Purpose of review: Acute bilateral blindness has an extensive differential diagnosis that requires a careful history and physical exam to narrow down. In this paper we discuss the pathophysiology and radiographic findings of each possible diagnosis for acute bilateral blindness.

Recent findings: Visual pathology with respect to bilateral blindness can be broadly broken down into three anatomic categories: media (i.e. the anterior and posterior chamber of the eye), retina, and neural visual pathway. Possible causes of rapid onset bilateral blindness include bilateral occipital infarcts, endogenous bacterial endophthalmitis, orbital cellulitis, orbital compartment syndrome, cavernous sinus thrombophlebitis, thyroid disease and bilateral non-arteritic ischemic optic neuropathy.

Summary: In this case we present a patient with acute onset of bilateral blindness, in addition to bilateral ophthalmoplegia, proptosis, and orbital chemosis. We believe this rare case of acute bilateral blindness is thought provoking and aids in the understanding of the differential diagnosis and underlying pathophysiology of visual loss.