Sudden Vision Loss is Painless

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Sudden Vision Loss is Painless

Sudden vision loss is an emergency. True sudden loss is usually painless, but causes other than the eye can cause pain.

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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Comments
  • John Richardosn March 14, 2011 at 1:21 am

    “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.

    • Randall V. Wong, M.D. March 15, 2011 at 11:50 am

      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

  • ajon August 14, 2011 at 4:30 pm

    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

    • Randall V. Wong, M.D. August 19, 2011 at 11:41 am

      Ajon,

      Have no clue. My thoughts include retinal disease or something of the central nervous system…stroke?

      Need more details.

      Randy

  • Andean October 3, 2011 at 4:02 am

    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

    • Randall V. Wong, M.D. October 3, 2011 at 11:07 am

      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

  • Andean October 17, 2011 at 4:23 am

    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.

    • Randall V. Wong, M.D. October 18, 2011 at 11:11 am

      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

  • Dee April 4, 2012 at 12:57 am

    Dr. Wong,

    I was diagnosed with a CRAO in my left eye on 10/07/11 just a few days shy of my 50th birthday. Since then I’ve had a full work up which found quite a few conditions that could have caused the CRAO but none that were “significant” enough to be the likely cause, or at least that’s what all my doctors keep telling me. The conditions include prediabetes, high lipedemia, mildly high cholesterol, mildly high blood pressure, and mild calcification of the mitral valve. I had an MRI which showed that I might have vasculitis or problem with my left ICA so I had a cerebral angiogram. That procedure showed that I have mild plaque (less than 70%) in the left ICA leading up into brain, an unruptured cerebral aneurysm in the left ICA cavernous segment. Shortly after the cerebral angiogram in December 2011, my opthamologist suspected I might have glaucoma and had me take a visual field test which showed that I have early glaucoma in the right eye. I have also been diagnosed with advanced osteoarthritis in my cervical spine, kyphosis, and either acid reflux or esophagitis all of which may or may not be contributing factors to my over-all health leading up to the CRAO.

    The medications I’m on include: aspirin, lovastatin, atenlol, trusopt (3x daily both eyes), zyrtec, benadryll, vitamin D (I’m very low due to malabsorption issues), and gabapentin (for nerve tingling/numbness).

    For a while my opthamologist wanted to see me every month since the CRAO. Then in February she said to make appts every three months even though she had just diagnosed me as having normal tension glaucoma. Shortly after she told me this she left the insurance company I’m with (Kaiser) and I was assigned a new opthamologist and saw him in March about a week ago. My IOP has gone up to 18 (same IOP as the day I had the CRAO in left eye) although prior to that my IOP in both eyes has been between 13-15. The new opthamologist thinks I’m “stable” since I haven’t had any significant change in my condition since December and now wants me to see him again in August.

    For the last three months, I’ve been noticing that my vision in my one remaining good eye (the CRAO in my left eye resulted in permanent blindness in that eye) will sometimes be blurry, kind of like double vision. This happens mostly at night and that’s also when I see halo around lights. The blurriness/double vision doesn’t last long, maybe a minute or two and then it returns to just normal with my still seeing halos around lights. I’ve read that what I may be experiencing is diabetic retinopathy even though I’ve only been recently diagnosed with prediabetes. I’ve been trying to keep my blood sugar under control, I’ve lost weight (20 lbs since CRAO), my cholesterol seems to be stabilizing, and so does my blood pressure at least when measured in the the doctors office/hospital. At work/home it goes up much higher when I’m under stress which is quite often since I’ve have a very stressful job.

    Glaucoma runs in my family as does high blood pressure, high cholesterol, and heart disease. Stroke also runs in my family. I’ve told my new opthamologist all of this and he still only wants to see me in August “unless anything significant changes.”

    My question to you is this. How often should I be seen by my new opthamologist given the fact that I had a CRAO almost 6 months ago? My IOP has gone back up and that worries me. My new opthamologist admitted that a OCT examination of my macula/optic nerves has not been done on my right eye and he doubts the diagnosis of my previous opthamologist that I have normal tension glaucoma and doesn’t believe trusopt is the best medication for me but didn’t change it because “he wants to get to know his new patients before changing medications”. My left eye sometimes aches and feels just as heavy as it did the day after my CRAO and my temple over my left eye is still tender even after all this time. I have been experiencing headaches every day on my left temple and left side of my head ever since the CRAO, but I’ve been told by the neurologist that it’s nothing to worry about.

    Am I being hyper-sensitive because of my CRAO? Or do I have reason to be concerned that I’m not being monitored as closely by my opthamologist I think he should given what has happened? What is the best practice to do in cases like mine?

    This is one of the first blogs I’ve read available about CRAOs and retinal diseases and I can see that it is quite extensive. I stumbled upon it by accident when I was looking up the symptoms of NVG. Perhaps when I switch insurance companies in January 2013, I’ll be able to make an appt with you. Can’t switch until federal health benefits open season.

    Thank you helping patients to better understand retinal conditions like mine!!

    Sincerely,
    Dee

    • Randall V. Wong, M.D. April 4, 2012 at 7:16 am

      Dear Dee,

      Wow. Lot’s going on here. To respond to your question;

      1. From my perspective, regular examination following CRAO should be done to look for signs of neovascular glaucoma, or, NVG. Sounds like they are attending to this.

      2. I would have to defer to their best judgement regarding the presence or absence of glaucoma. I can not contribute anything from my end.

      BTW – ask your doctor if you might have cataracts causing the halos.

      Stay in touch.

      Randy

  • Amy May 14, 2012 at 1:02 pm

    Hello, I am very worried. And would really really appreciate you advice.
    I have seen 3 eye docters and they say that they dont see anything wrong. No special test was done they just looked in my eyes with a light and did the eye drops.
    I am 23. I was born with 20/20, But in my teens it changed and I used to have 20/240 vision. But now it is changing rapidly without pain.
    I went in got checked 3 months ago it was 20/260 A couple months later I could physically tell it was harder to see… So I then decided to see a specialist….and he said my vision was now 20/325.. And that it was “normal to have that type of vision loss… So 3 weeks later I went back in to the first docter and now my vision is at 20/400…
    He said its that most unsual thing he has ever seen, “big change”, but that everything is fine…? I havent really had any abonormal pain, some eye strain probably because I have been having to work long hours lately. But otherwise no pain.
    But I am worried because if it continues at the rate it is going I will not be able to see anymore.

  • sheel singhal October 29, 2012 at 5:05 am

    Hello DR.
    I m sheel ( from India). My brother lost one eye vision suddenly. His age is 18yr old.
    Can u send your Email Id so i will forward all the details .Please help me and reply me ASAP…
    its very very Urgent
    thanks

    • Randall V. Wong, M.D. October 30, 2012 at 12:32 pm

      Dear Sheel,

      Please see my other email about my reviewing records.

      Randy

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