Visual disturbance

Last updated: July 29, 2026

Quick guide

Diagnostic approach

Visual acuity
Visual field testing
External eye examination
Examination of extraocular muscles
Examination of the pupils
Tonometry
Slit-lamp examination
Fluorescein staining
Fundoscopy
Examination for underlying etiology, e.g.:
- Neurological examination
- Examination of the temporal artery

Red flag features

Sudden vision loss or visual field defect
Relative afferent pupillary defect
Focal neurological deficits
Sudden onset or worsening of photopsia or floaters
Amaurosis fugax
Eye pain at rest or with ocular movements
Color desaturation
Recent ocular procedure
Palpable, tender temporal artery
ASCVD risk factors
Coagulopathy
Leukocoria
Fundoscopy signs of retinal ischemia, retinal hemorrhage, or disc edema or pallor
Red flags for painful red eye

Management checklist

Begin critical interventions as indicated, e.g.:
Consult ophthalmology urgently.

Summary

Visual disturbances is a broad term encompassing a range of vision-related symptoms, including blurred vision, vision loss, and visual phenomena (i.e., floaters, photopsia). Acute visual disturbances are sudden in onset and/or rapidly progressive, and they may be categorized into conditions associated with eye pain (at rest or on ocular movements) or without. Chronic visual disturbances may be insidious in onset and/or gradually progressive. Patients with red flags for acute visual disturbances are at risk of permanent vision loss and should be evaluated and managed urgently. Most conditions are diagnosed clinically on a comprehensive eye examination; diagnostics (e.g., imaging and culture) may be required based on the suspected etiology. Management is specific to the underlying cause.

Eye pain and red eye and traumatic eye injuries (including ocular chemical burns) are detailed separately. Diplopia is not discussed in this article.

Definitions

Vision loss

A nonspecific term used to describe a change in vision ranging from decreased visual acuity to complete loss of vision

Blurred vision: a visual disturbance in which objects appear out of focus (i.e., an inability to distinguish fine details in objects) ^[1]^[2]
Visual impairment: best-corrected visual acuity of ≤ 20/40 in the eye with better vision ^[3]
Visual field defect: a partial or complete loss of vision in a specific region of vision
Anopia: a partial or complete loss of vision that is further categorized into
- Monocular anopia: a complete loss of vision in one eye
- Hemianopia: a loss of vision in one half of the visual field
- Quadrantanopia: a loss of vision in one quarter of the visual field
Legally blind (US statutory definition) ^[4]
- Best-corrected central visual acuity of ≤ 20/200 in the eye with better vision
- OR widest visual field ≤ 20° in the eye with better vision

Visual phenomena

Floaters: a visual phenomenon in which spots or strings appear to drift through the visual field
Photopsia: a visual phenomenon in which flashes of light are seen without an external light source

Etiology

Some conditions may manifest with either acute or chronic vision loss or with overlapping symptoms (e.g., vision loss and visual phenomena); the following categorization is based on the most common clinical manifestation.

Acute visual disturbances ^[2]^[5]^[6]

Acute painful loss of vision

These conditions manifest with eye pain at rest or on ocular movements.

Acute painless loss of vision

Retinal vascular occlusion (e.g., CRAO, CRVO)
Retinal detachment
Nonarteritic anterior ischemic optic neuropathy
Vitreous hemorrhage
Posterior uveitis
Macular hole
Giant cell arteritis (GCA)
Stroke
Papilledema due to:
- Space-occupying lesions (e.g., intracranial tumors, brain abscess)
- Hydrocephalus
- Cerebral venous thrombosis
- Cryptococcal meningoencephalitis
Toxic-metabolic optic neuropathy due to:
- Methanol poisoning
- Drug-induced (e.g., ethambutol, aminoglycosides, barbiturates, linezolid, infliximab)

Sudden monocular loss of vision is more likely caused by a disorder of the globe (e.g., cornea, uvea, retina) or a prechiasmal visual pathway disorder. ^[2]^[5]

Sudden binocular loss of vision more likely results from damage to the retrochiasmal visual pathway or an optic chiasmal lesion. ^[2]^[5]

Transient loss of vision

Loss of vision lasts < 24 hours, typically < 1 hour.

