Sudden Loss of Central Vision and Visual Acuity

CLINICAL DIAGNOSTIC MANUAL

Sudden loss of central vision and visual acuity is an ophthalmic emergency that can have a significant impact on the patient’s quality of life. This symptom can be caused by various conditions affecting the optic nerve, retinal blood vessels, or internal structures of the eye. Rapid and accurate assessment of the underlying cause is crucial for initiating timely treatment and potentially preserving the patient’s vision.

Condition	Clinical Symptoms and Signs	Suspected Diagnosis	Confirmatory Diagnosis
Optic nerve injury (inflammation or atrophy)	Sudden vision loss, eye pain, blurred vision, visual field impairment	History of autoimmune diseases, eye pain, reduced visual acuity	Orbital MRI showing optic nerve inflammation or atrophy
Temporal arteritis	Sudden vision loss, headache, scalp tenderness, jaw claudication	Elderly patients with systemic symptoms and headache, elevated ESR and CRP	Temporal artery biopsy showing granulomatous inflammation
Cranial arteritis	Similar symptoms to temporal arteritis, with possible involvement of other cranial arteries	History of systemic symptoms and headache, elevated ESR and CRP	Temporal artery biopsy and additional imaging as needed
Retinal artery occlusion	Sudden, painless central vision loss, relative afferent pupillary defect, pale retina with cherry-red macula	Fundoscopic exam showing characteristic signs	Fluorescein angiography showing retinal artery obstruction
Retinal vein occlusion	Sudden vision loss, blurred vision, macular oedema, retinal haemorrhages	Fundoscopic exam showing haemorrhages and venous tortuosity	Fluorescein angiography showing retinal vein obstruction
Vitreous haemorrhage	Sudden vision loss, dark spots or shadows in the visual field, no eye pain	History of ocular trauma or diabetes, sudden vision loss	Ocular ultrasound showing blood in the vitreous