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Diseases » Blindness » Causes
 

Causes of Blindness

Contents
  1. Blindness: Introduction
  2. List of Causes
  3. Hidden causes
  4. Excerpts from book chapters
  5. Complication causes
  6. Causes of symptoms
  7. News
  8. Statistics about causes
  9. Related cause information

List of causes of Blindness

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Blindness) that could possibly cause Blindness includes:

More causes: see full list of causes for Blindness

Causes of Blindness (Diseases Database):

The follow list shows some of the possible medical causes of Blindness that are listed by the Diseases Database:

Source: Diseases Database

Blindness Causes: Book Excerpts

Blindness as a complication of other conditions:

Other conditions that might have Blindness as a complication may, potentially, be an underlying cause of Blindness. Our database lists the following as having Blindness as a complication of that condition:

Blindness as a symptom:

Conditions listing Blindness as a symptom may also be potential underlying causes of Blindness. Our database lists the following as having Blindness as a symptom of that condition:

What causes Blindness?

Article excerpts about the causes of Blindness:

Diabetes Statistics in the United States: NIDDK (Excerpt)

Diabetes is the leading cause of new cases of blindness in adults 20 to 74 years old. (Source: excerpt from Diabetes Statistics in the United States: NIDDK)

Aging and Your Eyes - Age Page - Health Information: NIA (Excerpt)

Retinal disorders are a leading cause of blindness in the United States. The retina is a thin lining on the back of the eye. It is made up of cells that get visual images and pass them on to the brain. Retinal disorders include age-related macular degeneration, diabetic retinopathy, and retinal detachment. (Source: excerpt from Aging and Your Eyes - Age Page - Health Information: NIA)

Medical news summaries relating to Blindness:

The following medical news items are relevant to causes of Blindness:

Cause statistics for Blindness:

The following are statistics from various sources about the causes of Blindness:

  • 97% of all blindness results from common eye diseases in the US (Research to Prevent Blindness, NISE, NSF)
  • 0.8% of diabetic adults attending specialist diabetes services suffered new blindness in Australia 2002 (Australia’s Health 2004, AIHW)
  • 12,000-24,000 new cases of blindness annually are due to diabetic retinopathy in the US (National Diabetes Statistics fact sheet, NIDDK, 2003)
  • Diabetes causes 8,000 new cases of blindness in the US (Research to Prevent Blindness, NISE, NSF)
  • 5,500 people each year become blind from glaucoma in the US (Research to Prevent Blindness, NISE, NSF)
  • 120,000 people are currently blind from glaucoma in the US (Research to Prevent Blindness, NISE, NSF)
  • 104,000 people are legally blind from because of age-related macular Degeneration in the US (Research to Prevent Blindness, NISE, NSF)
  • 30,000 people go blind because of uveitis in the US (Research to Prevent Blindness, NISE, NSF)
  • more statistics...»

Related information on causes of Blindness:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Blindness may be found in:

Causes of Blindness: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Blindness.

Papilledema: Differential Diagnosis
(In a Page: Signs and Symptoms)

Optic disc swelling due to increased ICP

  • Pseudotumor cerebri (idiopathic intracranial hypertension)
    –Most common cause of papilledema
    –Young, obese, or pregnant females
    –Associated with vitamin A overdose, OCPs, tetracycline, steroid withdrawal
  • Cerebral tumor (primary or metastatic)
  • Hydrocephalus (e.g., tumor, Arnold-Chiari malformation, aqueductal stenosis, postinfectious)
  • Intracranial hemorrhage (papilledema may not be seen acutely because it takes about 24 hours to develop after the ICP increases)
    –Subdural hematoma
    –Subarachnoid hemorrhage
    –Hemorrhagic stroke
    –Epidural hematoma
  • Intracranial infection
    –Brain abscess
    –Encephalitis (e.g., herpes)
    –Neurosyphilis
    –Toxoplasmosis
  • Meningitis (e.g., bacterial, viral, TB)
  • Malignant hypertension
  • Pre-eclampsia
    Optic disc swelling not due to increased ICP
  • Pseudopapilledema (the vessels traversing the disk margins are obscured, as in true papilledema): Optic disc drusen or congenitally anomalous disc
  • Papillitis: Unilateral, painful, vitreous cells
  • Papillophlebitis: Mild visual loss and disk swelling in young, healthy patient
  • Central retinal vein occlusion: Unilateral, associated with an acute loss of vision
  • Diabetic papillopathy: Disk edema with minimal visual loss, resolves spontaneously
  • Optic-disc vasculitis/ischemic optic neuropathy (giant cell/temporal arteritis)
  • Orbital optic-nerve tumors
  • Graves’ ophthalmopathy: History of thyroid dysfunction; may be associated with lid lag, proptosis, increased intraocular pressure
  • Uveitis: Associated with pain, photophobia, and scleral injection
  • Atypical optic neuritis

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Vision Loss: Differential Diagnosis
(In a Page: Signs and Symptoms)

Transient vision loss (<24 hours)

  • Papilledema: Lasts seconds, bilateral
  • Amaurosis fugax: Lasts minutes, unilateral
  • Vertebrobasilar artery insufficiency: Lasts minutes, bilateral
  • Migraine: Lasts 10–60 minutes
  • Impending central retinal vein occlusion
  • Ocular ischemic syndrome (carotid occlusive disease)
  • Sudden change in blood pressure; orthostatic hypotension
    • Transient acute increase in intraocular pressure (e.g., acute angle closure glaucoma, retro- or peribulbar hemorrhage)

    Vision loss >24 hours: Sudden, painless
  • Retinal artery or vein occlusion
  • Ischemic optic neuropathy (must rule out giant cell/temporal arteritis to prevent permanent bilateral vision loss)
  • Vitreous or aqueous hemorrhage (hyphema)
  • Retinal detachment
  • Other retinal or CNS disease (e.g., cortical blindness due to occipital lobe CVA)
  • Exposure (“Welder's flash”) or prolonged exposure to intense sunlight

Vision loss >24 hours: Gradual, painless
  • Cataract
  • Refractive error
  • Open angle glaucoma
  • Chronic retinopathy (e.g., age-related macular degeneration, diabetic retinopathy)
  • Chronic corneal disease (e.g., corneal dystrophy)
  • Optic neuropathy/atrophy (e.g., compressive lesion, toxic-metabolic cause, dominant optic neuropathy, radiation)
  • Retinitis pigmentosa
  • Pseudotumor cerebri

    • Vision loss >24 hours: Painful
  • Acute angle closure glaucoma
  • Optic neuritis (pain with extraocular motion)
  • Orbital apex/superior orbital fissure/ cavernous sinus syndrome
  • Uveitis
  • Corneal hydrops (keratoconus)
    • Ocular onchocerciasis (“river blindness”)
      –Common cause of blindness in developing nations due to Onchocerca volvulus worm
    • Corneal abrasion or ulcer
    • Herpes simplex or zoster infection
    '>

    » READ BOOK EXCERPT ONLINE »

    Source: In a Page: Signs and Symptoms, 2004

    Vision Loss: Differential Diagnosis
    (In A Page: Pediatric Signs and Symptoms)

    • Vascular causes
      –Amaurosis fugax: TIA of the retina lasting 5–60 minutes
      –Stroke causes loss of side vision usually to the left or right, may be interpreted as loss of vision in the right or left eye
      –Retinal vascular occlusion: Venous shows gradual decline with retinal hemorrhaging; arterial has sudden onset with minimal to no retinal hemorrhaging
      • Transient monocular blindness (TMB)
        –Lasts seconds
        –Due to positional changes in optic disc edema with increased intracranial hypertension, orthostatic hypotension, thyroid eye disease, and space-occupying lesions
    • Migraine variants are transient and may be associated with headache after presentation
    • Optic nerve edema or swelling from demyelinating disease, nonarteritic and arteritic optic neuropathy, toxicity (e.g., lead, chloramphenicol)
    • Optic atrophy
      • Retinal etiologies
        –Retinal surface wrinkling disorders
        –Idiopathic central serous retinopathy often associated with stress
        –Retinal detachment with probable history of floaters before loss of vision
    • Angle closure glaucoma
      • Postsurgical
        –Endophthalmitis: Often associated with ocular surgery and red eye
        –Cystoid macular edema may occur after ocular surgery
    • Vitreous hemorrhage
      –You will not be able to see into the eye
      • Infectious causes
        –Retinitis and/or uveitis due to toxoplasmosis, cytomegalovirus, Lyme, histoplasmosis
    • Trauma
    • Hysterical blindness
    • Cataracts
    • Hypoglycemia
    • Retinitis pigmentosa

