Emergency Eye Symptoms: When to See an Ophthalmologist Immediately?

Almost everyone knows what the first symptoms of an impending heart attack, stroke, or another acute condition requiring immediate medical intervention are.

In ophthalmology, there are also moments when timely assistance is crucial to whether a person will lose their vision or not. Dr. Doli Efremova, an expert with over 28 years of experience, explains under which eye-related symptoms we should immediately consult an eye doctor: Dr. Doli Efremova, a specialist with over 28 years of experience, who has recently become part of the team at the Specialized Eye Clinic ‘PENTAGRAM’:

Urgency in ophthalmology is a broad topic. I want to draw attention to some symptoms that precede potentially vision-threatening conditions and cases of acute vision loss with a risk of permanent damage without timely treatment.

These include vitreous detachment, retinal detachment, retinal vascular diseases – arterial and venous occlusion, described as “eye infarction”, vitreous hemorrhage (hemophthalmus), macular hemorrhage, neuropathies and others.

VITREOUS DETACHMENT is the most common of the aforementioned urgent conditions and requires a detailed examination on an emergency basis, as it can tear and detach the retina. It can occur spontaneously, triggered by physical exertion or trauma.

Risk factors: The frequency increases with age, in cases of high myopia, inflammatory diseases, and after some eye surgeries.
Symptoms: flashing lights, “floating flies,” floating spots, slight blurring of vision.
Diagnosis: Retinal tears are detected only during an eye examination and are treated with a laser on an urgent basis to prevent retinal detachment.
In cases of retinal detachment, there is a defect in the visual field corresponding to the affected area.
Treatment: Treatment is only surgical and as prompt as possible.

In the image: What the patient sees with vitreous and retinal detachment – flashing lights, flashes, newly appearing floating spots.In cases of retinal detachment, there is a shadow in the visual field or a gray curtain.

VITREOUS HEMORRHAGE (HEMOPHTHALMUS) – not only affects vision, but also hinders or completely prevents the examination of the fundus by obscuring the pathology that caused it. It can be due to the rupture of a retinal vessel, often accompanied by retinal tear.

Diagnosis: Performing an ultrasound is mandatory to rule out retinal detachment.

Risk factors: Hemophthalmos can also occur from pathological blood vessels (neovessels) resulting from retinal ischemia in untreated diabetic retinopathy, retinal vessel thrombosis, some inflammatory diseases, and other ischemic conditions.

Treatment: Timely laser treatment in these cases eliminates the ischemic stimulus and neovessels, significantly reducing the risk of complications.

Photo: Normal fundus and vitreous hemorrhages of varying severity.

VASCULAR OCCLUSIONS – “EYE INFARCT”.

Risk factors: The most common predisposing factors for retinal vascular occlusion are: arterial hypertension, atherosclerosis, diabetes, certain blood diseases, glaucoma.

Symptoms: The symptoms vary depending on the affected vessels, ranging from a slight decrease in central vision and a defect in the visual field to vision loss in the most severe cases of central retinal artery occlusion. Arterial occlusions are more severe, with rapidly occurring irreversible changes in the retina.

Treatment: Vision improvement is possible with treatment within the first few hours of the incident.

MACULAR HEMORRHAGERisk factors: Observed in age-related macular degeneration (AMD), high myopia, uveitis, angioid streaks, eye trauma. It is caused by the formation of pathological blood vessels in the choroid, which leak blood.

Symptoms: Symptoms include a sharp decrease in central vision and image distortion.
Diagnosis: To assess the severity of the condition, OCT (a non-invasive test) and fluorescein angiography (with intravenous contrast administration) are performed.
Treatment – Intravitreal injections that suppress angiogenesis (anti-VEGF)

Photo: Image distortion, dark spot in the center of the visual field in macular degeneration.

Photo: Macular hemorrhage.

ANTERIOR ISCHEMIC OPTIC NEUROPATHY – the most common acute optic neuropathy in patients over 50 years old – arteritic and non-arteritic type. The second is much more common.

Risk factors – structural features of the optic nerve (‘disc at risk’), systemic hypertension, diabetes, hyperlipidemia.
Symptoms: Symptoms include reduced visual acuity, characteristic visual field defects.
Diagnosis and treatment: It is extremely important to distinguish between the two forms due to the different therapeutic approaches.

RETROBULBAR NEURITIS – ‘THE PATIENT SEES NOTHING, AND THE DOCTOR SEES NOTHING’

Symptoms: Vision is reduced without visible pathological changes in the eye. There are disturbances in color vision, especially for the red color. It is more common in young women.
Causes – demyelinating processes (multiple sclerosis), viral, vasculitic, granulomatous diseases.

I mention only the most common causes of acute vision reduction. These conditions occur without pain, usually affecting one eye, and may go unnoticed for some time due to the overlapping visual fields of both eyes. They lead to serious complications, are difficult to treat, and result in permanent visual deficits. Some require an interdisciplinary approach.

Timely diagnosis and treatment are essential for restoring/improving vision, preventing complications, and avoiding irreversible damage.

Recommendations:

* Periodic checking of vision in the right and left eyes separately by consecutively covering one eye and then the other.

* If a vision deficit is found, especially an acutely occurring condition or any of the risk symptoms – immediate consultation with an ophthalmologist! It does not resolve on its own! It gets worse!

* For chronic conditions – regular monitoring by a specialist.

Photo: The visual fields of both eyes overlap for the most part. This is anatomically determined and gives us the ability for three-dimensional vision. Disadvantage: a reduction in vision or a defect in the visual field of one eye may go unnoticed because the other eye ‘covers’ the defect. Therefore, each eye must be examined separately.

Nota bene! Timely diagnosis and treatment of emergencies determine the outcome. Here, the phrase “Better late than never” does NOT apply.

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Dr. Dolly Efremova is an ophthalmologist with 28 years of experience in the specialty and professional interests in the field of cataract surgery, vitreoretinal surgery, and laser therapy for retinal diseases.

She graduated as a doctor from MU-Sofia, where in 2002 she also obtained a specialty in Ophthalmology.
She has impressive professional qualifications in the field of:

– Cataract surgery
– Laser therapy for retinal diseases
– Fluorescein angiography
– Ultrasound diagnostics in ophthalmology
– Vitreoretinal surgery, retinal detachment
– Penetrating eye injuries– Corneal transplantation
– Selective laser trabeculoplasty (SLT)

She specialized at Klinikum Dortmund, Germany.

Her professional career has almost entirely passed in the Ophthalmology Clinic of University Hospital ‘St. Anna’. Since the beginning of October 2025, she has been part of the team at ‘PENTAGRAM’ Eye Clinic and ‘PENTAGRAM 2012’ Medical Center.

You can schedule a consultation with Dr. Efremova at 0700 91 191 or online from HERE.