Vision loss
Synonyms and keywords: Visual loss

# Overview
Vision loss  is the absence of vision where it existed before, which can happen either acutely (i.e. abruptly) or chronically (i.e. over a long period of time). It may be caused by media opacities, retinal disease, optic nerve disease, visual pathway disorders, or functional disorders, or it may be due to an abnormality in the central nervous system.

# Classification
In order to gain insight into the pathophysiology of vision loss which will in turn guide treatment decisions, the signs and symptoms should be characterized:
- Unilateral
- Bilateral
- Transient
- Persistant
- Sudden
- Gradual
- Painless
- Painful

# Pathophysiology

## Media Opacity
Opacities of the clear refractive media of the eye such as the cornea, anterior chamber, lens, and vitreous humor may cause acute visual loss as manifested by blurry vision or reduced visual acuity.
While pupillary reflexes may be affected, these conditions generally do not cause a relative afferent pupillary defect.
Causes of media opacity include corneal edema, hyphema, cataract and vitreous hemorrhage.

## Retinal Disease
Retinal diseases may cause sudden visual loss.
Because the retina is being affected, there is usually a concomitant relative afferent pupillary defect.
Conditions that affect or destroy the retina include retinal detachment; macular disease (e.g., macular degeneration); and retinal vascular occlusions, the most important of which is central retinal artery occlusion.

## Optic Nerve Disease
Diseases which affect the optic nerve may cause acute visual loss.
Signs include an abnormal pupillary reflex, with an afferent pupillary defect when the optic nerve disease is unilateral.
The optic nerve can be affected by many diseases including optic neuritis, retrobulbar neuritis, papillitis, papilledema, glaucoma, ischemic optic neuropathy, and giant cell arteritis.

## Hypoxia
The eye is very sensitive to restriction of its supply of oxygen.  A dimming of vision (a brownout or greyout) accompanied by loss of peripheral perception may result from low blood pressure, shock, g-LOC (an aviation related problem) or simply standing up suddenly, especially if sick or otherwise infirm.  Vision usually returns readily once the conditions restricting blood flow are lifted.

## Visual Pathway Disorder
Visual pathway disorders are any problems that may impede the visual pathway.
Rarely, acute visual loss is caused by homonymous hemianopia and, more rarely, cortical blindness.

## Functional Disorder
The term functional disorder  is now used where hysterical and malingering were historically used.
This shift recognizes the inherent inability of the physician to identify the subjective experience of a patient (and thus whether that patient can truly see or not).

# Causes

## Transient Vision Loss (<24 hours)
- Amaurosis fugax
- Vision loss is unilateral and lasts only minutes
- Migrane
- Vision loss lasts 10-60 minutes
- Ocular ischemic syndrome (Cartoid Occlusive Disease)
- Papilledema
- Raised intracranial pressure
- Malignant hypertension
- Retinal detachment
- Sudden change in blood pressure
- Orthostatic hypotension
- Transient acute increase in thraocular pressure
- Acute Angle Closure Glaucoma
- Retro-or peribulbar hemorrhage
- Vertebrobasilar artery insufficiency
- Vision loss is bilateral and lasts minutes
- Vitreous hemorrhage
- Vitreous detachment

## Vision Loss > 24 hours:Sudden, Painless
- Exposure(Welder's flash)
- prolonged exposure to intense light/sunlight
- Ischemic optic neuropathy
- To prevent permanent loss, rule out giant cell/temporal arteritis
- Other retinal or central nervous system disease
- Occipital lobe CVA causing cortical blindness
- Optic Neuritis
- Retinal artery/vein occlusion
- Retinal detachment
- Vitreous or aqueous hemmorrhage (hyphema)

## Vision Loss >24 hours:Gradual, Painless
- Cataracts
- Cerebral Neoplasm
- Chronic retinopathy
- Age related macular degeneration
- Diabetic Retinopathy
- Chronic corneal disease
- Corneal dystrophy
- Corneal Ulcer
- Open angle Glaucoma
- Optic neuropathy/atrophy
- Compressive lesion
- Toxic-metabolic cause
- Radiation
- Pseudotumor cerebri
- Refractive error
- Retitnitis pigmentosa