    » READ BOOK EXCERPT ONLINE »

    Source: In A Page: Pediatric Signs and Symptoms, 2007

    Papilledema (Optic Disc Swelling): Differential Diagnosis
    (In A Page: Pediatric Signs and Symptoms)

    • Pseudotumor cerebri
      –Other symptoms: Headache, nausea, and vomiting all worse in morning, transient visual obscurations, diplopia
      –Diagnosis includes increased ICP, normal imaging, normal CSF
      –More common in obese females
    • Optic neuritis
      –May be associated with postviral syndromes or meningoencephalitis
      –Loss of vision, pain on eye movement
      –Vision usually improves within a few weeks, but not full recovery
    • Optic neuropathy
      –Compressive: Associated with NF1 and optic nerve glioma, presents with progressive visual loss, strabismus, nystagmus, proptosis
      –Infiltrative: From cancers (leukemias, lymphomas), infection, or inflammation (sarcoidosis, TB, toxocariasis, toxoplasmosis, CMV); optic disc swelling, vision loss, and hemorrhages
      –Toxic/nutritional optic neuropathy: Symmetric neuropathy from nutritional deficiency (thiamine, B12), drugs (tobacco/alcohol, chloramphenicol, rifampin), toxins (lead, methanol); visual field and vision loss; may recover with treatment
      –Leber optic neuropathy: Mitochondrial DNA transmission, presents late teens to middle 20s; visual field and vision loss, may spontaneously improve
    • Increased ICP: Idiopathic intracranial hypertension, intracranial hemorrhage, space-occupying lesion
    • Growth hormone supplementation
    • Retinal hemorrhage and loss of vision
    • Retinal vein occlusion
    • Malignant hypertension: Associated with retinal hemorrhage, exudates, and cotton wool spots
    • Optic neuropathy, nonarteritic or arteritic
    • Demyelinating disease
    • Infectious conditions: Toxoplasmosis, Lyme disease, Bartonella; hard exudates may be visible funduscopically

    » READ BOOK EXCERPT ONLINE »

    Source: In A Page: Pediatric Signs and Symptoms, 2007

    Hemianopsia: Medical causes
    (Handbook of Signs & Symptoms (Third Edition))

    Carotid artery aneurysm

    An aneurysm in the internal carotid artery can cause contralateral or bilateral defects in the visual fields

    It can also cause hemiplegia, a decreased LOC, a headache, aphasia, behavior disturbances, and unilateral hypoesthesia.

    Occipital lobe lesion

    The most common symptoms arising from a lesion of one occipital lobe are incomplete homonymous hemianopsia, scotomas, and impaired color vision The patient may also experience visual hallucinations —  flashes of light or color or visions of objects, people, animals, or geometric forms

    These may appear in the defective field or may move toward it from the intact field.

    Parietal lobe lesion

    Parietal lobe lesion produces homonymous hemianopsia and sensory deficits, such as an inability to perceive body position or passive movement or to localize tactile, thermal, or vibratory stimuli It may also cause apraxia and visual or tactile agnosia.

    Pituitary tumor

    A tumor that compresses nerve fibers supplying the nasal half of both retinas causes complete or partial bitemporal hemianopsia that first occurs in the upper visual fields but later can progress to blindness Related findings include blurred vision, diplopia, a headache and, rarely, somnolence, hypothermia, and seizures.

    Stroke

    Hemianopsia can result when a hemorrhagic, thrombotic, or embolic stroke affects part of the optic pathway

    Associated signs and symptoms vary according to the location and size of the stroke, but may include a decreased LOC; intellectual deficits, such as memory loss and poor judgment; personality changes; emotional lability; a headache; and seizures The patient may also develop contralateral hemiplegia, dysarthria, dysphagia, ataxia, a unilateral sensory loss, apraxia, agnosia, aphasia, blurred vision, decreased visual acuity, and diplopia

    He may also experience urine retention or incontinence, constipation, and vomiting.

    » READ BOOK EXCERPT ONLINE »

    Source: Handbook of Signs & Symptoms (Third Edition), 2006

    Scotoma: Medical causes
    (Handbook of Signs & Symptoms (Third Edition))

    Chorioretinitis

    Inflammation of the choroid and retina produces a paracentral scotoma. Ophthalmoscopic examination reveals clouding and cells in the vitreous, subretinal hemorrhage, and neovascularization. The patient may have photophobia along with blurred vision.

    Macular degeneration

    Any degenerative process or disorder affecting the fovea centralis results in a central scotoma. Ophthalmoscopic examination reveals changes in the macular area. The patient may notice subtle changes in visual acuity, in color perception, and in the size and shape of objects.

    Optic neuritis

    Inflammation, degeneration, or demyelination of the optic nerve produces a central, circular, or centrocecal scotoma. The scotoma may be unilateral with involvement of one nerve, or bilateral with involvement of both nerves. It can vary in size, density, and symmetry. The patient may report severe vision loss or blurring, lasting up to 3 weeks, and pain — especially with eye movement. Common ophthalmoscopic findings include hyperemia of the optic disk, retinal vein distention, blurred disk margins, and filling of the physiologic cup.

    Retinal pigmentary degeneration

    Retinal pigmentary degeneration causes premature retinal cell changes leading to cell death. One disorder, retinitis pigmentosa, initially involves loss of peripheral rods; the resulting annular scotoma progresses concentrically until only a central field of vision (tunnel vision) remains. The earliest symptom —  impaired night vision —  appears during adolescence. Associated signs include narrowing of the retinal blood vessels and pallor of the optic disk. Eventually, with invasion of the macula, blindness may occur.

    » READ BOOK EXCERPT ONLINE »

    Source: Handbook of Signs & Symptoms (Third Edition), 2006

    Vision loss: Medical causes
    (Handbook of Signs & Symptoms (Third Edition))

    Amaurosis fugax

    With amaurosis fugax, recurrent attacks of unilateral vision loss may last from a few seconds to a few minutes. Vision is normal at other times. Transient unilateral weakness, hypertension, and elevated intraocular pressure (IOP) in the affected eye may also occur.

    Cataract

    Typically, painless and gradual visual blurring precedes vision loss. As the cataract progresses, the pupil turns milky white.

    Concussion

    Immediately or shortly after blunt head trauma, vision may be blurred, double, or lost. Generally, vision loss is temporary. Other findings include headache, anterograde and retrograde amnesia, transient loss of consciousness, nausea, vomiting, dizziness, irritability, confusion, lethargy, and aphasia.

    Diabetic retinopathy

    Retinal edema and hemorrhage lead to visual blurring, which may progress to blindness.

    Endophthalmitis

    Typically, endophthalmitis — an intraocular inflammation — follows penetrating trauma, I.V. drug use, or intraocular surgery, causing possibly permanent unilateral vision loss; a sympathetic inflammation may affect the other eye.

    Glaucoma

    Glaucoma produces gradual visual blurring that may progress to total blindness. Acute angle-closure glaucoma is an ocular emergency that may produce blindness within 3 to 5 days. Findings are rapid onset of unilateral inflammation and pain, pressure over the eye, moderate pupil dilation, nonreactive pupillary response, a cloudy cornea, reduced visual acuity, photophobia, and perception of blue or red halos around lights. Nausea and vomiting may also occur.

    Chronic angle-closure glaucoma has a gradual onset and usually produces no symptoms, although blurred or halo vision may occur. If untreated, it progresses to blindness and extreme pain.

    Chronic open-angle glaucoma is usually bilateral, with an insidious onset and a slowly progressive course. It causes peripheral vision loss, aching eyes, halo vision, and reduced visual acuity (especially at night).

