Date of last review: Due to be updated

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