## Vision Loss >24 hours:Painful
- Acute Angle Closure Glaucoma
- Corneal hydrops
- Keratoconus
- Corneal abrasion/ulcer
- Herepes simplex/zoster
- Ocular onchocerciasis
- "River blindness"
- Onchocera volvulus worm
- Optic neuritis
- Orbital apex/superior orbital fissure/cavernous sinus syndrome
- Uveitis

## Life-Threatening Causes

## Common Causes

## Causes by Organ System

## Causes in Alphabetical Order
- 13q deletion syndrome
- 2-hydroxyglutaricaciduria
- 3 alpha methylglutaconicaciduria
- 3-methylglutaconic aciduria
- Acanthamoeba
- Achromatopsia
- Acromegaloid
- Acute disseminated encephalomyelitis
- Acute posterior multifocal placoid pigment epitheliopathy
- Acute retinal necrosis
- Age-related macular degeneration
- Al amyloidosis
- Albinism
- Alezzandrini syndrome
- Alpers' disease
- Alport syndrome
- Alstrom syndrome
- Alveolar hydatid disease
- Amaurosis congenita of leber
- Amaurosis fugax
- Amblyopia
- Amelogenesis imperfecta
- Amitriptyline
- Ampola syndrome
- Anencephaly
- Angioid streaks
- Aniridia
- Anisometropia
- Anophthalmia
- Anophthalmos
- Anterior segment mesenchymal dysgenesis
- Arachnoiditis
- Arteriovenous malformation
- Aspartoacylase deficiency
- Asthenopia
- Atherosclerosis
- Autoimmune uveitis
- Avitaminosis
- Axenfeld-rieger syndrome
- Bardet-biedl syndrome
- Basement membrane corneal dystrophy
- Basilar artery insufficiency syndrome
- Basilar artery migraine
- Batten disease
- Behcet's disease
- Benign essential blepharospasm
- Besnier-boeck-schaumann disease
- Bessman-baldwin syndrome
- Best vitelliform macular dystrophy
- Best's disease
- Bilateral occipital lobe infarct
- Bilateral optic neuritis
- Bilateral papilloedema
- Blepharitis
- Blind spot
- Blindness
- Blue cone monochromatism
- Blue diaper syndrome
- Blue-ringed octopus poisoning
- Bonnet-dechaume-blanc syndrome
- Bothnia retina dystrophy
- Brain aneurysm
- Brain tumors
- Calcification of basal ganglia
- Canavan leukodystrophy
- Car syndrome
- Carbachol
- Carbamazepine
- Cardiomyopathy
- Carotid atherosclerosis
- Carotid-cavernous fistula
- Cartilaginous
- Cassia stocco dos santos syndrome
- Cataract
- Catastrophic antiphospholipid syndrome
- Celecoxib
- Cenani lenz syndactylism
- Central retinal artery occlusion
- Central retinal vein occlusion
- Central serous chorioretinopathy
- Cerebral palsy
- Cerebrovascular accident
- Ceroid lipofuscinosis
- Cesium
- Chalazion
- Chandler's syndrome
- Charcot-marie-tooth syndrome
- Charge syndrome
- Chemical adverse reaction
- Chemical burn
- Chlorpheniramine
- Chorioretinitis
- Choroideremia
- Choroiditis
- Chromosome 11, deletion 11p
- Chromosome 13, partial monosomy 13q
- Chromosome 13q deletion syndrome
- Chromosome 13q deletion
- Chromosome 14q, partial deletion
- Chromosome 17, deletion 17q23 q24
- Chromosome 2p deletion syndrome
- Ciliary muscle spasm
- Cinnarizine
- Citrullinemia
- Classic childhood ald
- Clomifene
- Cloudy cornea (patient information)
- Cluster headache
- Cobra poisoning
- Coenzyme q - cytochrome c reductase
- Cogan-reese syndrome
- Cogan's syndrome
- Cohen syndrome
- Coloboma
- Color blindness
- Concussion
- Cone dystrophy
- Cone rod dystrophy
- Congenital cytomegalovirus infection
- Congenital disorder of glycosylation type 1g
- Congenital rubella syndrome
- Congenital toxoplasmosis
- Congenital x-linked retinoschisis
- Conversion disorder
- Cornea plana 1
- Corneal dystrophy
- Corneal foreign body
- Corneal hypesthesia
- Corneal opacity
- Corneal ulcer
- Cortical blindness
- Cortical hyperostosis
- Craniodiaphyseal dysplasia
- Craniometaphyseal dysplasia
- Craniosynostosis
- Craniotelencephalic dysplasia
- Cree leukoencephalopathy
- Creutzfeldt jakob disease
- Cross syndrome
- Cycloplegia
- Cystoid macular dystrophy
- Cytomegalovirus retinitis
- Cytomegalovirus
- Daphne poisoning
- Deferoxamine
- Deletion 11p
- Deletion 13q
- Dermatoosteolysis
- Desferrioxamine toxicity
- Desipramine
- Devic disease
- Diabetes insipidus
- Diabetic eye disease
- Diabetic ketoacidosis
- Diabetic retinopathy
- Didmoad syndrome
- Diphenhydramine
- Dothiepin
- Drugs
- Dry eye
- Dysosteosclerosis
