Have You Experienced Momentary Vision Loss?

You’re sitting at home enjoying your favorite TV show and all of a sudden the vision in one eye just goes away. You didn’t poke it or scratch it, and you certainly weren’t doing anything strenuous. After a brief delay, your sight returns. It’s a bit blurry, but you regain enough to comfortably resume watching your show. You are relieved. But should you see a doctor or just brush it off as just one of those weird momentary blips on the aging screen of life?

Medical experts say that sometimes, sudden vision loss may be a medical emergency and advise going to an emergency department, preferably one with a stroke center.

Blocked Blood Flow

An “eye stroke” is a colloquial term that means one of two things: blockage (occlusion) in a major vein, which drains de-oxygenated blood away from the retina, or a blockage in the major artery, which supplies oxygenrich blood to the retina.

“Of the two an artery occlusion is much more serious,” says Tara McCannel, MD, PhD, Director of the Ophthalmic Oncology Center at UCLA Medical Center. “Both are painless and can cause sudden dramatic loss of vision. An artery occlusion may be transient, and seemingly may resolve. For example, vision may be grey or blurry and then improve. But we consider that just as serious as if nothing improved. Whether recovered or not, that person needs to go to the emergency department and be urgently evaluated.”

Even if a retina exam doesn’t show a blockage, a stroke assessment may be advised for people who experience sudden vision disruption.

“In an artery occlusion, something may be throwing off a clot, sometimes in the heart or the carotid artery, or elsewhere,” says Dr. McCannel. “It’s an urgent situation because if the cause of the clot is unknown more could occur and result in a massive brain stroke.”

Reducing Risk Factors

These eye emergencies are usually due to blood-vessel-related conditions such high blood pressure, atherosclerosis, or cardiovascular disease. Inflammatory diseases, such as giant cell arteritis, that may affect the rest of the body may also be at play. Diabetes also increases risk. Because such chronic conditions increase with age, older people are more prone to retinal occlusions. These events are a wakeup call to take medications as prescribed, eat a healthy diet, partake in regular physical activity, and not smoke.

Retinal Artery Occlusion

A retinal artery occlusion can result in complete vision loss, peripheral
vision loss, or blind spots. Treatment can sometimes be helpful, but time is
of the essence. Treatment must commence within four to six hours of symptom onset. Options might include hyperbaric oxygen, ocular massage, and lowering the intraocular pressure of the eye, which may help dislodge a clot.

Retinal Vein Occlusion

A vein occlusion is more common and usually related to cardiovascular disease and hypertension, or sometimes underlying hypercoagulable states (abnormally increased blood clotting) which may be related to underlying inflammation. Symptoms depend on how extensive the vein occlusion is. “Vision may be a little off, but they can’t put their finger on it,” says Dr. McCannel. “As with most things the more mild it is, the better the prognosis for overall vision.”

People with vein occlusions may regain some vision, but may not completely recover all vision. Anti-VEGF (vascular endothelial growth factor) drugs used for age-related macular degeneration may be helpful in resolving the retinal edema resulting from vein occlusion. Laser treatment helps to reduce complications when the retinal vessels show more severe damage.

Diagnosing Occlusions

To diagnose retinal occlusions, an ophthalmologist must dilate the eyes
to take a thorough look at both retinas. Other tests may include optical coherence tomography, which creates a three-dimensional image that can detect retinal edema (swelling). A fluorescein angiogram is frequently performed to check the health of the eye’s blood vessels. The test requires the injection of a fluorescent dye into the bloodstream that can reveal abnormal blood vessels.

Early detection of retinal occlusions can help avoid severe vision loss. Get regular eye exams and seek medical attention if any sudden vision change occurs. Regular exams help catch problems when they are less severe and more treatable.

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