Complaints of changes in vision or loss of vision are common in the emergency department (ED). This complaint may represent a simple problem related to recent trauma or may be early evidence of systemic disease. Some causes require urgent recognition and management, whereas others require minimal outpatient treatment. Key to the diagnosis and recognition of the more significant causes is a logical and organized approach to the history and the physical examination of the patient with eye complaints. The important issues for the emergency physician are: 1) recognition of visual changes; 2) general localization of the lesion through an orderly and structured manner; and 3) appropriate referral if the diagnosis is not apparent or the treatment indicated requires specialized techniques.<sup>1 Achkar A.A., Lie J.T., Hunder G.G. , et al. How does previous corticosteroids treatment affect the biopsy findings in giant cell (temporal) arteritis? Ann Intern Med 1994 ;  120 : 987-992

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This article reviews an organized approach to the patient with the complaint of visual loss and considers the wide differential diagnosis that must be contemplated. Because a complete discussion of all possible causes causing acute and subacute visual loss is beyond the scope of this text, this article focuses specifically on the evaluation of the patient with the chief complaint of visual changes caused by central retinal artery occlusion, central retinal vein occlusion, retinal detachment, acute angle-closure glaucoma, giant cell temporal arteritis, and retrobulbar hemorrhage.