Acute blurring of vision

Acute visual phenomena

Sudden increase in floaters
- Vitreous hemorrhage
- Posterior vitreous detachment
- Retinal detachment
- Retinal tears
- Uveitis
Photopsia

Chronic visual disturbances ^[6]^[7]^[8]

Refractive errors (most common)
Cataract
Primary open-angle glaucoma
Chronic angle-closure glaucoma
Asteroid hyalosis
Corneal scarring
Pterygium with corneal extension
Keratoconjunctivitis sicca
Degenerative and dystrophic retinal diseases (e.g., age-related macular degeneration, retinitis pigmentosa)
Diabetic retinopathy
Hypertensive retinopathy
Vitreous degeneration
Pseudotumor cerebri syndrome
Toxic-metabolic optic neuropathy due to nutritional deficiencies (e.g., vitamin B12 deficiency, vitamin B1 deficiency)

Clinical evaluation

Focused history ^[2]^[5]^[7]

When obtaining a history and physical, be aware that patients may not be familiar with medical terminology when describing their symptoms (e.g., they may describe any visual abnormality as "blurred vision"). ^[2]

Characteristics of the visual disturbance
- Type of visual disturbance, e.g.:
  - Blurring of vision
  - Decreased visual acuity
  - Complete vs. partial loss of vision
  - Acute visual phenomena
- Monocular vs. binocular
- Duration: transient (< 24 hours) vs. persistent (≥ 24 hours)
- Progression: improving, worsening, static
- Inciting event: trauma (including ocular surgery) vs. spontaneous
Associated symptoms
- Ocular symptoms
  - Eye pain at rest or on ocular movement
  - Photophobia
  - Halos
  - Color desaturation
- Nonocular symptoms
  - Constitutional symptoms (e.g., fever, weight loss, night sweats)
  - Nausea, vomiting
  - Headache
  - Focal neurological deficits
  - Jaw claudication
Past history
- Ocular history (e.g., high myopia, ocular interventions)
- Systemic cardiovascular, metabolic, or inflammatory conditions (e.g., diabetes, hypertension, multiple sclerosis, immunocompromised state)
- History of migraine
- Use of anticoagulants or corticosteroids
- Tobacco and alcohol use
Family history of ocular conditions or autoimmune conditions

Focused physical examination ^[2]^[5]^[7]

Comprehensive examination of the eye, including:
Examination for the underlying etiology, including:
- Neurological examination
- Examination of the temporal artery

Do not use mydriatics until acute angle-closure glaucoma has been excluded. ^[2]^[9]

Normal visual acuity does not exclude vision-threatening diseases. ^[10]

Red flags for visual disturbances ^[2]^[5]^[11]

Sudden vision loss or visual field defect, including amaurosis fugax
Sudden onset or worsening of photopsia or floaters
Relative afferent pupillary defect
Focal neurological deficits
Eye pain at rest or with ocular movements
Color desaturation
Recent ocular procedure
Palpable, tender temporal artery
ASCVD risk factors
Coagulopathy
Leukocoria
Fundoscopy findings
- Signs of retinal ischemia (e.g., pale retina, cherry-red spot)
- Retinal hemorrhage
- Disc edema or pallor
See also "Red flags for painful red eye."

Diagnosis

Most conditions that cause visual disturbances are diagnosed clinically; laboratory testing and imaging are indicated in selected cases. See relevant articles for details.

Laboratory studies ^[2]

Diagnostics for GCA (e.g., ESR, CRP)
Diagnostics for stroke (e.g., point of care glucose, coagulation panel)

Imaging studies

Acute vision loss ^[12]
- Suspected orbital cellulitis: CT orbits and maxillofacial with IV contrast
- Suspected retinal detachment or vitreous hemorrhage: ocular ultrasound
Suspected neurological cause (acute or chronic vision loss)
- Optic nerve abnormality: MRI orbits without and with IV contrast ^[12]
- Brain tumors: MRI head without and with IV contrast ^[13]
- TIA: See "Neuroimaging in TIA." ^[14]
- Stroke: See "Neuroimaging in stroke." ^[14]
Suspected intraorbital mass (chronic or progressive monocular vision loss): MRI orbits without and with IV contrast ^[12]

Additional diagnostics

May be obtained by specialists depending on the underlying etiology, e.g:

Suspected keratitis: corneal scrapings for microscopy, culture, PCR
Suspected endophthalmitis: vitreous or aqueous sample for microscopy, culture, PCR
Suspected retinal vessel occlusion: retinal imaging (e.g., optical coherence tomography, electroretinogram)
Suspected GCA: temporal artery biopsy

Management

See relevant articles for details.

