Temporal artery ultrasound or biopsy pathway local protocol dependent
Disposition
Level of care criteria
ICU or monitored bed considerations
Large vessel occlusion stroke concern
Hemodynamic instability
Severe hypertensive emergency with neuro symptoms
Inpatient admission
Suspected stroke or TIA requiring expedited workup
Suspected giant cell arteritis with vision symptoms
Endophthalmitis suspicion
Observation pathway
Transient monocular loss with completed ED imaging and stable exam
Low risk TIA phenotype with rapid outpatient follow up arranged
Discharge criteria
Benign diagnosis with stable visual acuity
No alarm features
Reliable follow up within 24 to 72 hours as indicated
Transfer criteria
Facility capability limits
No ophthalmology coverage for time critical eye emergency
No stroke imaging or thrombectomy capability when indicated
Discharge Instructions
Copy discharge instructions
You were seen for sudden or recent vision change
Your exam and testing today suggest a non emergent cause
Your vision can still worsen after you leave
Return to the emergency department now if any of the following happen
Vision gets worse in either eye
New flashes of light
New shower of floaters
A curtain or shadow over vision
New severe eye pain
New redness with light sensitivity
New headache with jaw pain when chewing
Weakness
Numbness
Trouble speaking
Trouble walking
Follow up plan
Ophthalmology follow up within timeframe provided
Primary care follow up for vascular risk factors
Medication instructions
Use eye drops exactly as prescribed
Do not use contact lenses until cleared
Safety cautions
Do not drive until vision is back to normal
Avoid operating machinery if vision is impaired
References
Guidelines and key sources
Core references
American Academy of Ophthalmology preferred practice pattern retinal detachment 2020
American Academy of Ophthalmology preferred practice pattern central retinal artery occlusion 2024
American College of Rheumatology guideline for giant cell arteritis and polymyalgia rheumatica 2021
American Heart Association and American Stroke Association guideline for early management of acute ischemic stroke 2019
American Academy of Neurology practice guidance optic neuritis and demyelinating disease 2021
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.