    Ocular trauma

    Following eye injury, sudden unilateral or bilateral vision loss may occur. Vision loss may be total or partial and permanent or temporary. The eyelids may be reddened, edematous, and lacerated; intraocular contents may be extruded.

    Optic atrophy

    Degeneration of the optic nerve, optic atrophy can develop spontaneously or follow inflammation or edema of the nerve head, causing irreversible loss of the visual field with changes in color vision. Pupillary reactions are sluggish, and optic disk pallor is evident.

    Optic neuritis

    An umbrella term for inflammation, degeneration, or demyelinization of the optic nerve, optic neuritis usually produces temporary but severe unilateral vision loss. Pain around the eye occurs, especially with movement of the globe. This may occur with visual field defects and a sluggish pupillary response to light. Ophthalmoscopic examination commonly reveals hyperemia of the optic disk, blurred disk margins, and filling of the physiologic cup.

    Paget’s disease

    Bilateral vision loss may develop as a result of bony impingements on the cranial nerves. This occurs with hearing loss, tinnitus, vertigo, and severe, persistent bone pain. Cranial enlargement may be noticeable frontally and occipitally, and headaches may occur. Sites of bone involvement are warm and tender, and impaired mobility and pathologic fractures are common.

    Pituitary tumor

    As a pituitary adenoma grows, blurred vision progresses to hemianopia and, possibly, unilateral blindness. Double vision, nystagmus, ptosis, limited eye movement, and headaches may also occur.

    Retinal artery occlusion (central)

    Retinal artery occlusion is a painless ocular emergency that causes sudden unilateral vision loss, which may be partial or complete. Pupil examination reveals a sluggish direct pupillary response and a normal consensual response. Permanent blindness may occur within hours.

    Retinal detachment

    Depending on the degree and location of detachment, painless vision loss may be gradual or sudden and total or partial. Macular involvement causes total blindness.

    With partial vision loss, the patient may describe visual field defects or a shadow or curtain over the visual field as well as visual floaters.

    Retinal vein occlusion

    Most common in geriatric patients, retinal vein occlusion — a painless disorder — causes a unilateral decrease in visual acuity with variable vision loss. IOP may be elevated in both eyes.

    Rift Valley fever

    Rift Valley fever is a viral disease that causes inflammation of the retina and may result in some permanent vision loss. Typical signs and symptoms include fever, myalgia, weakness, dizziness, and back pain. A small percentage of patients may develop encephalitis or may progress to hemorrhagic fever that can lead to shock and hemorrhage.

    Senile macular degeneration

    Occurring in elderly patients, senile macular degeneration causes painless blurring or loss of central vision. Vision loss may proceed slowly or rapidly, eventually affecting both eyes. Visual acuity may be worse at night.

    Stevens-Johnson syndrome

    Corneal scarring from associated conjunctival lesions produces marked vision loss. Purulent conjunctivitis, eye pain, and difficulty opening the eyes occur. Additional findings include widespread bullae, fever, malaise, cough, drooling, inability to eat, sore throat, chest pain, vomiting, diarrhea, myalgias, arthralgias, hematuria, and signs of renal failure.

    Temporal arteritis

    Vision loss and visual blurring with a throbbing, unilateral headache characterize this disorder. Other findings include malaise, anorexia, weight loss, weakness, low-grade fever, generalized muscle aches, and confusion.

    Vitreous hemorrhage

    With vitreous hemorrhage, sudden unilateral vision loss may result from intraocular trauma, ocular tumors, or systemic disease (especially diabetes, hypertension, sickle cell anemia, or leukemia). Visual floaters and partial vision with a reddish haze may occur. The patient’s vision loss may be permanent.

    Other causes

    Drugs

    Chloroquine therapy may cause patchy retinal pigmentation that typically leads to blindness. Phenylbutazone may cause vision loss and increased susceptibility to retinal detachment. Digoxin, indomethacin, ethambutol, quinine sulfate, and methanol toxicity may also cause vision loss.

    » READ BOOK EXCERPT ONLINE »

    Source: Handbook of Signs & Symptoms (Third Edition), 2006

    Hemianopsia: Medical causes
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    Carotid artery aneurysm

    An aneurysm in the internal carotid artery can cause contralateral or bilateral defects in the visual fields. It can also cause hemiplegia, decreased LOC, headache, aphasia, behavior disturbances, and unilateral hypoesthesia.

    Occipital lobe lesion

    The most common symptoms arising from a lesion of one occipital lobe are incomplete homonymous hemianopsia, scotomas, and impaired color vision. The patient may also experience visual hallucinations: flashes of light or color, or visions of objects, people, animals, or geometric forms. These may appear in the defective field or may move toward it from the intact field.

    Parietal lobe lesion

    This disorder produces homonymous hemianopsia and sensory deficits, such as an inability to perceive body position or passive movement or to localize tactile, thermal, or vibratory stimuli. It may also cause apraxia and visual or tactile agnosia.

    Pituitary tumor

    A tumor that compresses nerve fibers supplying the nasal half of both retinas causes complete or partial bitemporal hemianopsia that first occurs in the upper visual fields but later can progress to blindness. Related findings include blurred vision, diplopia, headache, and (rarely) somnolence, hypothermia, and seizures.

    Stroke

    Hemianopsia can result when a hemorrhagic, thrombotic, or embolic stroke affects any part of the optic pathway. Associated signs and symptoms vary according to the location and size of the stroke but may include decreased LOC; intellectual deficits, such as memory loss and poor judgment; personality changes; emotional lability; headache; and seizures. The patient may also develop contralateral hemiplegia, dysarthria, dysphagia, ataxia, unilateral sensory loss, apraxia, agnosia, aphasia, blurred vision, decreased visual acuity, and diplopia as well as urine retention or incontinence, constipation, and vomiting.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

    Scotoma: Medical causes
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    Chorioretinitis

    Inflammation of the choroid and retina produces a paracentral scotoma. Ophthalmoscopic examination reveals clouding and cells in the vitreous, subretinal hemorrhage, and neovascularization. The patient may have photophobia along with blurred vision.

    Glaucoma

    Prolonged elevation of IOP can cause an arcuate scotoma. Poorly controlled glaucoma can also cause cupping of the optic disk, loss of peripheral vision, and reduced visual acuity. The patient may also see rainbow-colored halos around lights.

    Macular degeneration

    Any degenerative process or disorder affecting the fovea centralis results in a central scotoma. Ophthalmoscopic examination reveals changes in the macular area. The patient may notice subtle changes in visual acuity, in color perception, and in the size and shape of objects.

    Migraine headache

    Transient scintillating scotomas, usually bilateral and often homonymous, can occur during a classic migraine aura. Besides pain, characteristic associated symptoms include paresthesia of the lips, face, or hands; slight confusion; dizziness; and photophobia.

    Optic neuritis

    Inflammation, degeneration, or demyelination of the optic nerve produces a central, circular, or centrocecal scotoma. The scotoma may be unilateral with involvement of one nerve, or bilateral with involvement of both nerves. It can vary in size, density, and symmetry. The patient may report severe visual loss or blurring, lasting up to 3 weeks, and pain—especially with eye movement. Common ophthalmoscopic findings include hyperemia of the optic disk, retinal vein distention, blurred disk margins, and filling of the physiologic cup.

    Retinal pigmentary degenerations

    These disorders cause premature retinal cell changes leading to cell death. One disorder, retinitis pigmentosa, initially involves loss of peripheral rods; the resulting annular scotoma progresses concentrically until only a central field of vision (tunnel vision) remains. The earliest symptom—impaired night vision—appears during adolescence. Associated signs include narrowing of the retinal blood vessels and pallor of the optic disk. Eventually, with invasion of the macula, blindness may occur.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

    Vision loss: Medical causes
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    Amaurosis fugax

    In this disorder, recurrent attacks of unilateral vision loss may last from a few seconds to a few minutes. Vision is normal at other times. Other findings may include transient unilateral weakness, hypertension, and elevated intraocular pressure (IOP) in the affected eye.

    Cataract

    Typically, painless and gradual visual blurring precedes vision loss. As the cataract progresses, the pupil turns milky white.

