GPAtlas🧭 When to suspect
Blurred vision is one of the most common – and most deceptive – presentations in primary care. It spans the entirely benign (an out-of-date spectacle prescription) to the immediately sight- and life-threatening (a retinal artery occlusion, or giant cell arteritis).
Resist reaching for a diagnosis. Instead, answer two questions that organise the whole assessment:
• First, was the onset sudden (minutes to a few days) or gradual (weeks to months)?
• Second, is the eye painful or painless?
These two axes map cleanly onto distinct disease groups and onto urgency.
One important caveat colours the history: patients frequently describe long-standing monocular loss as a sudden event, because they only notice it by chance when the good eye is briefly covered.
• Always establish when the eye was last definitely normal.
• Always test each eye separately.
| Pattern | Conditions to consider |
|---|---|
| Sudden & painful | Acute angle-closure glaucoma, anterior uveitis (iritis), microbial keratitis or corneal ulcer, scleritis, optic neuritis (pain on eye movement) |
| Sudden & painless | Retinal detachment, retinal artery occlusion (CRAO/BRAO), retinal vein occlusion (CRVO/BRVO), vitreous haemorrhage, wet (neovascular) age-related macular degeneration (AMD), ischaemic optic neuropathy (including arteritic – Giant cell arteritis [GCA]), amaurosis fugax (TIA) |
| Gradual & painless | Uncorrected refractive error, cataract, chronic open-angle glaucoma, dry AMD, diabetic retinopathy |
| Gradual & painful (uncommon) | Chronic or recurrent uveitis, some compressive or inflammatory optic neuropathies |
Source: NICE · Royal College of Ophthalmologists
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