Acute Visual Changes in the Elderly

Key Points

History

When an elderly patient presents complaining of visual changes, it is imperative for the physician to attempt to further qualify the symptoms. Visual perceptions may be difficult to describe for some patients, and culture and past experiences can influence a patient’s perception and description of symptoms. The type of vision change is a key piece of ophthalmic history. Vision changes can represent negative or positive visual phenomena. Negative visual phenomena constitute the loss of all or

Physical examination

The initial physical assessment begins with a gross inspection of the orbit, which will reveal disconjugate gaze, and obvious signs of trauma or infection. Next, the patient’s best-corrected visual acuity is assessed. When possible, each eye should be tested separately at both distance and near. If the patient cannot see even the largest optotype on the vision chart (ie, the “big E”), the patient should be assessed for ability to count the examiner’s fingers, see the examiner’s hand movements,

Classification and management

Vision changes may be classified based on a patient’s history and presentation of symptoms. Often a patient may complain of an abrupt vision change only to discover through further evaluation that there is a chronic cause and simply an acute awareness of the change by the patient. For the purposes of this review, vision changes have been classified into unilateral versus bilateral and painful versus painless, thus allowing for quick differentiation of causes of vision changes based on

Summary

Acute vision changes are common in the elderly population. Even small changes in visual perception will prompt a visit to the emergency room or physician office. The ability to recognize emergency situations from exacerbation of chronic conditions can be challenging. Prompt evaluation and appropriate referral may prevent significant morbidity and mortality.