    Concussion

    Immediately or shortly after blunt head trauma, the patient may develop blurred, double, or lost vision. Vision loss is usually temporary. Other findings include headache, anterograde and retrograde amnesia, transient loss of consciousness, nausea, vomiting, dizziness, irritability, confusion, lethargy, and aphasia.

    Corneal dystrophies, hereditary

    Some corneal dystrophies cause vision loss with associated pain, photophobia, tearing, and corneal opacities.

    Diabetic retinopathy

    Retinal edema and hemorrhage lead to visual blurring, which may progress to blindness.

    Endophthalmitis

    Typically, this intraocular inflammation follows penetrating trauma, I.V. drug use, or intraocular surgery, causing unilateral vision loss that may be permanent; a sympathetic inflammation may affect the other eye.

    Glaucoma

    This disorder produces gradual visual blurring that may progress to total blindness. Acute angle-closure glaucoma is an ocular emergency that may produce blindness within 3 to 5 days. It’s characterized by rapid onset of unilateral inflammation and pain, pressure over the eye, moderate pupil dilation, nonreactive pupillary response, a cloudy cornea, reduced visual acuity, photophobia, and perception of blue or red halos around lights. Nausea and vomiting may also occur.

    Chronic angle-closure glaucoma has a gradual onset and usually produces no symptoms, although blurred or halo vision may occur. If untreated, it progresses to blindness and extreme pain.

    Chronic open-angle glaucoma usually has an insidious onset, progresses slowly, and affects both eyes. It causes peripheral vision loss, aching eyes, halo vision, and reduced visual acuity (especially at night).

    Herpes zoster

    When this disorder affects the nasociliary nerve, bilateral vision loss is accompanied by eyelid lesions, conjunctivitis, skin lesions (usually on the nose), and ocular muscle palsies.

    Hyphema

    Blood in the anterior chamber can reduce vision to light perception only. Most hyphemas are the direct result of blunt trauma to the normal eye.

    Keratitis

    This inflammation of the cornea may lead to complete unilateral vision loss. Other findings include an opaque cornea, increased tearing, irritation, and photophobia.

    Ocular trauma

    Sudden unilateral or bilateral vision loss may occur after an eye injury. Vision loss may be total or partial and permanent or temporary. The eyelids may be reddened, edematous, and lacerated; intraocular contents may be extruded.

    Optic atrophy

    Degeneration of the optic nerve, optic atrophy can develop spontaneously or follow inflammation or edema of the nerve head, causing irreversible loss of the visual field with changes in color vision. Pupillary reactions are sluggish, and optic disk pallor is evident.

    Optic neuritis

    An umbrella term for inflammation, degeneration, or demyelinization of the optic nerve, optic neuritis usually produces temporary but severe unilateral vision loss, pain around the eye (especially with movement of the globe), a sluggish pupillary response to light and, possibly, visual field defects. Ophthalmoscopic examination commonly reveals hyperemia of the optic disk, blurred disk margins, and filling of the physiologic cup.

    Paget’s disease

    In this disorder, bony impingements on the cranial nerves may cause bilateral vision loss, which may be accompanied by hearing loss, tinnitus, vertigo, and severe, persistent bone pain. Cranial enlargement may be noticeable frontally and occipitally, and headaches may occur. Sites of bone involvement are warm and tender, and impaired mobility and pathologic fractures are common.

    Papilledema

    Papilledema is characterized by swelling of both optic disks from increased intracranial pressure. Acute papilledema may lead to momentary blurring or transiently obscured vision, whereas chronic papilledema may lead to vision loss.

    Pituitary tumor

    As a pituitary adenoma grows, blurred vision progresses to hemianopia and, possibly, unilateral blindness. Double vision, nystagmus, ptosis, limited eye movement, and headaches may also occur.

    Retinal artery occlusion (central)

    This painless ocular emergency causes sudden unilateral vision loss, which may be partial or complete. Pupil examination reveals a sluggish direct pupillary response and a normal consensual response. Permanent blindness may occur within hours.

    Retinal detachment

    Depending on the degree and location of detachment, painless vision loss may be gradual or sudden and total or partial. Macular involvement causes total blindness. Other effects include visual floaters, light flashes, and a sensation of a shadow or curtain over the visual field.

    Retinal Vein Occlusion

    Most common in geriatric patients, this painless disorder causes a unilateral decrease in visual acuity with variable vision loss. IOP may be elevated in both eyes.

    Rift Valley fever

    Inflammation of the retina is a complication of this viral disease that may result in some degree of permanent vision loss. Typical signs and symptoms include fever, myalgia, weakness, dizziness, and back pain. A small percentage of patients may develop encephalitis or hemorrhagic fever that can lead to shock and hemorrhage.

    Senile macular degeneration

    Occurring in elderly patients, this disorder causes painless blurring or loss of central vision. Vision loss may proceed slowly or rapidly, eventually affecting both eyes. Visual acuity may be worse at night.

    Stevens-Johnson syndrome

    Corneal scarring from associated conjunctival lesions produces marked vision loss, which may be accompanied by purulent conjunctivitis, eye pain, and difficulty opening the eyes. Additional findings include widespread bullae, fever, malaise, cough, drooling, inability to eat, sore throat, chest pain, vomiting, diarrhea, myalgia, arthralgia, hematuria, and signs of renal failure.

    Temporal arteritis

    Vision loss and visual blurring with a throbbing, unilateral headache characterize this disorder. Other findings include malaise, anorexia, weight loss, weakness, low-grade fever, generalized muscle aches, and confusion.

    Trachoma

    This rare disorder may initially produce varying degrees of vision loss and a mild infection resembling bacterial conjunctivitis. Conjunctival follicles, red and edematous eyelids, pain, photophobia, tearing, and exudation also occur. After about 1 month, conjunctival follicles enlarge into inflamed yellow or gray papillae.

    Uveitis

    Inflammation of the uveal tract may result in unilateral vision loss. Anterior uveitis produces moderate to severe eye pain, severe conjunctival injection, photophobia, and a small, nonreactive pupil. Posterior uveitis may produce insidious onset of blurred vision, conjunctival injection, visual floaters, pain, and photophobia. Associated posterior scar formation distorts the shape of the pupil.

    Vitreous hemorrhage

    This condition, which may result from intraocular trauma, ocular tumors, or systemic disease (especially diabetes, hypertension, sickle cell anemia, or leukemia), can cause sudden unilateral vision loss, visual floaters, and a reddish haze. The vision loss may be permanent.

    Other causes

    Drugs

    Chloroquine therapy may cause patchy retinal pigmentation that typically leads to blindness. Digoxin derivatives, indomethacin, ethambutol, quinine sulfate, and methanol toxicity may also cause vision loss.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

    Night blindness [Nyctalopia]: Medical causes
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    Cataracts

    Night blindness and halo vision occur early in senile-type cataract formation. As the cataract matures, it causes gradual, painless visual blurring and vision loss, sometimes with visible lens opacity.

    Choroidal dystrophies

    Night blindness and decreased peripheral vision may occur early in choroidal dystrophies. Disease progression causes loss of central vision.

    Fundus albipunctatus

    Night blindness is the chief complaint in this retinal and choroidal disease. Multiple small, round, yellow-white dots are present on the retina.

    Fundus flavimaculatus

    With this disease, night blindness may be pronounced or may be an incidental finding. Irregular yellow or white lesions appear deep in the retina.

    Glaucoma

    Night blindness occurs late in chronic open-angle glaucoma, with halo vision, gradually impaired bilateral visual acuity, loss of peripheral vision and, possibly, slight eye pain.

    Goldman-Favre dystrophy

    With this disorder, night blindness is usually the chief complaint. The retina resembles that seen in retinitis pigmentosa.

    Oguchi’s disease

    This rare, hereditary retinal and choroidal degeneration produces night blindness and a retina with a yellowish metallic sheen.

    Optic nerve atrophy

    This disorder may cause night blindness, visual field and color vision defects, and decreased visual acuity. Pupillary reactions are sluggish, and optic disk pallor is evident.

    Retinitis pigmentosa

    In this usually hereditary retinal degeneration, night blindness is characteristically the first symptom, usually arising in adolescence. Scattered black pigmentary bodies form in a characteristic “bone-spicule” arrangement on the retina. As the disease progresses, the visual field gradually constricts, causing tunnel or “gun barrel” vision and eventually total blindness.

