Sudden Visual Loss Path: Visual Loss and Glaucoma
Sudden Visual Loss
Sudden visual loss is a common, time‑sensitive emergency department (ED) presentation. Rapid, structured assessment distinguishes primary ophthalmic emergencies that need same‑day ophthalmology from neurovascular causes that require stroke/TIA pathways. Early documentation and prompt referral following local pathways and national guidance (NICE NG128; NICE NG81) improve the chance of preserving vision and meet standards of care.
Classification - where the problem lies
- Ocular media (anterior segment and vitreous): corneal injury/ulcer, hyphema, acute angle‑closure glaucoma, vitreous haemorrhage, endophthalmitis, uveitis.
- Retina and retinal circulation: retinal detachment (rhegmatogenous, tractional, exudative), central/branch retinal artery occlusion (CRAO/BRAO), retinal vein occlusion (CRVO/BRVO), macular ischaemia, infectious retinitis.
- Neurovisual pathways: optic neuritis, anterior ischaemic optic neuropathy (arteritic - GCA; non‑arteritic NAION), chiasmal or retrochiasmal lesions (tumour, stroke) causing field defects.
Initial ED approach - rapid, reproducible steps
1. Localise
- Determine monocular versus binocular loss.
- Determine transient (seconds-minutes) versus persistent loss.
- Determine painful versus painless presentation.
- Determine central versus peripheral field loss.