Differential Diagnosis of Acute Painless Vision Loss (Uninflamed eye)
Retinal artery occlusion
Retinal vein occlusion.
Retinal detachment
Macular degeneration (exudative)
Optic neuritis e.g. from multiple sclerosis
Ischemic optic neuropathy
Vitreous hemorrhage
Stroke
Giant cell arteritis / temporal arteritis
Hyperglycemia (blurry vision)
Polycythemia vera (blurry vision)
Diplopia
Papilledema (optic disc swelling due to elevated intracranial pressure)
Factitious; Conversion disorder; Somatization syndrome; Anxiety reaction
This ddx is for acute persistent visual loss, not acute transient vision loss
Thinking through the Differential Diagnosis
It’s important to visualize the anatomy of the eye: Anatomy of the Eye.
Causes of acute persistent vision loss by anatomy (from front to back of the eye).
Inflammation of the anterior structures of the eye is typically associated with a red, painful, and light sensitive eye, whereas inflammation that is isolated to intermediate and posterior structures may be associated with a normal general appearance of the eye and no pain. There may be a decrease in the red reflex and/or patient complaint of new floaters with inflammation of the intermediate and posterior structures.
Because of that, the eye with acute painless vision loss will usually be uninflamed.
Further Reading
J La State Med Soc. 2009 Jul-Aug;161(4):214-6, 218-23. https://www.ncbi.nlm.nih.gov/pubmed/19785313
Am Fam Physician. 2016 Aug 1;94(3):219-226. Vision Loss in Older Adults. https://www.aafp.org/afp/2016/0801/p219.html