- “Top Ten” Eye Emergencies: Part 1
- “Top Ten” Retinal Eye Emergencies: Part II
- Sudden Vision Loss is Painless
True sudden vision loss can occur from a variety of reasons and are considered emergencies. Most commonly retinal disease is the culprit. Almost all causes of are painless. While both macular degeneration and diabetic retinopathy can lead to blindness, they both usually do so slowly. There are exceptions.
Vision Loss from Diabetes
Vision lost from diabetic retinopathy is usually due to macular edema and is very slowly progressive. Diabetic retinal detachments can also blind, but these, too, occur slowly.
A vitreous hemorrhage can occur in minutes although the sight is only temporarily affected.
Wet Macular Degeneration
Compared to the dry form of the disease, wet macular degeneration is rapid, but does not usually cause abrupt loss of sight. The vision loss can be rapid, say over a period of days or weeks.
Sometimes, the neovascular membrane (the “wet” abnormal blood vessels) can bleed within the retinal tissue and cause sudden loss of vision.
Vitreous Hemorrhage
One cause of bleeding into the vitreous is diabetic retinopathy as stated above. Other causes can include a retinal tear. There are a few other causes, but are very uncommon.
By the way, patients on blood thinners generally do NOT develop a vitreous hemorrhage.
Vascular Occlusions
Both retinal vein occlusions and retinal artery occlusions can cause instant loss of vision.
Retinal Detachments
Usually rapid loss of vision, but not sudden. A retinal detachment can cause rather quick progressive loss of vision starting with the peripheral vision moving centrally. This can occur over a day or two, but not minutes.
Corneal Abrasions
This may be the only exception to the painless statement. The surface of the cornea is responsible for about 2/3 of the focusing power of the (that’s why laser vision correction is performed on the cornea). If you scratch the cornea, you get sudden loss of vision and…pain!
Other Causes Related to the Brain
Injury to the optic nerve and stroke can also cause sudden loss of vision. There are certain situations with the optie nerve where pain may be involved. Strokes are usually painless, but other neurologic conditions may be associated.
What Does This Mean? It is impossible to diagnose sudden vision loss over the phone. We treat sudden vision loss as an emergency at our office. Happily, most of the time there really is no emergency because every one’s definition of “sudden” and “vision loss” are different, but how would we know?
In an eye doctor’s office, these unscheduled visits can kill an office schedule. It happens quite often, as you can imagine, to a retinal specialist.
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Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Fairfax, Virginia
***This post is for information purposes only. This posting does not offer legal or medical advice, so nothing in it should be construed as legal or medical advice. The information on this blog/post is only offered for informational purposes. You shouldn’t act or rely on anything in this blog or posting or use it as a substitute for legal/medical advice from a licensed professional. The content of this posting may quickly become outdated, especially due to the nature of the topics covered, which are constantly evolving. The materials and information on this posting/blog are not guaranteed to be correct, complete, or timely. Nothing in this posting/blog and nothing you or I do creates a doctor-patient relationship between you and the blog; between you and me; or between you and Randall Wong, M.D. or RetinaEyeDoctor.com. Even if you try to contact me through the blog or post a comment on the blog you are still not creating a doctor-patient relationship. Although, I am a doctor, I’m not YOUR doctor until and unless there is a written agreement specifically providing for a doctor-patient relationship.***
“In an eye doctor’s office, these unscheduled visits can kill an office schedule. It happens quite often, as you can imagine, to a retinal specialist.”
Yes, because money and your office schedule is more important than one of your patients actually having an emergency. Taking care of someone who panics is what doctors do. Oh yeah over booking and overcharging the insurance company is another.
Idiot.
Dear John,
If you read carefully, it is all about seeing a patient who is actually having a problem. And we see them immediately.
Thanks for your valuable input.
Randy
Hi,
A few days ago, my mum had an abrupt but painless loss/deterioration of vision. She says she sees narrowly, more like at night even when its day time. She was immediately taken to a clinic and given some medicine to take and go back after 2 weeks. Even though you would not know without seeing her, what would you think about possibilities of her condition
Thanks
Ajon,
Have no clue. My thoughts include retinal disease or something of the central nervous system…stroke?
Need more details.
Randy
I have one patient with a history of diabetic for almost 10 years. She has a sudden vision loss. she also diagnosed with DVT. is there any correlation between the loss of vision with DVT? Could it be thrombosis in retina artery? Thank you
Dear Andean,
Unlikely related. Any embolus from a DVT, in theory, would get filtered out in the lungs. Thrombosis in a retinal artery does occur and the source is usually plaque from the carotids. Emboli from the heart can also occur.
If you have more information, please let me know.
r
Her doppler shows chronic limb ischemia, there was no acute thrombosis. I consult her to the ophthalmologist and he stated that the vision loss due to diabetic.. in your opinion, what might be the problem that can cause sudden vision loss in a diabetic person, Randy? Thank you.
Andean,
Really need to know more about what the ophthalmologist saw during the exam. My first guess is that she had a vitreous hemorrhage (bleeding inside the eye).
r