This guideline last updated 28/06/2022 15:42:37

Differential diagnosis

• Poor patient performance at automated perimetry
• Giant cell arteritis
• Cerebral metastasis
• Cerebral tumour

Possible management by Optometrist

Treatment

• None

Advice

• See GP urgently if symptomatic and acute
  • Exclude/treat giant cell arteritis
  • Exclude/treat atrial fibrillation
    • Risk of further embolic events can be prevented through anticoagulation
  • Address vascular risk factors
    • Smoking status
    • Alcohol
    • Diet
    • Exercise
    • Blood pressure
    • Diabetes
  • Referral, depending on local guidelines: to acute stroke service, ophthalmology or in line with locally agreed referral pathway guidance.
    • Speed of referral depends on duration of symptoms
  • If chance finding then further investigation is not urgent
    • Send referral with visual fields to ophthalmology
    • Explain patient may be referred direct to CT head scan, but to await advice.

Management Category

• Referral to GP
• Referral, depending on local guidelines: to acute stroke service, ophthalmology or in line with locally agreed referral pathway guidance.

Possible management by Ophthalmologist

• Exclusion of atrial fibrillation
• If acute, or in the young, specialist vascular evaluation by stroke team
• Neuroimaging
• Advice on risk reduction