Vision: Sudden Changes that Might Spell Emergency

Sudden changes in your vision can sometimes be caused by things that doctors can fix quickly. Delay in treatment can cause permanent visual loss or even blindness. So here’s a list of important visual changes to watch for and act on quickly.

Immediately seek medical attention – emergency room or same day eye doctor visit — for:

• Changes in the appearance of objects
• Veiled or blurry vision
• Any trauma to the eye
• Localized pain, especially if accompanied by nausea or a headache
• Spots, floaters, or flashers in your vision
• Loss of a portion of vision or all vision even if it resolves itself quickly (this can be a sign of stroke)
• Difficulty moving your eyes or eyelids
• Changes in the physical appearance of your eyes, such as swelling, or changes in iris color
• Halos around lights, or unusual sensitivity to light
• Sudden trouble focusing on objects
• Changes in pupil size not caused by light
• Dry eyes with itching or burning
• Wavy or crooked appearance to straight lines
• Unusual sensitivity to light or glare
• Crossed eyes
• Dark spot in the center of your field of vision
• Double vision
• Excess discharge or tearing

Here is some background on those symptoms:

• “Floaters” or “flashers” in the eye can mean the retina is starting to detach. It’s important to get to an emergency room or an ophthalmologist’s office promptly. Do not let any doctor tell you the eye is normal until you have had a “dilated pupil” eye examination. A regular eye exam that a primary care doctor or emergency doctor can do, without dilating the pupil, doesn’t see all the parts of the retina so detachment can be missed. Treatment of a detaching retina can preserve good vision if it’s done before the central part of the retina, called the macula, detaches.
• Eye pain and redness can be caused by sudden blockage of the outflow of fluid from the eye. This is called acute closed angle glaucoma, and it can be misdiagnosed as conjunctivitis, iritis or corneal abrasion. Make sure the doctor checks the pressure in the eye before the patient is sent home.
• Sudden loss of vision in one eye – even if the vision returns – can mean you are about to have a stroke. Emergency treatment is necessary.
• Sudden loss of part of the vision in one eye – typically there is a horizon that you cannot see above or below – can mean an inflammatory disease called giant cell arteritis. Often the vision in that eye cannot be saved, but steroid treatment can prevent loss of vision in the other eye.

Acute closed angle glaucoma and retinal detachment can both lead to severe permanent damage to vision. Thankfully, both can be treated with generally good prognoses if their symptoms are recognized in time.

Here is a list of less urgent eye-related symptoms that may not merit same-day care but should send you to the eye doctor:

Contact an ophthalmologist to discuss:

• Difficulty or delay in adjusting to darkness
• Skin growths near the eye
• Swelling, itchiness, or tenderness
• Redness or pronounced blood vessels
• Difficulty focusing on objects that are close up or far away
• Change in iris color
• Growing bump on the eyelid

Don’t dismiss failing vision in an elderly relative as normal. It could be glaucoma. Every patient should get a vision check and a pressure check at least every couple of years.

Because drugs can cause glaucoma, any change in vision needs to be communicated to the doctor with a full list of all medications and dietary supplements the patient is taking.