Transient visual loss or obscuration can be a symptom of minor ocular surface disorder or it may be the harbinger of permanent and total visual loss or even stroke. The key to determining which of these afflicts your patient is in a targeted history, comprehensive examination, judicious investigation and appropriate treatment or referral.
A 78-year-old woman presented to her GP describing the sudden onset of right-sided visual loss. The episode initially resolved after five minutes but then progressed rapidly and painlessly to total loss of vision in her right eye several days later. The woman also described six weeks of difficulty with swallowing, which was later associated with jaw claudication and pain behind her right eye. These symptoms occurred on a background of polymyalgia rheumatica that had been well controlled with oral prednisolone 2.5 mg per day.