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C3 - Vision Loss - Introduction

Jessica Mason, MD, Mel Herbert, MD MBBS FAAEM, and Stuart Swadron, MD, FRCPC

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C3 2019 01 January - Vision Loss Written Summary 317 KB - PDF

C3 - Vision Loss 

Jessica Mason MD, Stuart Swadron MD, Mel Herbert MD

Peer Reviewer Nicholas Testa, MD


* Drug doses are a guide only, always check a second source and follow local practice guidelines

Take Home Points

  • Most causes of acute visual loss are serious and require emergent consultation with an ophthalmologist and/or a neurologist
  • A complete neurological exam is essential in patients with acute vision loss, as it may represent a stroke syndrome
  • Patients presenting with an acute onset of “flashers” and “floaters” should be evaluated for retinal detachment (RD)


In this episode of C3, we cover a particularly frightening presenting complaint: acute vision loss.  It is the third in our recent series on the eye; we recently covered the painful red eye and eye trauma.  Although complete or near complete blindness in one or both eyes is relatively uncommon, due to the significant impact it can have on quality of life, it always deserves an immediate evaluation and prompt specialty consultation.

In this episode, we focus on the entities that typically result in a complete blindness, either in a portion of the visual field or its entirety.  This is in contrast to a myriad of other more common visual complaints, such as blurry vision (often a metabolic problem) and double vision (often a neurological problem).  The differential diagnosis for both of these presentations is somewhat broader.  Nonetheless, there is considerable overlap among all of these presentations and often it is only after a more complete history and examination that we are able to determine the direction of our evaluation.

After a brief list of the most critical diagnoses to identify, we explore the specific features to look for with each.

robert k., mr -

HI everyone,

Thanks for reviewing vision loss this month. I work with a lot of elderly people and see a lot of RD/PVD/VH and sometimes amaurosis fugax.

With respect to painful vision loss, and GCA/temporal arteritis, I was wondering if you could talk a little bit about the other form of AION, called NA-AION. After more than 20years doing this job, I have seen two cases recently of NA-AION. Both patients presented after waking up with a significant visual field deficit in one eye
(one of the two had fuzzy vision the day before in the eye).

Word on the street is that,
Temporal arteritis or arteritic AION is actually a less common of anterior ischemic optic neuropathy, than non-arteritic AION caused by hypertension/diabetes/high cholesterol/smoking.

Below is a nice review by cleveland clinic of AION. It would be fab if you could share it with everyone.

Mel, Stuart, Jessica, could you please talk about this a little more in you mailbag segment in the near future please.


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C3 - Vision Loss Full episode audio for MD edition 54:23 min - 51 MB - M4AC3 2019 01 January Vision Loss Board Review Answers 242 KB - PDFC3 2019 01 January Vision Loss Board Review Questions 237 KB - PDFC3 2019 01 January - Vision Loss Individual MP3s 74 MB - ZIPC3 2019 01 January - Vision Loss Written Summary 317 KB - PDF