Visual loss

Sudden loss of vision is often due to a vascular cause and associated nausea and vomiting suggests orbital haemorrhage. Although periorbital or subconjunctival ecchymosis may be evident at presentation, often it does not track forward from the orbit (and become visible) for several days. Vaso-obliterative conditions, such as orbital mucormycosis or Wegener's granulomatosis, may also be associated with multiple cranial nerve deficits.

Optic nerve compression generally causes a progressive loss of function, which the patient will notice as failing colour perception and a "drab", "washed-out" and "grey" quality to their vision. Slow-growing retrobulbar masses may compress the globe and affect vision by inducing hypermetropia (or premature presbyopia) or by causing choroidal folds. Gaze evoked amaurosis - with visual failure on certain ductions - may occur with large and slowly growing retrobulbar masses that stretch the optic nerve.

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