Perform a focused clinical evaluation.
Assess for red flags for visual disturbances.
Red flags present:
- Begin critical interventions as indicated, e.g.:
  - Stroke: Begin initial management of acute stroke.
  - GCA: Start empiric high-dose glucocorticoids immediately.
  - Acute angle-closure glaucoma: Place the patient in supine position and initiate IOP-lowering therapy.
  - Orbital compartment syndrome: Perform emergency orbital decompression with lateral canthotomy and cantholysis.
- Urgently consult ophthalmology for further management.
- Determine disposition with involved specialists based on the underlying condition.
Red flags absent: Refer to ophthalmology for further evaluation and management of the underlying cause.

Common causes

Acute painless loss of vision ^[2]^[5]

These conditions typically manifest with monocular visual disturbances.

Common causes of acute painless visual disturbance ^[2]^[5]
	Characteristic clinical features	Diagnostic findings	Management
Vitreous hemorrhage ^[15]	Floaters Vision loss or visual field defect	Clinical diagnosis Slit-lamp examination: blood between the posterior vitreous base and internal limiting membrane Ultrasound: echogenic debris in the vitreous humor	Urgent ophthalmology consult Evaluation for concurrent retinal detachment See "Vitreous hemorrhage."
Posterior vitreous detachment ^[16]	Photopsia Floaters Vision loss or visual field defect	Clinical diagnosis Slit-lamp examination: detached posterior surface of the vitreous cavity with Weiss ring	Urgent ophthalmology consult Evaluation for concurrent retinal detachment See "Posterior vitreous detachment."
Retinal detachment ^[17]	Photopsia Floaters Vision loss or visual field defect	Clinical diagnosis Fundoscopy: detached retinal areas appear pale, retinal tears Ultrasound: hyperechoic membrane within the vitreous cavity	Urgent ophthalmology consult Reduce head and eye movements. See "Management of retinal detachment."
Central retinal artery occlusion ^[18]^[19]	Vision loss History of ASCVD risk factors Other signs of stroke	Clinical diagnosis Relative afferent pupillary defect (RAPD) Fundoscopy: pale retina with cherry-red spot	Urgent ophthalmology consult Transfer to the emergency department or stroke center. Identify and treat the underlying cause (e.g., ischemic stroke, hypercoagulability). See "Central retinal artery occlusion."
Central retinal vein occlusion ^[20]	Vision loss or blurred vision History of ASCVD risk factors	Clinical diagnosis RAPD Fundoscopy Diffuse retinal hemorrhages Dilated, tortuous retinal veins Cotton wool spots Macular edema Papilledema	Urgent ophthalmology consult Identify and treat the underlying etiology. See "Central retinal vein occlusion."
Nonarteritic anterior ischemic optic neuropathy ^[21]	Visual field defect History of ASCVD risk factors	Clinical diagnosis RAPD Fundoscopy: pale, edematous optic disc; peripapillary hemorrhage	Trial of hemodilution and systemic glucocorticoid therapy See "Anterior ischemic optic neuropathy."
Arteritic anterior ischemic optic neuropathy ^[22]^[23]^[24]	Visual field defect Headache typically over the temples Tender temporal artery Jaw claudication Constitutional symptoms (e.g., fever, weight loss)	Clinical diagnosis RAPD Fundoscopy: same as for nonarteritic anterior ischemic optic neuropathy Laboratory studies ESR ≥ 50 mm/hour CRP ≥ 10 mg/L Thrombocytosis Duplex ultrasound of temporal arteries: noncompressible thickened or stenosed artery	Urgent ophthalmology consult Immediate high-dose systemic glucocorticoids Temporal artery biopsy See “Treatment of GCA.”

Vitreous hemorrhage Posterior vitreous detachment Rhegmatogenous retinal detachment Acute central retinal artery occlusion Central retinal vein occlusion Papilledema in non-arteritic anterior ischemic optic neuropathy (NAION) Dry age-related macular degeneration Subretinal hemorrhage (wet age-related macular degeneration) Giant cell arteritis

Acute painful loss of vision

These conditions typically manifest with monocular visual disturbances. See also "Traumatic eye injuries."

