This handout is for acute (sudden) vision loss — neuro-ophthalmology / em triage. Your care team identified this based on: sudden painless monocular vision loss — crao / aion / crvo / rd / vitreous hemorrhage until excluded; crao = acute ischemic stroke (mac grory stroke 2021 aha scientific statement, pmid 33677974).
Other reasons your team may use this plan: sudden vision loss with eye/peri-ocular pain — acute angle-closure glaucoma, optic neuritis, endophthalmitis, scleritis, arteritic aion with headache (maz acr/vf 2021, pmid 34235884; beck ontt nejm 1992, pmid 1734247); transient vision loss (amaurosis fugax / blackout, recovered) — retinal or cortical tia equivalent; route to tia/stroke workup (mac grory stroke 2021, pmid 33677974); binocular field loss / homonymous hemianopia / "cortical blindness" with or without other neuro deficits — occipital/post-chiasmal stroke (mac grory stroke 2021, pmid 33677974).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| methylprednisolone | 500-1000 mg | IV | once daily × 3 days | Maz ACR/VF 2021 (PMID 34235884) — IV pulse glucocorticoid for GCA with threatened/established vision loss; Liu Ophthalmology 1994 (PMID 7800356) — IV therapy associated with less fellow-eye involvement and slightly better visual prognosis vs oral. Goal: save the FELLOW eye. |
| prednisone | 1 mg/kg (typically 60 mg) | PO | once daily | Maz ACR/VF 2021 (PMID 34235884) — high-dose oral glucocorticoid started immediately on strong GCA suspicion when IV pulse not indicated/available; never delayed for biopsy (biopsy yield preserved for ~2 weeks) |
| low_dose_aspirin_adjunct_and_urgent_temporal_artery_biopsy | — | — | — | Maz ACR/VF 2021 (PMID 34235884) — antiplatelet adjunct consideration; arrange temporal-artery biopsy ≤2 weeks but treat first. Definitive taper + tocilizumab owned by rheum.giant-cell-arteritis.core.v1. |
Plan: Acute vision loss — etiology-stratified emergency therapy (recognise → stabilise → route OUT)
Call 911 or go to the nearest emergency room right away if you have:
CRAO/amaurosis: stroke/cardiology secondary prevention is the long-tail deliverable — antithrombotic, vascular-risk control, carotid intervention if indicated (Mac Grory Stroke 2021 PMID 33677974) via neuro.acute-stroke.core.v1 / neuro.tia.core.v1. GCA: long glucocorticoid taper + tocilizumab + relapse surveillance via rheum.giant-cell-arteritis.core.v1. Optic neuritis: MS/NMOSD/MOGAD demyelination workup + DMT via neuro.optic-neuritis.core.v1. Low-vision rehabilitation and counselling for irreversible loss; functional vision loss → supportive follow-up.
Guideline: Mac Grory et al, Stroke 2021 — AHA Scientific Statement on Management of Central Retinal Artery Occlusion (CRAO = acute ischemic stroke) + Maz et al, Arthritis Rheumatol 2021 — ACR/Vasculitis Foundation Guideline for the Management of Giant Cell Arteritis + Optic Neuritis Treatment Trial (Beck NEJM 1992/1993; Arch Ophthalmol 1993) + EAGLE Trial (Schumacher Ophthalmology 2010, intra-arterial fibrinolysis NOT recommended) + Hayreh CRAO retinal-survival studies + AAO Preferred Practice Pattern (Retinal Vein Occlusions / Retinal Detachment, current cycle)