An Evidence-Based Approach to Abnormal Vision in the Emergency Department -

An Evidence-Based Approach to Abnormal Vision in the Emergency Department
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Publication Date: April 2020 (Volume 22, Number 4)

No CME for this activity


Kelly O’Keefe, MD, FACEP
Program Director, Professor of Clinical Sciences, Florida State University College of Medicine Emergency Medicine Residency, Tallahassee, FL; Sarasota Memorial Hospital, Sarasota, FL
Sarah Temple, MD, FACEP
Assistant Professor of Clinical Sciences, Florida State University College of Medicine, Tallahassee, FL

Peer Reviewers

Ashley Norse, MD, FACEP
Associate Chair of Operations, Associate Professor of Emergency Medicine, University of Florida Heath Jacksonville, Jacksonville, FL
Jeremy Rose, MD, MPH, FRCPC
Assistant Professor of Emergency Medicine, Icahn School of Medicine at Mount Sinai; Associate Medical Director, David B. Kriser Department of Emergency Medicine, Mount Sinai Beth Israel, New York, NY


Patients present to the ED with visual disturbances that may be painful or painless and may include loss of visual acuity, field cuts, diplopia, and headache. A detailed history and complete ocular examination are essential to obtaining the correct diagnosis and offering expedited treatment and referral. This review discusses the differential diagnosis for patients experiencing abnormal vision from a nontraumatic or minimally traumatic etiology, and reviews diagnostic and treatment strategies from an evidence-based perspective, including point-of-care ocular ultrasound. Management of the needs of special populations, such as patients with sickle cell disease, HIV, and those with a ventriculoperitoneal shunt, is reviewed.

Excerpt From This Issue

A 40-year-old woman is brought in to the ED by her husband, complaining of blurred vision and dizziness. She said she had visited an urgent care clinic last week with a new diagnosis of migraine headache. Her examination is remarkable for right eyelid ptosis, limited movement of the right eye to left gaze, and a right dilated pupil compared to the left. Her husband comments that his brother “had the same thing with his diabetes,” and asks you to check her sugar, but you think something else might be going on...

A nurse interrupts and tells you there is another patient in the room next door who has suddenly lost sight in both eyes, and the nurse wants to know whether she should call a stroke alert. You excuse yourself and step out to see a 21-year-old woman who is hyperventilating and screaming, “I can’t see! I can’t see!” You ponder the cause of her symptoms, and you note that her medications include alprazolam and sertraline. You wonder what the best way to confirm your suspected diagnosis would be...

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