- Eales disease
- Ebola
- Ectodermal dysplasia
- Ehlers-danlos syndrome
- Emanuel syndrome
- Empty sella syndrome
- Encephalocele
- Encephalocele anterior
- Encephalocele frontal
- Endophthalmitis
- Enhanced s-cone syndrome
- Episodic ataxia
- Essential iris atrophy
- Esthesioneuroblastoma
- Euphorbiaceae
- Eye cancer
- Eye injury
- Eye melanoma
- Fahr's syndrome
- Familial amyloid polyneuropathy
- Familial infantile metachromatic leukodystrophy
- Feline spongiform encephalopathy
- Fetal methylmercury syndrome
- Flynn-aird syndrome
- Foreign body
- Franceschetti-klein syndrome
- Francois dyscephalic syndrome
- Fuchs atrophia gyrata chorioideae et retinae
- Fuchs' dystrophy
- Fundus albipunctatus
- Galactokinase deficiency
- Gangliosidosis
- Ghose-sachdev-kumar syndrome
- Giant cell arteritis
- Glaucoma
- Glioblastoma
- Goldbergshprintzen syndrome
- Graves ophthalmopathy
- Gronblad-strandberg-touraine syndrome
- Gustavson syndrome
- Hallervorden-spatz syndrome
- Hand-schuller-christian syndrome
- Head injury
- Heidenhain syndrome
- Helminth infections
- Hemianopia
- Hereditary diseases
- Herns syndrome
- Herpes
- Herpes simplex
- Herpetic keratitis
- Hiv
- Homonymous hemianopia
- Hurler syndrome
- Hydranencephaly
- Hydrocephalus
- Hydroxyzine
- Hyperopia
- Hyperornithinemia
- Hypertension of pregnancy
- Hyphema
- Hypoglycaemia
- Hypophosphatemia
- Hysteria
- Imidazole syndrome
- Incontinentia pigmenti
- Increased intracranial pressure
- Infant cytomegalic virus
- Infantile cortical hyperostosis
- Infantile neuroaxonal dystrophy
- Infantile refsum disease
- Inflammatory processes
- Intraocular hemorrhage
- Intraocular melanoma
- Intraocular pressure
- Iridocorneal endothelial syndrome
- Iridocyclitis
- Iridogoniodysgenesis
- Ischemic optic neuropathy
- Ivabradine
- Jensen syndrome
- Juvenile retinoschisis
- Kallmann syndrome
- Kearnssayre syndrome
- Keratitis
- Keratomalacia
- Krabbe leukodystrophy
- Krause-kivlin syndrome
- Langerhans cell histiocytosis
- Lattice corneal dystrophy
- Lawrence-moon syndrome
- Leber's congenital amaurosis
- Leber's optic atrophy
- Leg absence
- Lens pathology
- Leprosy
- Lethal congenital contracture syndrome
- Leukodystrophy
- Linear iga bullous dermatosis
- Lithium
- Lobstein disease
- Lord
- Lowe oculocerebrorenal syndrome
- Lymphoma
- Macular degeneration
- Macular dystrophy
- Macular edema
- Macular hole
- Maculopathy
- Malignant hypertension
- Marsden syndrome
- Marshall syndrome
- Mefloquine
- Melanoma of the choroid
- Mental retardation
- Mercaptolactace-cysteine disulfiduria
- Mercury poisoning
- Metachromatic leukodystrophy
- Metamorphopsia
- Metaphyseal dysplasia
- Methanol
- Microcephaly
- Microphthalmia
- Microphthalmos
- Microvascular diabetes complications
- Microvascular disease
- Midline craniofacial anomalies
- Migraine
- Minamata disease
- Mitochondrial disease
- Monosodium methanarsenate
- Monosodium methyl arsenate
- Morning glory disc anomaly
- Morpholine
- Mucolipidosis
- Mucopolysaccharidosis
- Mucormycosis
- Mucosa-associated lymphoid tissue
- Mucous membrane pemphigoid
- Multifocal choroiditis
- Multiple endocrine neoplasia type 1
- Multiple lentigines syndrome
- Multiple sclerosis
- Mycosis fungoides
- Nalidixic acid
- Nasopharyngeal carcinoma
- Nasopharyngeal carcinoma
- Nasopharynx cancer
- Nelson syndrome
- Neuroaxonal dystrophy
- Neurodegeneration with brain iron accumulation
- Neurodegenerative syndrome
- Neurofibromatosis
- Neuromyelitis optica
- Neuropathic ataxia
- Neuropathy
- Niemann-pick disease
- Night blindness
- Noble-bass-sherman syndrome
- Norrie syndrome
- Nortriptyline
- Nutritional amblyopia
- Nutritional deficiencies
- Nyssen-van bogaert syndrome
- Obal syndrome
- Occipital lobe tumours
- Ocular cicatricial pemphigoid
- Ocular herpes
- Ocular histoplasmosis syndrome
- Ocular ischemic syndrome
- Ocular oncology
- Ocular trauma
- Oculocerebrorenal syndrome
- Oculocutaneous albinism
- Oguchi disease
- Oligodontia
- Olivopontocerebellar atrophy
- Open-angle glaucoma
- Ophthalmia neonatorum
- Ophthalmoplegia
- Optic atrophy
- Optic nerve compression
