Causes of monocular loss of vision
Painless Cause Details Central retinal artery occlusion Sudden painless monocular loss of vision. There is a pale fundus with a cherry red macular spot. Often atherosclerotic or embolic. Some consider digital massage of the globe in an attempt to dislodge the obstruction. Thrombolysis has been considered if the presentation is quick.
Central retinal vein occlusion Gradual vision loss of minutes and hours. Fundus shows a "stormy appearance" distended, tortuous retinal veins; retinal haemorrhages. Associated with hypertension, diabetes, glaucoma, and increased blood viscosity (e.g., leukaemia).
Retinal detachment Sudden painless, unilateral loss of vision with floaters and seeing flashes of light. Often described as a curtain [or veil] coming down in front of my eye. Refer immediately to an ophthalmologist because surgery to reattach the retina can save the patient's sight.
Stroke or transient ischaemic attack (amaurosis fugax) May be due to ipsilateral carotid stenosis and requires carotid duplex as well as other workup. Refer to TIA clinic or stroke service.
Vitreous haemorrhage May see dark spots (floaters) and blurred vision. Loss of the red reflex. Unable to see fundus. Due to new vessels bleeding in those with diabetes. Rest and head elevation. May need a surgical vitrectomy
Optic neuritis or papillitis Comes on over hours. There may be eye pain but not always so included in painful and painless causes. Usually unilateral but is sometimes bilateral. Can be the first presentation of MS. Exclude an intracranial SOL. Lyme disease and syphilis are rare causes. Less severe cases may only have altered colour vision and depth perception and painful eye movement. The inflamed nerve may be seen as disc margin. Treatment with systemic steroids may be considered.
Migraine with aura Painful but only due to associated migraine headache. Some can occur without the classical headache and be painless. Rare but can occur. Look for nausea and vomiting and aura. Younger, female, family history, history of migraine with aura
Painful Cause Details Temporal Arteritis with headache Uncommon, but usually striking, cause of headache. Age over 50 and ESR over 50. The ye is painless. Diagnosis can be made by demonstrating choroidal shutdown on fluorescein angiography. Also USS of temporal artery or biopsy. Refer immediately to eyes.
Closed-angle glaucoma See the topic. Age > 40, Black, Family history. Refer to Ophthalmology. Clinically silent.
Migraine with aura Painful but only due to associated migraine headache. Some can occur without the classical headache and be painless. Rare but can occur. Look for nausea and vomiting and aura. Younger, female, family history, history of migraine with aura
Optic neuritis or papillitis Comes on over hours. There may be eye pain. Usually unilateral but is sometimes bilateral. Can be the first presentation of MS. Exclude an intracranial SOL. Lyme disease and syphilis are rare causes. Less severe cases may only have altered colour vision and depth perception and painful eye movement. The inflamed nerve may be seen as disc margin. Treatment with systemic steroids may be considered.
Trauma Usually obvious. Chemical burns to the eye need copious irrigation with water. Fractures of the orbit. Alkali burns penetrate deeper into the eye. Trauma can cause a ruptured globe that needs surgery.
Sudden monocular blindness
Causes of monocular blindness Prosthetic eye
Cataract
Senile macular degeneration
Glaucoma
Trachoma
Diabetic retinopathy
Trauma
Optic neuritis/atrophy
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Monocular loss of vision
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