History and Examination

• Establish when vision loss occurred and in which eye
• Assess cardiovascular risk factors
• Exclude features of giant cell arteritis (link opens in a new Window/tab)
• Palpate the temporal artery (unlike giant cell arteritis expect them to be palpable and non tender)
• Measure visual acuity
• Examine the pupil reactions for an RAPD
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  Relative afferent pupillary defect (RAPD)

  A relative afferent pupillary defect (RAPD) is seen on examination by shining light in one eye, then the other.

  If the left eye has an RAPD it will show little constriction of the pupil when a light is shone into that eye, but when the light is shone into the right eye, the left constricts.

  When swinging back to the left eye it paradoxically dilates, as it is not as responsive to stimulation (as the optic nerve is damaged).

  (? See the pupil section for details ?)

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• Test visual fields (typically unilateral altitudinal hemianopia)
• Examine the optic discs with an ophthalmoscope, ideally dilated.

Test visual fields:

Altitudinal visual field defect

Humphrey visual field test showing an inferior altitudinal field defect

Source: Reproduced from Optic disc macroaneurysm in evolution: from incidental finding to branch retinal artery occlusion and spontaneous resolution, Raja G. Das-Bhaumik, Dan Lindfield, Shauna M. Quinn, Steven J. Charles, Br J Ophthalmol published online May 7, 2009. BMJ Publishing Group Ltd.