disease.
  • Iritis (inflammation of the iris)* [visual loss.]
  • Leber’s optic atrophy* * (synonyms: Leber’s hereditary optic neuropathy (LHON); Leber’s optic neuropathy; Leber’s hereditary optic atrophy; Leber’s optic atrophy) – rare hereditary disease of the ganglion cells of the optic nerve; occurrence with bilateral symptomatology [sudden loss of vision in a child.
  • Optic neuritis (neuritis nervi optici; optic neuritis).
  • Papillitis* – optic neuritis at its exit point from the eye bulb (optic papilla).
  • Uveitis posterior* * – inflammation of the choroid of the eye; in this case, the eye is not visibly reddened.
  • Occlusion of the central retinal artery* * (synonym: central retinal artery occlusion (ZAV); central retinal artery; retinal central artery occlusion; Engl. central retinal artery occlusion (CRAO)) – with subsequent ischemia (reduced blood supply) of the retina; only about 22% of patients show a spontaneous recovery of their visual acuity! Symptomatology: Sudden and painless highest such loss of visual acuity in one eye.
  • Occlusion of the vena centralis retinae* * (central retinal vein).
  • Retrobulbar neuritis* /* * – sometimes only a little eye pain, also possible without pain (synonym: neuritis nervi optici (NNO); optic neuritis): optic neuritis in the area behind the eyeball; can occur as an independent symptom (“clinically isolated syndrome”) or as an initial manifestation of multiple sclerosis (MS); distribution of unilateral to bilateral is 50: 50, with a slight tendency to unilateral expression [sudden loss of vision in children].

Cardiovascular system (I00-I99).

  • Apoplexy* * (stroke)
  • Moyamoya disease* * (from Jap. moyamoya “fog”) – disease of cerebral vessels in which there is narrowing or occlusion of cerebral arteries [sudden loss of vision in a child]; also occurs in an adult.

Musculoskeletal system and connective tissue (M00-M99).

  • Arteritis temporalis* (synonyms: Arteriitis cranialis; Horton’s disease; giant cell arteritis; Horton-Magath-Brown syndrome) – systemic vasculitis (vascular inflammation) affecting the arteriae temporales (temporal arteries), especially in the elderly; visual loss is painless, sudden, and irreversible [emergency! ]Note: unilateral visual loss is often not noticed; second eye may follow one to 10 days later. 60 to 90% of those affected complain of severe constant headache.Here, rapid action is required even before the biopsy result (see below of the disease of the same name).

Psyche – nervous system (F00-F99; G00-G99).

  • Anterior (anterior) ischemic optic neuropathy (AION)* * – acute occlusion of an ophthalmic artery supplying the optic nerve; arteriitic AION due to cranial arteritis is much less common than nAION (10%: 90% ratio) [ophthalmic emergency].
  • Epilepsy* * [sudden loss of vision in child]
  • Hysteria* *
  • Idiopathic intracranial hypertension* (IIH; synonym: Pseudotumor cerebri, PTC) – increased intracranial pressure without explanatory cause; 90% of patients suffer from headaches, these usually increase when bending forward, coughing or sneezing; in every second patient, papilledema (swelling (edema) at the junction of the optic nerve with the retina, which is noticeable as a protrusion of the optic nerve head; congestive papilledema i. R. bilateral); occurrence with bilateral ocular symptomatology [sudden loss of vision in child].
  • Cortical blindness* * – blindness caused by damage to the cerebral cortex.
  • Migraine* /* * [sudden loss of vision in a child.]
  • Psychogenic vision loss* * [sudden vision loss in child]
  • Damage to the optic nerve* * (optic nerve).
  • Subacute sclerosing panencephalitis (SSPE)* * – late complication after measles infection, which entails a generalized encephalitis (brain inflammation) with nerve demyelination (demyelination) and severe damage and always ends lethally (fatally) [sudden loss of vision in children].
  • Transient ischemic attack* * (TIA) – sudden circulatory disturbance of the brain, leading to neurological disorders that regress within 24 hours.

Environmental stress – intoxications (poisoning).

  • Quinine intoxication (quinine poisoning)

Injury, poisoning, and certain other sequelae of external causes (S00-T98).

  • “Minor head trauma “* * – acute cortical blindness resulting from vasospasm (“vascular spasm”); several hours after trauma [sudden loss of vision in child].
  • “Blinding “* [decrease in visual acuity]

Legend

  • In bold, diseases that are common.
  • * Painful visual disturbance
  • * * Painless visual disturbance
  • [sudden loss of vision in child]
  • [decrease in visual acuity]