    Vitamin A deficiency

    Night blindness is typically the first symptom of vitamin A deficiency. Associated findings include xerophthalmia (conjunctival dryness) and Bitot’s spots (gray-white conjunctival plaques). The patient may complain of visual blurring or vision loss. His skin may be dry and scaly. His mucous membranes may be shrunken and hardened.

    Other causes

    Drugs

    Isotretinoin, used to treat inflammatory acne, rarely causes night blindness.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

    Eye pain [Ophthalmalgia]: Medical causes
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    Acute angle-closure glaucoma

    Blurred vision and sudden excruciating pain in and around the eye characterize this disorder; the pain may be so severe that it causes nausea, vomiting, and abdominal pain. Other findings are halo vision, rapidly decreasing visual acuity, and a fixed, nonreactive, moderately dilated pupil.

    Astigmatism

    Uncorrected astigmatism commonly causes headaches and eye fatigue, aching, and redness. This disorder occurs in both older and younger people.

    Blepharitis

    Burning pain in both eyelids is accompanied by conjunctival injection and an itching, sticky discharge. Related findings include a foreign-body sensation, eyelid ulcerations, and loss of eyelashes.

    Burns

    In chemical burns, sudden severe eye pain may occur with erythema and blistering of the face and eyelids, photophobia, miosis, conjunctival injection, blurring, and inability to keep the eyelids open. In ultraviolet radiation burns, moderate to severe pain occurs about 12 hours after exposure along with photophobia and vision changes.

    Chalazion

    A chalazion causes localized tenderness and swelling on the upper or lower eyelid. Eversion of the lid reveals conjunctival injection and a small red lump.

    Conjunctivitis

    Some degree of eye pain and excessive tearing occur in four types of conjunctivitis. Allergic conjunctivitis causes mild, burning, bilateral pain accompanied by itching, conjunctival injection, and a characteristic ropey discharge.

    Bacterial conjunctivitis causes pain only when it affects the cornea. Otherwise, it typically produces burning, a foreign-body sensation, a purulent discharge, and conjunctival injection.

    If the cornea is affected, fungal conjunctivitis may cause pain and photophobia. Without corneal involvement, it produces itching, burning eyes; a thick, purulent discharge; and conjunctival injection.

    Viral conjunctivitis produces itching, red eyes; a foreign-body sensation; visible conjunctival follicles; and eyelid edema.

    Corneal abrasions

    This type of injury typically produces a foreign-body sensation, excessive tearing, photophobia, and conjunctival injection.

    Corneal erosion (recurrent)

    In this disorder, severe pain occurs on waking and continues throughout the day. Accompanying the pain are conjunctival injection and photophobia.

    Corneal ulcers

    Both bacterial and fungal corneal ulcers cause severe eye pain. They may also cause a purulent eye discharge, sticky eyelids, photophobia, and impaired visual acuity. In addition, bacterial corneal ulcers produce a grayish white, irregularly shaped ulcer on the cornea; unilateral pupil constriction; and conjunctival injection. Fungal corneal ulcers produce conjunctival injection, eyelid edema and erythema, and a dense, cloudy, central ulcer surrounded by progressively clearer rings.

    Dacryoadenitis

    Temporal pain may affect both eyes in this disorder. Associated findings include exophthalmos, conjunctival injection, severe eyelid erythema and edema, and a purulent eye discharge.

    Dacryocystitis

    Pain and tenderness near the tear sac characterize acute dacryocystitis. Additional signs include excessive tearing, a purulent discharge, eyelid erythema, and swelling around the lacrimal punctum.

    Episcleritis

    Deep eye pain occurs as tissues over the sclera become inflamed. Related effects include photophobia, excessive tearing, conjunctival edema, and a red or purplish sclera.

    Erythema multiforme major

    This disorder commonly produces severe eye pain, entropion, trichiasis, purulent conjunctivitis, photophobia, and decreased tear formation.

    Foreign bodies in the cornea and conjunctiva

    Sudden severe pain is common in this condition, but vision usually remains intact. Other findings include excessive tearing, photophobia, miosis, a foreign-body sensation, a dark speck on the cornea, and dramatic conjunctival injection.

    Glaucoma

    Open-angle glaucoma may cause mild aching in the eyes as well as loss of peripheral vision, halo vision, and reduced visual acuity that isn’t corrected by glasses. Acute angle-closure glaucoma may cause severe pain and pressure over the eye, blurred vision, halo vision, decreased visual acuity, and nausea and vomiting.

    Herpes zoster ophthalmicus

    Eye pain occurs with severe unilateral facial pain, usually several days before vesicles erupt. Other signs include red, swollen eyelids; excessive tearing; a serous eye discharge; conjunctival injection; and a white, cloudy cornea.

    Hordeolum (stye)

    This lesion usually produces localized eye pain that increases as the stye grows. Eyelid erythema and edema are also common.

    Hyphema

    Occurring after eye injury or surgery, hyphema accompanies sudden pain in and around the eye. Orbital and eyelid edema, conjunctival injection, and visual impairment may also occur.

    Interstitial keratitis

    Associated with congenital syphilis, this corneal inflammation produces eye pain with photophobia, blurred vision, prominent conjunctival injection, and grayish pink corneas.

    Iritis (acute)

    Moderate to severe eye pain occurs with severe photophobia, dramatic conjunctival injection, and blurred vision. The constricted pupil may respond poorly to light.

    Keratoconjunctivitis sicca

    This condition—known as dry eye syndrome—causes chronic burning pain in both eyes, itching, a foreign-body sensation, photophobia, dramatic conjunctival injection, and difficulty moving the eyelids. A copious mucoid discharge and inadequate tearing are typical.

    Lacrimal gland tumor

    This neoplastic lesion usually produces unilateral eye pain, impaired visual acuity, and some degree of exophthalmos.

    Migraine headache

    Migraines can produce head pain so severe that the eyes also ache. Nausea, vomiting, blurred vision, and light and noise sensitivity may also occur.

    Ocular laceration and intraocular foreign bodies

    Penetrating eye injuries usually cause mild to severe unilateral eye pain and impaired visual acuity. Eyelid edema, conjunctival injection, and an abnormal pupillary response may also occur.

    Optic cellulitis

    This disorder causes dull, aching pain in the affected eye, some degree of exophthalmos, eyelid edema and erythema, a purulent discharge, impaired extraocular movement and, occasionally, decreased visual acuity and fever.

    Optic neuritis

    In this disorder, pain in and around the eye occurs with eye movement. Severe vision loss and tunnel vision develop but improve in 2 to 3 weeks. Pupils respond sluggishly to direct light but normally to consensual light.

    Orbital floor fracture

    Sometimes called a blowout fracture, this injury causes eye pain, dramatic eyelid edema and, possibly, enophthalmos and diplopia.

    Orbital pseudotumor

    This disorder causes deep, boring eye pain and diplopia in about 50% of patients. However, prominent exophthalmos and lateral ocular deviation are more characteristic. Eyelid edema and limited extraocular movement may also occur.

    Pemphigus

    In this disorder, bilateral eye pain and irritation may be accompanied by blurred vision and a thick discharge. Blisters may develop on the conjunctiva alone or may extend to the nasal, oral, and vulvar mucous membranes as well as the skin.

    Scleritis

    This inflammation produces severe eye pain and tenderness, conjunctival injection, bluish purple sclera and, possibly, photophobia and excessive tearing.

    Sclerokeratitis

    Inflammation of the sclera and cornea causes pain, burning, irritation, and photophobia.

    Subdural hematoma

    Following head trauma, a subdural hematoma commonly causes severe eye ache and headache. Related neurologic signs depend on the hematoma’s location and size.

    Trachoma

    Along with pain in the affected eye, trachoma causes excessive tearing, photophobia, an eye discharge, eyelid edema and erythema, and visible conjunctival follicles.

    Uveitis

    Anterior uveitis causes sudden severe pain, dramatic conjunctival injection, photophobia, and a small, nonreactive pupil.

    Posterior uveitis causes insidious onset of similar features, plus gradual blurring of vision and distorted pupil shape.

