| ⚪ Painless Causes | Details |
|---|
| 🟥 Central Retinal Artery Occlusion (CRAO) |
Sudden, profound, painless vision loss. Fundus: pale retina with a cherry-red spot in macula 🎯. Usually embolic/atherosclerotic. Ophthalmic emergency — globe massage or thrombolysis if very early. |
| 🟦 Central Retinal Vein Occlusion (CRVO) |
Gradual painless vision loss. Fundus: "blood and thunder" appearance 🌩️ (dilated, tortuous veins, widespread retinal haemorrhages). Associated with HTN, diabetes, glaucoma, hyperviscosity (e.g. myeloma, leukaemia). |
| 🟨 Retinal Detachment |
Sudden vision loss with flashes & floaters ✨, often described as a "curtain/veil" descending. Urgent ophthalmology referral — surgery can restore sight. |
| ⚠️ Amaurosis Fugax (TIA/Stroke) |
Transient monocular blindness ("black curtain" lasting seconds-minutes) due to ipsilateral carotid stenosis. Requires carotid Doppler and TIA clinic referral 🧠. |
| 🩸 Vitreous Haemorrhage |
Floaters + blurred vision; loss of red reflex; fundus not visible. Common in diabetic retinopathy. Manage with head elevation, may require vitrectomy. |
| 🧩 Optic Neuritis / Papillitis |
Subacute vision loss, often painful with eye movement. May affect colour vision first 🎨. Can be first sign of MS. Other causes: syphilis, Lyme. Consider steroids. |
| 🌪️ Migraine with Aura |
Visual disturbance (scintillations, zig-zag lines) ± headache, nausea. May occur without pain ("acephalgic migraine"). Often younger women with FHx. |
| 🔴 Painful Causes | Details |
|---|
| ⏳ Temporal Arteritis (GCA) |
Age >50, headache, jaw claudication. ESR >50. Painless visual loss but often accompanied by systemic symptoms. Risk of permanent blindness 🚨. Start high-dose steroids immediately — do not delay biopsy/USS. |
| 🔒 Acute Angle-Closure Glaucoma |
Severe ocular pain, headache, blurred vision with halos 🌈, red eye, fixed mid-dilated pupil. Associated with nausea/vomiting. Ophthalmic emergency — needs urgent IOP reduction. |
| 🧩 Optic Neuritis (painful form) |
Hours–days. Painful eye movement, visual blurring, altered colour perception. Strong MS association. Treat with IV methylprednisolone if severe. |
| 💥 Trauma |
Obvious cause. Includes blunt trauma, ruptured globe, orbital fractures, or chemical burns (alkali burns penetrate deeply 🔥). Requires irrigation and ophthalmic review. |
| 🌪️ Migraine (painful form) |
As above but associated with migraine headache. Distinguish from TIA by gradual onset and positive symptoms (flashing lights) rather than pure blackout. |
