Acute bilateral blindness is an emergent condition that may signal lif
e-threatening disease. This article details an emergency medicine appr
oach to the patient with acute bilateral blindness, and reports a case
of an elderly woman whose sole presenting complaint was acute loss of
vision, She was ultimately diagnosed as having pulmonary embolism, Th
e approach focuses on identification of life-threatening disease proce
sses, while differentiating between ocular, psychogenic, and cortical
etiologies.