- Optic nerve disorder
- Optic neuritis
- Optic pathway glioma
- Opticoacoustic nerve atrophy dementia
- Orbit tumour
- Orbital lymphangioma
- Orbital mass
- Ornithine translocase deficiency
- Osteochondrodysplatic dwarfism
- Osteoporosis
- Pachydermoperiostosis
- Pantothenate kinase-associated neurodegeneration
- Panuveitis
- Papilledema
- Papillitis
- Papilloedema
- Papilloedema
- Paraneoplastic cerebellar degeneration
- Partial monosomy 13q
- Pellagra-like syndrome
- Pepper spray
- Periorbital cellulitis
- Peripheral type neurofibromatosis
- Phacolytic glaucoma
- Phenylbutazone
- Phenytoin toxicity
- Phosgene oxime
- Photopsia
- Physostigmine
- Pigmentary retinopathy
- Pipecolic acidemia
- Pituitary adenoma
- Plant poisoning
- Plum syndrome
- Polychondritis
- Posterior column ataxia
- Posterior leucoencephalopathy syndrome
- Posterior vitreous detachment
- Pre-eclampsia
- Pregnancy toxemia
- Presbyopia
- Presumed ocular histoplasmosis syndrome
- Prochlorperazine
- Progressive multifocal leukoencephalopathy
- Progressive supranuclear palsy
- Protanopia
- Pseudotumor cerebri
- Pseudoxanthoma elasticum
- Psychogenic
- Pterygium
- Purtscher's retinopathy
- Pyle disease
- Pyruvate decarboxylase
- Pyruvate decarboxylase deficiency
- Quinidine
- Raised intraocular pressure
- Ramos-arroyo syndrome
- Reese-ellsworth syndrome
- Refractive error
- Refsum disease
- Renal tubulopathy
- Retinal artery occlusion
- Retinal cone dystrophy
- Retinal degeneration
- Retinal detachment
- Retinal dysplasia
- Retinal migraine
- Retinal tear
- Retinal vein occlusion
- Retinitis pigmentosa
- Retinitis punctata albescens
- Retinoblastoma
- Retinopathy
- Retinoschisis
- Retrolental fibroplasia
- Rhabditida
- Rhabdomyosarcoma
- Rhinocerebral mucormycosis
- Rhinocerebral zygomycosis
- Rhino-orbito-cerebral phycomycosis
- Rieger syndrome
- Rift valley fever
- Roberts syndrome
- Rofecoxib
- Rollet syndrome
- Roy-maroteaux-kremp syndrome
- Rufous oculocutaneous albinism
- Sandhoff disease
- Sarcoidosis
- Schindler disease
- Scleritis
- Sclerosteosis
- Sclerostin
- Secernentea
- Senile macular degeneration
- Senile retinoschisis
- Senior-loken syndrome
- Senter syndrome
- Septo-optic dysplasia
- Septum pellucidum
- Shaken baby syndrome
- Shingles
- Sialidosis
- Sickle cell anemia
- Simell-takki syndrome
- Singh-chhaparwal-dhanda syndrome
- Small syndrome
- Smith martin dodd syndrome
- Spastic tetraplegic
- Spherophakia-brachymorphia syndrome
- Spinocerebellar ataxia
- Stargardt disease
- Stevens-johnson syndrome
- Stickler syndrome
- Striped blister beetle poisoning
- Stroke
- Subacute combined degeneration of the cord
- Subacute myelo-optic neuropathy
- Subacute sclerosing leukoencephalitis
- Subacute sclerosing panencephalitis
- Sudanophilic cerebral sclerosis
- Superior orbital fissure
- Syndactyly
- Syphilis
- Takayasu arteritis
- Tapetal-like reflex
- Tay-sachs disease
- Temozolomide
- Temporal arteritis
- Thalidomide
- Thallium poisoning
- Thanos syndrome
- Thyroid eye disease
- Tolosa-hunt syndrome
- Toxins
- Toxoplasmosis
- Trachoma
- Transient ischaemic attack
- Transthyretin amyloidosis
- Treacher collins syndrome
- Usher syndrome
- Uveal diseases
- Uveal melanoma
- Uveitis
- Vascular diseases
- Vascular retinopathies
- Vasculitis
- Vasterbotten dystrophy
- Verloes van maldergem marneffe syndrome
- Vertebral artery dissection
- Verteporfin
- Vigabatrin
- Vision impairment
- Visual hallucinations
- Vitamin a deficiency
- Vitelliform macular dystrophy
- Vitreous detachment
- Vitreous floaters
- Vitreous hemorrhage
- Von hippel-lindau disease
- Wagener syndrome
- Wagner-stickler syndrome
- Wagr syndrome
- Wegener's granulomatosis
- Wegener's granulomatosis
- Weill-marchesani syndrome
- Wells jankovic syndrome
- Wildervanck syndrome
- Wilms tumor
- Winchester syndrome
- Wolf-hirschhorn syndrome
- Wolfram syndrome
- Woods black norbury syndrome
- Wrinkly skin syndrome
- Wyburn-mason syndrome
- Xanthomatosis cerebrotendinous
- X-linked congenital stationary night blindness
- X-linked intellectual disability
- Ziconotide
- Zunich neuroectodermal syndrome
- Zygomycosis