    Lens-induced uveitis causes moderate eye pain, conjunctival injection, pupil constriction, and severely impaired visual acuity. In fact, the patient usually can perceive only light.

    Other causes

    Treatments

    Contact lenses may cause eye pain and a foreign-body sensation. Ocular surgery may also produce eye pain, ranging from a mild ache to a severe pounding or stabbing sensation.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

    Eye Pain: Differential Overview
    (Field Guide to Bedside Diagnosis)

    ❑ Conjunctivitis

    ❑ Corneal abrasion

    ❑ Foreign body

    ❑ Sinusitis

    ❑ Migraine

    ❑ Acute glaucoma

    ❑ Orbital cellulitis

    ❑ Zoster prodrome

    ❑ Orbital fracture

    ❑ Keratitis

    ❑ Scleritis

    ❑ Iritis

    ❑ Optic neuritis

    ❑ Temporal arteritis

    » READ BOOK EXCERPT ONLINE »

    Source: Field Guide to Bedside Diagnosis, 2007

    Visual Disturbance: Differential Overview
    (Field Guide to Bedside Diagnosis)

    Acute Loss/Scotoma

    ❑ Ophthalmic migraine

    ❑ Amaurosis fugax

    ❑ Retinal detachment

    ❑ Acute angle closure glaucoma

    ❑ Optic neuritis

    ❑ Papilledema

    ❑ Retinal artery occlusion

    ❑ Giant cell arteritis

    ❑ Trauma

    ❑ Toxic

    ❑ Occipital stroke

    ❑ Ischemic optic neuropathy

    ❑ Retinal hemorrhage

    ❑ Vitreous hemorrhage

    ❑ Central retinal vein occlusion

    Gradual Loss

    ❑ Refractive error

    ❑ Intraocular hypertension

    ❑ Cataract

    ❑ Diabetic retinopathy

    ❑ Macular degeneration

    ❑ Cytomegalovirus retinitis

    ❑ Drugs

    ❑ Keratoconjunctivitis sicca

    ❑ Optic nerve compression

    ❑ Pituitary adenoma

    ❑ Choroidal melanoma

    ❑ Retinitis pigmentosa

    » READ BOOK EXCERPT ONLINE »

    Source: Field Guide to Bedside Diagnosis, 2007

    Eye pain: Medical causes
    (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

    See Eye pain: causes and associated findings, page 142.

    Acute angle-closure glaucoma

    Blurred vision and sudden, excruciating pain in and around the eye characterize acute angle-closure glaucoma; the pain may be so severe that it causes nausea, vomiting, and abdominal pain. Other findings are halo vision, rapidly decreasing visual acuity, and a fixed, nonreactive, moderately dilated pupil.

    Astigmatism

    Uncorrected astigmatism commonly causes headache and eye fatigue, aching, and redness. This disorder occurs in both older and younger people.

    Blepharitis

    Burning pain in both eyelids is accompanied by itching, sticky discharge, and conjunctival injection. Related findings include foreign-body sensation, lid ulcerations, and loss of eyelashes.

    Burns

    With chemical burns, sudden and severe eye pain may occur with erythema and blistering of the face and lids, photophobia, miosis, conjunctival injection, blurring, and inability to keep the eyelids open. (See Eye irrigation for chemical burns, page 143.) With ultraviolet radiation burns, moderate to severe pain occurs about 12 hours after exposure along with photophobia and vision changes.

    Chalazion

    A chalazion causes localized tenderness and swelling on the upper or lower eyelid. Eversion of the lid reveals conjunctival injection and a small red lump.

    Conjunctivitis

    Some degree of eye pain and excessive tearing occurs with four types of conjunctivitis. Allergic conjunctivitis causes mild, burning, bilateral pain accompanied by itching, conjunctival injection, and a characteristic ropey discharge.

    Bacterial conjunctivitis causes pain only when it affects the cornea. Otherwise, it produces burning and a foreign-body sensation. A purulent discharge and conjunctival injection are also typical.

    If the cornea is affected, fungal conjunctivitis may cause pain and photophobia. Even without corneal involvement, it produces itching, burning eyes; a thick, purulent discharge; and conjunctival injection.

    Viral conjunctivitis produces itching, red eyes, foreign-body sensation, visible conjunctival follicles, and eyelid edema.

    Corneal abrasions

    With corneal abrasions, eye pain is characterized by a foreign-body sensation. Excessive tearing, photophobia, and conjunctival injection are also common.

    Corneal erosion (recurrent)

    Severe pain occurs on waking and continues throughout the day. Accompanying the pain are conjunctival injection and photophobia.

    Corneal ulcers

    Both bacterial and fungal corneal ulcers cause severe eye pain. They may also cause a purulent eye discharge, sticky eyelids, photophobia, and impaired visual acuity. In addition, bacterial corneal ulcers produce a grayish white, irregularly shaped ulcer on the cornea, unilateral pupil constriction, and conjunctival injection. Fungal corneal ulcers produce conjunctival injection, eyelid edema and erythema, and a dense, cloudy, central ulcer surrounded by progressively clearer rings.

    Dacryoadenitis

    Temporal pain may affect both eyes in dacryoadenitis. Associated findings include exophthalmos, conjunctival injection, severe eyelid erythema and edema, and a purulent eye discharge.

    Dacryocystitis

    Pain and tenderness near the tear sac characterize acute dacryocystitis. Additional signs include profuse tearing, a purulent discharge, eyelid erythema, and swelling in the lacrimal punctum area.

    Episcleritis

    Deep eye pain occurs as tissues over sclera become inflamed. Related effects include photophobia, excessive tearing, conjunctival edema, and a red or purplish sclera.

    Erythema multiforme major

    Erythema multiforme major commonly produces severe eye pain, entropion, trichiasis, purulent conjunctivitis, photophobia, and decreased tear formation.

    Foreign bodies in the cornea and conjunctiva

    Sudden severe pain is common but vision usually remains intact. Other findings include excessive tearing, photophobia, miosis, a foreign-body sensation, a dark speck on the cornea, and dramatic conjunctival injection.

    Glaucoma

    Open-angle glaucoma may cause mild aching in the eyes as well as loss of peripheral vision, halo vision, and reduced visual acuity that isn’t corrected by glasses. Angle-closure glaucoma may cause pain and pressure over the eye, blurred vision, halo vision, decreased visual acuity, and nausea and vomiting.

    Herpes zoster ophthalmicus

    Eye pain occurs with severe unilateral facial pain, usually several days before vesicles erupt. Other signs include red, swollen eyelids; excessive tearing; a serous eye discharge; conjunctival injection; and a white, cloudy cornea.

    Hordeolum (stye)

    Hordeolum is a lesion that usually produces localized eye pain that increases as the stye grows. Eyelid erythema and edema are also common.

    Hyphema

    Occurring after eye injury or surgery, hyphema accompanies sudden pain in and around the eye. Orbital and lid edema, conjunctival injection, and visual impairment may occur.

    Interstitial keratitis

    Associated with congenital syphilis, interstitial keratitis produces eye pain with photophobia, blurred vision, prominent conjunctival injection, and grayish pink corneas.

    Iritis (acute)

    Moderate to severe eye pain occurs with severe photophobia, dramatic conjunctival injection, and blurred vision. The constricted pupil may respond poorly to light.

    Keratoconjunctivitis sicca

    Keratoconjunctivitis sicca — known as dry eye syndrome — causes chronic burning pain in both eyes, itching, a foreign-body sensation, photophobia, dramatic conjunctival injection, and difficulty moving the eyelids. Excessive mucoid discharge and inadequate tearing are typical.

    Lacrimal gland tumor

    Lacrimal gland tumor is a neoplastic lesion that usually produces unilateral eye pain, impaired visual acuity, and some degree of exophthalmos.

    Migraine headache

    Migraines can produce pain so severe that the eyes also ache. Additionally, nausea, vomiting, blurred vision, and light and noise sensitivity may occur.

    Ocular laceration and intraocular foreign bodies

    Penetrating eye injuries usually cause mild to severe unilateral eye pain and impaired visual acuity. Eyelid edema, conjunctival injection, and an abnormal pupillary response may also occur.

