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A 25-year-old man presents with sudden loss of vision. Why?

NursingSKL clinical tip

By NursingSKL
January 9, 2023
iStock/ajr_images; NursingSKL

In any patient with visual loss it is imperative to ask two questions.

  1. Is the visual loss in one or both eyes? If the visual loss is monocular (one eye) it is likely related to an eye problem affecting the cornea, anterior chamber, vitreous, retina, or optic nerve. If it is binocular, it likely affects the chiasm or the occipital lobe.
  2. Is there pain associated with the visual loss? If there is pain, it is likely related to a problem in the front of the eye, including such problems as corneal abrasions and infections, inflammation in the eye and angle closure glaucoma.

In this particular patient, a dilated examination showed that the patient had significant areas of retinal “cloudy swelling” (this is what ophthalmologists call retinal whitening and it is due to thickening of the superficial axons of the retina). Retinal cloudy swelling is indicative of retinal artery ischemia. This patient was also noted to have some thinning of the retinal artery (the normal vein to artery ratio is typically 3:2). A chalky-white embolus was noted at the level of the central retinal artery as it exited the optic nerve. The patient was diagnosed with a retinal artery occlusion.

Clinical tip: Always determine if visual loss is from one or both eyes.

In this video, you will learn the four questions that every nurse needs to ask every patient with acute visual loss (and one is linked to a potentially lethal condition!).

This clinical tip was provided by NursingSKL, a collaborative initiative between leading doctors and nurses to improve nurses’ clinical skills. Go to to find out more, meet the faculty, and try our free Practicum on Diabetes Care.
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