# Diagnosis

## History and Symptoms
History
include:
- Age
- Onset:
- Rate of loss
- Any specific trauma
- Headaches
- Medication
- Specific medical history
- Alcohol, drug and/or tabacco use

## Physical Examination

### Eyes
The examination should focus on:
- Acuity
- Blood pressure
- Color vision
- Cranial exam
- cranial nerve innervation
- Fundus
- Intraocular pressure
- Ocular media opacity
- Optic disc exam

## Laboratory Findings
- ESR
- Fasting blood glucose
- HgBa1c
- PPD
- RPR
- FTR-ABS
- ACE level
- Vitamin B12
- Folate

## MRI and CT
- CT/MRI of head and chest

# Evaluation of Monocular Transient Visual Loss
Abbreviations:
TVL, transient visual loss.

# Treatment

## Medical Therapy
- Systemic Steroids can be prescribed for the following:
- Temporal arteritis
- Optic neuritis
- Pituitary apoplexy
- Herpes zoster
- Nonarteritic ischemic optic neuropathy patients
- Asprin
- Cavernous sinus thrombosis
- Antibiotics
- Anticoagulation
- Corneal hydrops
- Cycloplegic,hypertonic NaCl ointment

## Surgery

## Corneal Hydrops
Corneal transplant

## Retinal Detachment
Surgical repair

## Cataracts
Surgical removal

## Temporal Arteritis
Temporal biopsy and steroids.

# Related Chapters
- Blindness
- Eye examination
- Low vision
- Visual acuity
- Visual impairment