    Optic cellulitis

    Optic cellulitis causes dull, aching pain in the affected eye, some degree of exophthalmos, eyelid edema and erythema, purulent discharge, impaired extraocular movement and, occasionally, decreased visual acuity and fever.

    Optic neuritis

    With optic neuritis, pain in and around the eye occurs with eye movement. Severe vision loss and tunnel vision develop but improve in 2 to 3 weeks. Pupils respond sluggishly to direct light but normally to consensual light.

    Orbital floor fracture

    Sometimes called a blowout fracture, orbital floor fracture causes eye pain, dramatic eyelid edema and, possibly, enophthalmos and diplopia.

    Orbital pseudotumor

    Orbital pseudotumor causes deep, boring eye pain and diplopia in about 50% of all patients. However, prominent exophthalmos and lateral ocular deviation are more characteristic. Eyelid edema and restricted extraocular movement may also occur.

    Pemphigus

    With pemphigus, bilateral eye pain and irritation may be accompanied by blurred vision and a thick discharge. Blisters may develop on the conjunctiva alone or may extend to the nasal, oral, and vulvar mucous membranes as well as the skin.

    Scleritis

    Scleritis is a inflammation that produces severe eye pain and tenderness, along with conjunctival injection, bluish purple sclera and, possibly, photophobia, loss of vision, and excessive tearing.

    Sclerokeratitis

    Inflammation of the sclera and cornea causes pain, burning, irritation, and photophobia.

    Subdural hematoma

    After head trauma, a subdural hematoma commonly causes severe eye ache and headache. Related neurologic signs depend on the hematoma’s location and size.

    Trachoma

    Along with pain in the affected eye, trachoma causes excessive tearing, photophobia, eye discharge, eyelid edema and redness, and visible conjunctival follicles.

    Uveitis

    Anterior uveitis causes sudden onset of severe pain, dramatic conjunctival injection, photophobia, and a small, nonreactive pupil.

    Posterior uveitis causes insidious onset of similar features, plus gradual blurring of vision and distorted pupil shape.

    Lens-induced uveitis causes moderate eye pain, conjunctival injection, pupil constriction, and severely impaired visual acuity. In fact, the patient usually can perceive only light.

    Other causes

    Medical treatments

    Contact lenses may cause eye pain and a foreign-body sensation. Ocular surgery may also produce eye pain, ranging from a mild ache to a severe pounding or stabbing sensation.

    » READ BOOK EXCERPT ONLINE »

    Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

    Vision loss: Medical causes
    (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

    Amaurosis fugax

    With this amaurosis fugax, recurrent attacks of unilateral vision loss may last from a few seconds to a few minutes. Vision is normal at other times. Transient unilateral weakness, hypertension, and elevated IOP in the affected eye may also occur.

    Cataract

    Typically, painless and gradual blurred vision precedes vision loss. As the cataract progresses, the pupil turns milky white.

    Concussion

    Immediately or shortly after blunt head trauma, vision may be blurred, double, or lost. Generally, vision loss is temporary. Other findings include headache, anterograde and retrograde amnesia, transient loss of consciousness, nausea, vomiting, dizziness, irritability, confusion, lethargy, and aphasia.

    Diabetic retinopathy

    Retinal edema and hemorrhage lead to blurred vision, which may progress to blindness.

    Endophthalmitis

    Typically, endophthalmitis, an intraocular inflammation, follows penetrating trauma, I.V. drug use, or intraocular surgery, causing possibly permanent unilateral vision loss; a sympathetic inflammation may affect the other eye.

    Glaucoma

    Glaucoma produces gradual blurred vision that may progress to total blindness. Findings are the rapid onset of unilateral inflammation and pain, pressure over the eye, moderate pupil dilation, nonreactive pupillary response, a cloudy cornea, reduced visual acuity, photophobia, and perception of blue or red halos around lights. Nausea and vomiting may also occur.


    ALERT: Acute angle-closure glaucoma is an ocular emergency that may produce blindness within 3 to 5 days.

    Chronic angle-closure glaucoma has a gradual onset and usually produces no symptoms, although blurred or halo vision may occur. If untreated, it progresses to blindness and extreme pain.

    Chronic open-angle glaucoma is usually bilateral, with an insidious onset and a slowly progressive course. It causes peripheral vision loss, aching eyes, halo vision, and reduced visual acuity (especially at night).

    Hereditary corneal dystrophies

    Some dystrophies cause vision loss with associated pain, photophobia, tearing, and corneal opacities.

    Herpes zoster

    When herpes zoster affects the nasociliary nerve, bilateral vision loss is accompanied by eyelid lesions, conjunctivitis, skin lesions that usually appear on the nose, and ocular muscle palsies.

    Hyphema

    Blood in the anterior chamber can reduce vision to light perception only. Most hyphemas are the direct result of blunt trauma to the normal eye.

    Keratitis

    An inflammation of the cornea, keratitis may lead to complete unilateral vision loss. Other findings include an opaque cornea, increased tearing, irritation, and photophobia.

    Ocular trauma

    Following eye injury, sudden unilateral or bilateral vision loss may occur. Vision loss may be total or partial and permanent or temporary. The eyelids may be reddened, edematous, and lacerated; intraocular contents may be extruded.

    Optic atrophy

    Degeneration of the optic nerve, optic atrophy can develop spontaneously or follow inflammation or edema of the nerve head, causing irreversible loss of the visual field with changes in color vision. Pupillary reactions are sluggish, and optic disk pallor is evident.

    Optic neuritis

    An umbrella term for inflammation, degeneration, or demyelinization of the optic nerve, optic neuritis usually produces temporary but severe unilateral vision loss. Pain around the eye occurs, especially with movement of the globe. This may occur with visual field deficits and a sluggish pupillary response to light. Ophthalmoscopic examination commonly reveals hyperemia of the optic disk, blurred disk margins, and filling of the physiologic cup.

    Paget’s disease

    Bilateral vision loss may develop as a result of bony impingements on the cranial nerves. This occurs with hearing loss, tinnitus, vertigo, and severe, persistent bone pain. Cranial enlargement may be noticeable frontally and occipitally, and headaches may occur. Sites of bone involvement are warm and tender, and impaired mobility and pathologic fractures are common.

    Papilledema

    Papilledema is characterized by swelling of the optic disk from increased intracranial pressure; both optic disks are affected. Acute papilledema may lead to momentary blurring or transiently obscured vision, whereas chimeric papilledema may lead to vision loss.

    Pituitary tumor

    As a pituitary adenoma grows, blurred vision progresses to hemianopia and, possibly, unilateral blindness. Double vision, nystagmus, ptosis, limited eye movement, and headaches may also occur.

    Retinal artery occlusion (central)

    A painless ocular emergency, retinal artery occlusion causes sudden unilateral vision loss, which may be partial or complete. Pupil examination reveals a sluggish direct pupillary response and a normal consensual response. Permanent blindness may occur within hours.

    Retinal detachment

    Depending on the degree and location of detachment, painless vision loss may be gradual or sudden and total or partial. Macular involvement causes total blindness.

    With partial vision loss, the patient may describe visual field deficits or a shadow or curtain over the visual field as well as visual floaters.

    Retinal vein occlusion (central)

    Most common in elderly patients, retinal vein occlusion is a painless disorder that causes a unilateral decrease in visual acuity with variable vision loss. IOP may be elevated in both eyes.

    Rift Valley fever

    A viral disease, Rift Valley fever causes inflammation of the retina and may result in some permanent vision loss. Typical signs and symptoms include fever, myalgia, weakness, dizziness, and back pain. A small percentage of patients may develop encephalitis or may progress to hemorrhagic fever that can lead to shock and hemorrhage.

    Senile macular degeneration

    Occurring in elderly patients, senile macular degeneration causes painless blurring or loss of central vision. Vision loss may proceed slowly or rapidly, eventually affecting both eyes. Visual acuity may be worse at night.

    Stevens-Johnson syndrome

    Corneal scarring from associated conjunctival lesions produces marked vision loss. Purulent conjunctivitis, eye pain, and difficulty opening the eyes occur. Additional findings include widespread bullae, fever, malaise, cough, drooling, an inability to eat, sore throat, chest pain, vomiting, diarrhea, myalgia, arthralgia, hematuria, and signs of renal failure.

