The American journal of emergency medicine · 2026
Evaluation of acute visual changes in the pediatric emergency department: Etiologies and red flags.
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Akkaya Bilge, Özcan Ahmet Serkan, Erdem Fatma Şule, Öztürk Betül, Yaradılmış Raziye Merve, Aydın Orkun, Güngör Ali, Tuygun Nilden
Аннотация
INTRODUCTION: Acute visual changes-including blurred vision, diplopia, photopsia, visual hallucinations, and vision loss-pose a diagnostic challenge in children due to limited symptom description and limited cooperation during examination. We aimed to (1) characterize the etiologies of children presenting to a pediatric emergency department (PED) with acute visual changes and (2) identify clinical predictors of pathologic neuroimaging findings.
METHODS: We conducted a retrospective, single-center study at a tertiary PED between 2022 and 2024. Patients aged 1 month to 18 years were identified through structured chief complaint fields and keyword searches of electronic medical records (e.g., "blurred vision," "vision loss," "double vision"). Acute visual changes were defined as sudden-onset symptoms occurring within 72 h before presentation. Clinical features were compared between patients with pathologic neuroimaging findings and those with normal imaging results.
RESULTS: We included 444 patients in the study. The most common etiologies were neurological (29%), ocular (23%), and systemic (18%). Neuroimaging was performed in 178 patients (40%); among them, 63 (35%) demonstrated pathologic findings. Vision loss, pain with eye movements, focal neurological deficits, signs of meningeal irritation, dysmetria, tremor, papilledema, abnormal pupillary light reflexes, and a positive Romberg sign were significantly more frequent among patients with pathologic neuroimaging findings (p < 0.001). In multivariable analysis, focal neurological deficits, pain with eye movement, paresthesia, tremor, and abnormal pupillary light reflex abnormalities were independently associated with pathologic imaging findings.
CONCLUSION: Although most pediatric acute visual changes are benign, a clinically important proportion are associated with significant neuroimaging abnormalities. Specific neurological examination findings may help identify children at higher risk for intracranial pathology. Prospective multicenter studies are needed to validate these predictors and refine imaging strategies in the PED.
METHODS: We conducted a retrospective, single-center study at a tertiary PED between 2022 and 2024. Patients aged 1 month to 18 years were identified through structured chief complaint fields and keyword searches of electronic medical records (e.g., "blurred vision," "vision loss," "double vision"). Acute visual changes were defined as sudden-onset symptoms occurring within 72 h before presentation. Clinical features were compared between patients with pathologic neuroimaging findings and those with normal imaging results.
RESULTS: We included 444 patients in the study. The most common etiologies were neurological (29%), ocular (23%), and systemic (18%). Neuroimaging was performed in 178 patients (40%); among them, 63 (35%) demonstrated pathologic findings. Vision loss, pain with eye movements, focal neurological deficits, signs of meningeal irritation, dysmetria, tremor, papilledema, abnormal pupillary light reflexes, and a positive Romberg sign were significantly more frequent among patients with pathologic neuroimaging findings (p < 0.001). In multivariable analysis, focal neurological deficits, pain with eye movement, paresthesia, tremor, and abnormal pupillary light reflex abnormalities were independently associated with pathologic imaging findings.
CONCLUSION: Although most pediatric acute visual changes are benign, a clinically important proportion are associated with significant neuroimaging abnormalities. Specific neurological examination findings may help identify children at higher risk for intracranial pathology. Prospective multicenter studies are needed to validate these predictors and refine imaging strategies in the PED.