很多患者在初级医疗保健机构就诊，常在正常工作时间之外。[1]Rossi T, Boccassini B, Iossa M, et al. Triaging and coding ophthalmic emergency: the Rome Eye Scoring System for Urgency and Emergency (RESCUE): a pilot study of 1,000 eye-dedicated emergency room patients. Eur J Ophthalmol. 2007 May-Jun;17(3):413-7.
http://www.ncbi.nlm.nih.gov/pubmed/17534826?tool=bestpractice.com
[2]Fea A, Bosone A, Rolle T, et al. Eye injuries in an Italian urban population: report of 10,620 cases admitted to an eye emergency department in Torino. Graefes Arch Clin Exp Ophthalmol. 2008 Feb;246(2):175-9.
http://www.ncbi.nlm.nih.gov/pubmed/18183412?tool=bestpractice.com
当泪膜至枕叶皮质区的视觉系统存在异常时，可能出现视力丧失。最初需确定的最重要的因素是症状出现的快速性。早期评估是否存在疼痛、复视、闪光和/或飞蚊症等伴随症状也很重要。这有助于识别存在可能危及生命疾病的患者，并且让需要立即接受眼科医师意见或手术干预的患者得到重视。[1]Rossi T, Boccassini B, Iossa M, et al. Triaging and coding ophthalmic emergency: the Rome Eye Scoring System for Urgency and Emergency (RESCUE): a pilot study of 1,000 eye-dedicated emergency room patients. Eur J Ophthalmol. 2007 May-Jun;17(3):413-7.
http://www.ncbi.nlm.nih.gov/pubmed/17534826?tool=bestpractice.com
[3]Ramos M, Kruger EF, Lashkari K. Biostatistical analysis of pseudophakic and aphakic retinal detachments. Semin Ophthalmol. 2002 Sep-Dec;17(3-4):206-13.
http://www.ncbi.nlm.nih.gov/pubmed/12759852?tool=bestpractice.com
突然发生或者在数分钟到数小时内发生的急性视力丧失通常需要急诊眼科处理。亚急性或慢性视力丧失患者（视力丧失在数周、数月或数年内发生）可能仍需要专科医师建议，但通常不是紧急事宜
任何显著的视力丧失都需要眼科医生会诊，以获取关于转诊时机的建议
视力丧失也可能是多种全身性疾病的首发症状，需要进一步检查。[4]Klig JE. Ophthalmologic complications of systemic disease. Emerg Med Clin North Am. 2008 Feb;26(1):217-31.
http://www.ncbi.nlm.nih.gov/pubmed/18249264?tool=bestpractice.com
急性视力丧失
视网膜或视神经疾病通常表现为急性发作。 其他急性视力丧失的原因包括急性闭角型青光眼、视网膜血管阻塞和外伤
患者的年龄和病史测定有助于诊断
慢性视力丧失
患者可能突然意识到慢性恶化的症状；意味着可能因慢性视力丧失而到急诊科就诊，从而增加了诊断难度
回顾相关症状有助于区分急症与非急症，并安排适当的眼科诊疗
全身性因素
必需采集完整既往史，侧重血管和神经过程以及视力等病史
糖尿病视网膜病变可在糖尿病确诊之前出现，因此对于所有出现急性视力丧失的患者，检测血糖水平非常重要。对所有新诊断出糖尿病的成年人安排眼科检查。[5]Jones HL, Walker EA, Schechter CB, et al. Vision is precious: a successful behavioral intervention to increase the rate of screening for diabetic retinopathy for inner-city adults. Diabetes Educ. 2010 Jan-Feb;36(1):118-26.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582664
http://www.ncbi.nlm.nih.gov/pubmed/20044537?tool=bestpractice.com
[6]Solomon SD, Chew E, Duh EJ, et al. Diabetic retinopathy: a position statement by the American Diabetes Association. Diabetes Care. 2017 Mar;40(3):412-8.
https://www.doi.org/10.2337/dc16-2641
http://www.ncbi.nlm.nih.gov/pubmed/28223445?tool=bestpractice.com
其他严重的全身性疾病（包括肉芽肿性多血管炎、细菌性脑膜炎或弥漫性恶性肿瘤）可能需要在急诊科或者入院进行处理。[7]Mitra A, Chavan R, Gunda M. Occult giant cell arteritis and steroid therapy: how urgent is urgent? Ann Ophthalmol (Skokie). 2006 Winter;38(4):343-5.
http://www.ncbi.nlm.nih.gov/pubmed/17726223?tool=bestpractice.com
