What is included in the physical exam to evaluate transient vision loss (TVL)?

Updated: May 21, 2019
  • Author: Andrew J Tatham, MD, MBA, FRCOphth, FEBO, FRCS(Ed); Chief Editor: Andrew G Lee, MD  more...
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Answer

Answer

The examination should look for ocular and systemic causes of the visual disturbance, as follows:

Check visual acuity; in children who are old enough to report a visual disturbance, it is possible to measure a Log Mar or Snellen visual acuity.

  • Check the pupils for a relative afferent pupillary defect.
  • Examine the visual fields, perform a cover test, and examine extraocular motility.
  • Perform a slit-lamp examination of the anterior segment, including fluorescein examination of the tear film, conjunctiva, and cornea, and measure the intraocular pressure (IOP); anterior-segment causes of transient vision loss are many, ranging from tear film abnormalities to intermittent angle closure, corneal disease, or uveitis. [3]
  • Perform dilated funduscopy; this may reveal optic disc edema, retinal emboli, or ocular ischemia.
  • If the vision is still reduced at presentation, perform a refraction; in addition, consider tests (eg, fogging test, prism shift test, stereoscopic tests, visual evoked potentials, and pattern electroretinography [ERG]) that may help exclude nonorganic visual loss. [35, 36]
  • If pain is present, look for its specific causes (eg, angle-closure glaucoma, optic neuritis, or optic disc edema, suggesting increased IOP).

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