Common causes of acute painful loss of vision (vision-threatening causes of eye pain) ^[2]
	Characteristic clinical features	Diagnostic findings	Management
Orbital compartment syndrome ^[25]^[26]	Proptosis Periorbital swelling Firm globe resistant to digital retropulsion Ophthalmoplegia and/or diplopia	Clinical diagnosis RAPD Tonometry: elevated intraocular pressure (IOP) Fundoscopy: papilledema, venous congestion, retinal artery pulsation	Lateral canthotomy and cantholysis See “Treatment” in “Orbital compartment syndrome.”
Orbital cellulitis ^[27]^[28]	Pain, swelling, and/or erythema Systemic signs of infection (e.g., fever, malaise) Red flags for orbital cellulitis	Clinical diagnosis CT orbits and sinuses with contrast may show an orbital abscess or foreign bodies.	IV antibiotics and/or antifungals See “Management” in “Orbital cellulitis.”
Endophthalmitis ^[29]	Acute vision loss Conjunctival hyperemia and chemosis	Clinical diagnosis RAPD Fundoscopy: reduced or absent red reflex Slit-lamp examination: hypopyon and/or hazy aqueous chamber	Empiric intravitreal antimicrobial therapy See "Treatment of endophthalmitis."
Acute angle-closure glaucoma ^[9]^[30]	Firm, red eye; ciliary flush Midsized, unresponsive pupil Halos around light sources Decreased visual acuity; loss of peripheral vision Nausea and vomiting	Clinical diagnosis Tonometry: elevated IOP (> 21 mm Hg) Slit-lamp examination: shallow anterior chamber, hazy cornea	Urgent reduction of IOP See “Treatment of acute angle-closure glaucoma.”
Optic neuritis ^[31]^[32]	Reduced visual acuity Subacute vision loss Visual field defects, dyschromatopsia Retrobulbar pain that worsens with eye movement	Clinical diagnosis RAPD MRI head and orbits: optic nerve enhancement	Neurology consultation High-dose glucocorticoid therapy See “Treatment” in “Optic neuritis.”
Herpes zoster ophthalmicus ^[33]	Painful erythematous vesicular rash in the ophthalmic nerve dermatome Fever, headache, fatigue Conjunctival injection, chemosis, photophobia Impaired vision Hutchinson sign of the nose	Clinical diagnosis Slit-lamp examination with fluorescein staining: punctate or pseudodendritic corneal lesions	Antiviral therapy for herpes zoster See “Treatment” in “Herpes zoster ophthalmicus.”
Bacterial keratitis ^[34]	Red eye, photophobia, blurry vision Foreign body sensation Purulent discharge History of contact lens use	Clinical diagnosis Slit-lamp examination: hypopyon Fluorescein staining: round corneal ulcer or infiltrate	Topical antibiotics for bacterial keratitis See “Treatment” in “Bacterial keratitis.”
Herpes simplex keratitis ^[35]	Red eye, photophobia, blurry vision Foreign body sensation Corneal hypesthesia	Clinical diagnosis Fluorescein staining: superficial dendritic ulcers	Topical or oral antivirals See “Treatment” in “Herpes simplex keratitis.”
Corneal ulcer ^[36]	Often a complication of keratitis Foreign body sensation Epiphora, conjunctival injection Blurry and/or decreased vision	Clinical diagnosis Slit-lamp examination: corneal epithelial defect, stromal edema, cells and flare	Treatment of underlying cause (e.g., topical antibiotics or antivirals) See “Management” in “Corneal ulcer.”
Corneal foreign body ^[37]	Sudden onset of symptoms, often after a triggering event Epiphora, photophobia, foreign body sensation Blurred vision Difficulty keeping eye open	Slit-lamp examination and/or eversion of the upper eyelid: visible foreign body, rust rings, corneal defect Positive Seidel test indicates open globe injury. CT or ultrasound orbit: foreign body	Corneal foreign body removal Tetanus prophylaxis and antibiotics as indicated See “Management” in “Corneal foreign body.”
Anterior uveitis ^[38]^[39]	Dull periocular pain Red eye, photophobia, blurry vision Epiphora Ciliary injection	Clinical diagnosis Slit-lamp examination: cells and flare, hypopyon	Supportive care (e.g., topical corticosteroids or cycloplegics) Treatment of underlying cause See “Management” in “Uveitis.”

