Patient handout

Acute / sudden vision loss

PRODUCTION

1. Your condition

This handout is for acute / sudden vision loss. Your care team identified this based on: sudden monocular or binocular vision loss (aao ppp 2020-2023).

Other reasons your team may use this plan: sudden painless visual field defect (curtain, scotoma, altitudinal) (aao ppp); painful red eye with halos around lights — angle-closure (aao ppp); flashing lights, floaters, curtain — rd / vitreous hemorrhage (aao ppp).

2. Your medications

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	1 g IV	IV	daily × 3 days	Emergent visual GCA — pulse before biopsy; biopsy still informative within 2 wk; prevents contralateral blindness (AAN GCA 2022)
prednisone	1 mg/kg PO (typically 60-80 mg)	PO	daily, taper per response over 12-18 mo	Maintenance after pulse (AAN GCA 2022)
aspirin	81 mg	PO	daily	Vascular complications — observational benefit (AAN GCA 2022)
tocilizumab	162 mg SC weekly	SC	weekly	GiACTA NEJM 2017 PMID 28745999 — sustained remission + steroid sparing

Plan: GCA visual emergency — IV pulse methylpred + ASA + tocilizumab steroid-sparing (AAN GCA 2022; GiACTA 2017)

3. When to call your provider

Contact your care team if any of the following happen:

GCA relapse symptoms → emergent ED + restart pulse (AAN GCA 2022)
New optic neuritis episode → MS clinic urgent + neuro.ms-flare.core.v1 pathway
New CRAO/amaurosis → ED + neuro.ischaemic-stroke.v1 pathway

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Painless monocular vision loss + cherry-red spot + retinal pallor + onset <4.5 h — STAT route to stroke pathway (AHA/ASA 2021 PMID 34024117 — ophthalmic-artery branch as stroke equivalent)(life-threatening)
Age ≥50 + ESR ≥50 + CRP elevated + visual symptoms (amaurosis fugax or AION) ± jaw claudication (LR+ ~6) ± scalp tenderness (LR+ ~5) ± temporal tenderness — STAT high-dose IV methylpred 1 g × 3 d BEFORE biopsy to prevent contralateral blindness (AAN GCA 2022; GiACTA Stone 2017 PMID 28745999)(life-threatening)
Severe eye pain + nausea + halos + IOP > 40-80 mmHg + cloudy cornea + fixed mid-dilated pupil — protocol.angle_closure.v1 (timolol + apraclonidine + pilocarpine + acetazolamide + mannitol simultaneously) + emergent YAG iridotomy (AAO PPP AACG)(life-threatening)
Curtain over vision + flashes + floaters + fundus or POCUS shows detachment — macula-on = emergent OR within 24 h; macula-off = urgent within days (AAO PPP)
Fundus shows flame hemorrhages in all 4 quadrants (CRVO) or one quadrant (BRVO) + cotton-wool spots + macular edema + HTN/DM/glaucoma history — intravitreal anti-VEGF (AAO PPP)
Painful (worse with eye movement) monocular vision loss + RAPD + central scotoma + young adult — IV methylpred 1 g × 3 d (ONTT); MRI brain + orbits; AQP4/MOG before chronic immunosuppression (Beck ONTT NEJM 1992 PMID 1734247)
Visual field defect respecting vertical meridian + cortical signs (alexia, agnosia, neglect) — occipital stroke; route to neuro.ischaemic-stroke.v1 (AHA/ASA 2021)(life-threatening)
Sudden severe headache + bitemporal hemianopia + cranial neuropathies + adrenal insufficiency features — STAT MRI pituitary + hydrocortisone 100 mg IV + neurosurgery (AAO PPP)(life-threatening)
Bilateral central scotomata + AGMA + osmolar gap + history of antifreeze / illicit alcohol — fomepizole + folate + dialysis (EXTRIP)(life-threatening)

5. Follow-up

Ophthalmology, neurology, rheumatology / vascular as warranted; long-term steroid taper + tocilizumab + bone health (GCA); anti-VEGF q4-6w (RVO); AION risk-factor modification (GiACTA 2017; AAN GCA 2022)

6. Sources

Guideline: AAO Preferred Practice Patterns 2020-2023 + AAN GCA 2022 + ONTT NEJM 1992 + GiACTA NEJM 2017 + EUSO 2024 CRAO + AHA/ASA 2021 (CRAO stroke equivalent)