Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
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A new field defect may be a stroke or retinal emergency
Sudden loss of one side of the visual world, a descending curtain or a new deficit with neurological symptoms can occur despite preserved central acuity and a comfortable eye.
Action: Establish the last known normal time, test each eye and arrange immediate stroke or emergency eye assessment according to the pattern; do not wait for formal perimetry before escalating an acute deficit.
Synopsis
Screen the distribution of visual function at the bedside, recognise localising field patterns and understand when a confrontation result requires urgent investigation or formal perimetry.
Confrontation screens visual fields around fixation; it is not a precise map of retinal sensitivity and cannot replace formal perimetry.
Sit at the patient's eye level and assess each eye separately, with the patient fixing your open opposite eye and the fellow eye covered.
Present comparable targets in all quadrants while watching fixation; use several positions and approaches rather than a single finger sweep.
Key red flags
An abrupt homonymous field defect, with or without weakness or speech disturbance, requires emergency stroke assessment even when a brief FAST screen is otherwise unrevealing.
Investigation priorities
01
Monocular quadrant confrontationFirst step
Screen for reproducible asymmetry in visual function around fixation.
Management branches
Bedside techniqueScreen both monocular fields carefully
A visual complaint or neurological examination requires assessment beyond central acuity.
Explain fixation and the response required, position your eyes at the patient's level and cover the untested eye without pressure.
Present targets in multiple positions in every quadrant, maintaining comparable distance and checking that the patient does not follow the stimulus.
Ongoing assessmentConfirm stable defects and support function
A nonacute or uncertain deficit remains after the initial clinical evaluation.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.