Sudden Loss of Vision: Symptoms, Complaints, Signs

The following symptoms and complaints may occur together with acute visual loss (sudden visual loss):

Leading symptom

• Acute visual loss (sudden loss of vision).

Associated symptoms

• Flashes of light
• Cephalgia (headache)
• Eye pain

Caveat!

• Mydriatic (pupil dilating agents) should not be used in the initial contact by the general practitioner, as it may distort the clinical picture.

Warning signs (red flags)

• Visual loss monocular (“affecting one eye”) → think of: Eye or optic nerve affected anterior to the chiasm.
• Cherry-red spot on the fovea centralis (visual fossa) → pathognomonic (evidence of disease) for retinal artery occlusion
• Light biltze → think of: Ablatio retinae (retinal detachment), vitreous hemorrhage, migraine, transitory ischemic attack (TIA; sudden circulatory disturbance of the brain leading to neurological disorders that regress within 24 hours) or apoplexy (stroke).
• Acute, painless, unilateral visual loss + elderly patient → Ablatio retinae (retinal detachment)Vitreous hemorrhage can also cause acute unilateral visual deterioration; often there is an underlying diabetic disease.In a central retinal artery occlusion (CAD), the unilateral visual loss typically – in contrast to the retinal detachment – abruptly.
• Headache → think of:
  • Acute glaucoma (acute angle-closure glaucoma; glaucoma attack).
  • Arteritis temporalis (synonyms: Arteriitis cranialis; Horton’s disease; giant cell arteritis; Horton-Magath-Brown syndrome) – systemic vasculitis (vascular inflammation) that affects the arteriae temporales (temporal arteries), especially in older people.
  • Apoplexy (stroke)
  • Ophthalmic migraine (synonyms: ophthalmic migraine; migraine ophtalmique) – variant of migraine in which transient, bilateral visual disturbances (flickering, flashes of light, scotomas (restrictions of the visual field); similar to a “normal” migraine with aura) occur; often without headache, but sometimes with headache, which sometimes occurs only after the visual disturbances; duration of symptoms usually 5-10 minutes, rarely longer than 30-60 minutes Retinal migraine, in which only the retina, i.e. the retina at the back of the eye, is affected, must be distinguished from ocular migraine. i.e., the retina at the back of the eye, is affected – variant of migraine in which completely reversible monocular (“affecting one eye”), positive and/or negative visual phenomena (flickering, scotomas, or blindness) occur; these occur together with headaches that begin while the visual disturbances are still present or follow within 60 minutes
• Painful eye (eye pain) → think of: acute glaucoma (acute angle-closure glaucoma; glaucoma attack).
• Ocular motility disturbed → think of: infra-/supranuclear paresis.