🩺 Symptom Guide
Painless Sudden Loss of Vision
Sudden painless monocular or binocular reduction or loss of vision; treat as retinal vascular occlusion, retinal detachment, giant cell arteritis, or stroke until proven otherwise
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Red flags
- Urgent same-day ophthalmology / stroke-level escalation is required for all true sudden painless visual loss, especially if any of the following are present: profound monocular vision loss
- altitudinal or field defect
- amaurosis fugax preceding complete loss
- flashes and floaters with curtain-like shadow
First actions / assessment
- Assess ABCDE if systemically unwell, then perform focused emergency eye and neurovascular assessment. Clarify exact onset and tempo, monocular versus binocular symptoms, complete versus partial loss, visual-field loss, curtain/veil, flashes, floaters, preceding transient visual loss, headache, scalp tenderness, jaw claudication, polymyalgia symptoms, focal neurology, trauma, anticoagulants, vascular risk factors, atrial fibrillation, carotid disease, migraine history, and prior retinal disease. Document visual acuity in each eye before treatment where possible. Examine pupils including for RAPD, gross visual fields, ocular movements, red reflex if possible, fundus if skilled and equipment available, and perform brief stroke screen and pulse examination. If giant cell arteritis is suspected, send ESR/CRP and arrange urgent specialty review, but do not delay treatment while waiting for results. If CRAO is suspected, urgent stroke-style evaluation is appropriate because it is a form of acute ischemic stroke.
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Symptom Guide · StatResus — Emergency Medicine Reference