Orbital cellulitis Fungal endophthalmitis Acute angle-closure glaucoma Papillitis in optic neuritis Herpes zoster keratitis Herpes zoster ophthalmicus Hutchinson sign of the nose Infective keratitis Herpes simplex keratitis Corneal ulcer Corneal foreign body Corneal rust ring Anterior uveitis

Chronic visual disturbances

Common causes of chronic visual disturbance
	Characteristic clinical features	Diagnostic findings	Management
Refractive errors ^[40]	Blurred vision at distance (myopia) or near (hyperopia) Headaches associated with visual tasks Monocular or binocular	Clinical diagnosis	Corrective lenses Refractive surgery See "Overview of refractive errors."
Acquired cataract ^[41]	Reduced visual acuity Monocular or binocular Glare and halos around lights	Clinical diagnosis Slit-lamp examination: grey, white, or brownish clouding of lens Absent or decreased red reflex	Corrective lenses for mild symptoms Surgery for significant symptoms See "Treatment of cataracts."
Open-angle glaucoma ^[42]	Progressive painless binocular visual field loss (from peripheral to central) Arcuate scotoma Impaired adaptation to darkness	Tonometry: normal or elevated IOP Fundoscopy: optic disc cupping, pallor, disc hemorrhage Perimetry: scotoma Gonioscopy: normal anterior chamber angle	Tailor therapy to the patient's comorbidities and tolerance. Medical therapy (e.g., topical prostaglandin analogs, beta blockers, alpha-2 agonists, carbonic anhydrase inhibitors) Surgery (e.g., laser trabeculoplasty, surgical trabeculectomy) See "Treatment of open-angle glaucoma."
Age-related macular degeneration (AMD) ^[43]	Painless central or pericentral visual impairment Dry AMD Slow progressive central vision loss (over decades) Monocular or binocular Wet AMD Subacute central vision loss (over weeks to months) Can also manifest acutely with symptoms of retinal detachment Typically monocular	Amsler grid: metamorphopsia and scotomas Fundoscopy Dry AMD: drusen, retinal pigment epithelial atrophy or hypertrophy Wet AMD: gray-green retinal discoloration, subretinal hemorrhage, serous retinal detachment, disciform scar	Lifestyle modifications (e.g., antioxidant-rich diet, smoking cessation) Wet AMD: intravitreal anti-VEGF therapy See "Treatment of AMD."
Diabetic retinopathy (DR) ^[44]	Monocular or binocular Early stages: usually asymptomatic Advanced stages Significant visual impairment progressing to blindness Complications (e.g., macular edema, vitreous hemorrhage, retinal detachment)	Fundoscopy Nonprogressive DR: microaneurysms, retinal hemorrhages, hard exudates, cotton-wool spots Progressive DR: neovascularization Macular edema	Optimize glycemic control. Manage ASCVD risk factors. Treatment options depend on the severity of DR (e.g., surveillance, panretinal photocoagulation, intravitreal anti-VEGF therapy, vitrectomy). See "Treatment of DR."
Pseudotumor cerebri syndrome ^[45]	Monocular or binocular Variable visual disturbances (e.g., transient darkening of vision, photopsia, vision loss) Headache Pulsatile tinnitus Cranial nerve palsies	Visual field testing: peripheral vision loss Fundoscopy: bilateral papilledema MRI brain: normal parenchyma with empty sella Lumbar puncture: elevated opening pressure See "Diagnostic criteria for pseudotumor cerebri syndrome."	Identify and treat the underlying cause. Consider pharmacological treatment with acetazolamide. Surgery (e.g., CSF shunt) for severe or vision-threatening disease. See "Treatment of pseudotumor cerebri syndrome."

Mature cataract Congenital cataract Glaucomatous excavation of the optic disc Drusen in nonexudative age-related macular degeneration Nonproliferative diabetic retinopathy

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Visual disturbance

Quick guide

Diagnostic approach

Red flag features

Management checklist

Summary

Definitions

Vision loss

Visual phenomena

Etiology

Acute visual disturbances [2][5][6]

Acute painful loss of vision

Acute painless loss of vision

Transient loss of vision

Acute blurring of vision

Acute visual phenomena

Chronic visual disturbances [6][7][8]

Clinical evaluation

Focused history [2][5][7]

Focused physical examination [2][5][7]

Red flags for visual disturbances [2][5][11]

Diagnosis

Laboratory studies [2]

Imaging studies

Additional diagnostics

Management

Common causes

Acute painless loss of vision [2][5]

Acute painful loss of vision

Chronic visual disturbances

3 free articles left this month

Acute visual disturbances ^[2]^[5]^[6]

Chronic visual disturbances ^[6]^[7]^[8]

Focused history ^[2]^[5]^[7]

Focused physical examination ^[2]^[5]^[7]

Red flags for visual disturbances ^[2]^[5]^[11]

Laboratory studies ^[2]

Acute painless loss of vision ^[2]^[5]