• 1. Monocular

  • Acute

Painless

Retinal artery or vein occlusion, ophthalmic artery occlusion, ischemic optic neuropathy, giant cell arteritis (GCA), vitreous hemorrhage, retinal detachment, sudden discovery of preexisting unilateral visual loss.

Painful

Corneal lesion (e.g., abrasion, ulcer), uveitis, dry eye syndrome, acute angle-closure glaucoma, endophthalmitis, corneal hydrops, optic neuritis (pain with eye movement; however, ∼10% of cases are painless).

• • Transient (vision returns to normal within 24 hours)

Painless

Amaurosis fugax, GCA, optic disc drusen, impending central retinal vein occlusion (CRVO), ocular ischemic syndrome, acephalgic migraine, orthostatic hypotension.

Painful

Migraine, dry eye syndrome, superficial punctate keratopathy.

• 2. Binocular

  • Acute and/or transient

Painless

Stroke (homonymous hemianopsia), vertebrobasilar insufficiency, ciliary spasm or ciliary body rotation, papilledema, acephalgic migraine.

Painful

Migraine, dry eye syndrome, superficial punctate keratopathy, pituitary apoplexy, papilledema (may have headache).

• 3. Monocular/binocular

  • Chronic

Painless

Refractive error, cataract, open-angle glaucoma, chronic angle-closure glaucoma, corneal scar, optic neuropathy, dry eye syndrome, chronic retinal disease (e.g., diabetic retinopathy, age-related macular degeneration [AMD]).

Painful

Dry eye syndrome, superficial punctate keratopathy.

• 4. Posttraumatic visual loss: Corneal irregularity, hyphema, ruptured globe, traumatic cataract, commotio retinae, retinal detachment, choroidal detachment, retinal or vitreous hemorrhage, lens dislocation, traumatic optic neuropathy, cranial neuropathies, central nervous system (CNS) injury, sympathetic ophthalmia (rare).

NOTE Although a diagnosis of exclusion, remember to consider nonphysiologic vision loss.