Changes in vision or loss of vision are common complaints for patients pres
enting to the emergency department. Such complaints may represent a simple
problem related to recent trauma, early evidence of a systemic disease, or
may be a vision-threatening lesion. A logical and organized approach to the
history and the physical examination of the patient with eye complaints is
key to the diagnosis and treatment of the more significant causes of these
complaints. This article reviews an organized approach to the patient with
complaint of visual loss and considers the wide differential diagnosis. It
focuses specifically on the evaluation of the patient complaining of visua
l changes resulting from central retinal artery occlusion, central retinal
vein occlusion, retinal detachment, acute angle-closure glaucoma, giant cel
l temporal arteritis, and retrobulbar hemorrhage.