    Temporal arteritis

    Vision loss and visual blurring with a throbbing, unilateral headache characterize temporal arteritis. Other findings include malaise, anorexia, weight loss, weakness, low-grade fever, generalized muscle aches, and confusion.

    Trachoma

    A rare disorder, trachoma may initially produce varying vision loss and a mild infection resembling bacterial conjunctivitis. Conjunctival follicles, red and edematous eyelids, pain, photophobia, tearing, and exudation also occur. After about 1 month, conjunctival follicles enlarge into inflamed yellow or gray papillae.

    Uveitis

    Inflammation of the uveal tract may result in unilateral vision loss. Anterior uveitis produces moderate to severe eye pain, severe conjunctival injection, photophobia, and a small, nonreactive pupil. Posterior uveitis may produce an insidious onset of blurred vision, conjunctival injection, visual floaters, pain, and photophobia. Associated posterior scar formation distorts the shape of the pupil.

    Vitreous hemorrhage

    With vitreous hemorrhage, sudden unilateral vision loss may result from intraocular trauma, ocular tumors, or systemic disease (especially diabetes, hypertension, sickle cell anemia, or leukemia). Visual floaters and partial vision with a reddish haze may occur. The vision loss may be permanent.

    Other causes

    Drugs

    Chloroquine therapy may cause patchy retinal pigmentation that typically leads to blindness. Phenylbutazone may cause vision loss and increased susceptibility to retinal detachment. Digoxin, indomethacin, ethambutol, quinine sulfate, and methanol toxicity may also cause visual disturbances and possibly vision loss.

    » READ BOOK EXCERPT ONLINE »

    Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

    Eye pain: Medical causes
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Blepharitis

    With blepharitis, burning pain in both eyelids is accompanied by itching, sticky discharge, and conjunctival injection. Related findings include foreign-body sensation, lid ulcerations, and loss of eyelashes.

    Burns

    With chemical burns, sudden and severe eye pain may occur with erythema and blistering of the face and lids, photophobia, miosis, conjunctival injection, blurring, and inability to keep the eyelids open. With ultraviolet radiation burns, moderate to severe pain occurs about 12 hours after exposure along with photophobia and vision changes.

    Chalazion

    A chalazion causes localized pain, tenderness, redness, and swelling on the upper or lower eyelid. Eversion of the lid reveals conjunctival injection and a small red lump.

    Conjunctivitis

    Allergic conjunctivitis causes mild, burning, bilateral pain accompanied by itching, conjunctival injection, and a characteristic ropey discharge.

    Bacterial conjunctivitis causes pain only when it affects the cornea. Otherwise, it produces burning and a foreign-body sensation. A purulent discharge and conjunctival injection are also typical.

    If the cornea is affected, fungal conjunctivitis may cause pain and photophobia. Even without corneal involvement, it produces itching, burning eyes; a thick, purulent discharge; and conjunctival injection.

    Viral conjunctivitis produces itching, red eyes, foreign-body sensation, visible conjunctival follicles, and eyelid edema.

    Corneal abrasions

    With corneal abrasions, eye pain is characterized by a foreign-body sensation. Excessive tearing, photophobia, and conjunctival injection are also common. The patient commonly reports feeling that “something is in” the eye.

    Corneal erosion (recurrent)

    With recurrent corneal erosion, severe pain occurs on waking and continues throughout the day. Conjunctival injection and photophobia also occur.

    Corneal ulcers

    Both bacterial and fungal corneal ulcers cause severe eye pain. They may also cause a purulent eye discharge, sticky eyelids, photophobia, and impaired visual acuity. In addition, bacterial corneal ulcers produce a grayish white, irregularly shaped ulcer on the cornea, unilateral pupil constriction, and conjunctival injection. Fungal corneal ulcers produce conjunctival injection, eyelid edema and erythema, and a dense, cloudy, central ulcer surrounded by progressively clearer rings.

    Dacryocystitis

    Pain and tenderness near the tear sac characterize acute dacryocystitis. Additional signs include excessive tearing, a purulent discharge, eyelid erythema, and swelling in the lacrimal punctum area.

    Foreign body in the cornea or conjunctiva

    Sudden severe pain is common but vision usually remains intact. Other findings include excessive tearing, photophobia, miosis, a foreign-body sensation, a dark speck on the cornea, and dramatic conjunctival injection.

    Glaucoma

    Open-angle glaucoma may cause mild aching in the eyes as well as loss of peripheral vision, halo vision, and reduced visual acuity that isn’t corrected by glasses. Angle-closure glaucoma is characterized by blurred vision and sudden, excruciating pain in and around the eye. The pain may be so severe that it causes nausea, vomiting, and abdominal pain. Other findings are halo vision, rapidly decreasing visual acuity, and a fixed, nonreactive, moderately dilated pupil.

    Herpes zoster ophthalmicus

    With herpes zoster ophthalmicus, eye pain occurs with severe unilateral facial pain, usually days before vesicles erupt. Other signs include red, swollen eyelids; excessive tearing; a serous eye discharge; conjunctival injection; and a white, cloudy cornea.

    Hordeolum

    A hordeolum (stye) usually produces localized eye pain, burning, and discomfort that increases as the stye grows. Eyelid erythema and edema are also common.

    Hyphema

    Occurring after eye injury or surgery, hyphema accompanies sudden pain in and around the eye. Orbital and lid edema, conjunctival injection, and visual impairment may occur. The patient may report nausea.

    Keratoconjunctivitis sicca

    Keratoconjunctivitis sicca, also known as dry eye syndrome, causes chronic burning pain in both eyes, itching, a foreign-body sensation, photophobia, dramatic conjunctival injection, and difficulty moving the eyelids. Excessive mucoid discharge and inadequate tearing are typical.

    Lacrimal gland tumor

    Lacrimal gland tumor is a neoplastic lesion that usually produces unilateral eye pain, impaired visual acuity, and some degree of exophthalmos. The patient may also have ptosis and eye deviation.

    Ocular laceration and intraocular foreign bodies

    Penetrating eye injuries usually cause mild to severe unilateral eye pain and impaired visual acuity. Eyelid edema, conjunctival injection, and an abnormal pupillary response may also occur.

    Optic cellulitis

    Optic cellulitis causes dull, aching pain in the affected eye, some degree of exophthalmos, eyelid edema and erythema, purulent discharge, impaired extraocular movement and, occasionally, decreased visual acuity and fever.

    Optic neuritis

    With optic neuritis, pain in and around the eye occurs with eye movement. Severe vision loss and tunnel vision develop but improve in 2 to 3 weeks. Pupils respond sluggishly to direct light but normally to consensual light.

    Orbital floor fracture

    Sometimes called a blowout fracture, orbital floor fracture causes eye pain, dramatic eyelid edema and, possibly, enophthalmos and diplopia. The patient may report recent eye trauma and reduced vision. Ecchymosis and ptosis may be visible.

    Orbital pseudotumor

    An orbital pseudotumor causes deep, boring eye pain and diplopia in about 50% of patients. However, prominent exophthalmos and lateral ocular deviation are more characteristic. Eyelid edema and restricted extraocular movement may also occur.

    Uveitis

    Anterior uveitis causes sudden onset of severe pain, dramatic conjunctival injection, photophobia, and a small, nonreactive pupil. Posterior uveitis causes insidious onset of similar features, plus gradual blurring of vision and distorted pupil shape. Lens-induced uveitis causes moderate eye pain, conjunctival injection, pupil constriction, and severely impaired visual acuity (the patient usually can perceive only light).

    Other causes

    Treatments

    Contact lenses may cause eye pain and a foreign-body sensation. Ocular surgery may also produce eye pain, ranging from a mild ache to a severe pounding or stabbing sensation.

    » READ BOOK EXCERPT ONLINE »

    Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

    Hemianopsia: Medical causes
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Carotid artery aneurysm

    An aneurysm in the internal carotid artery can cause contralateral or bilateral defects in the visual fields. It can also cause hemiplegia, decreased LOC, headache, aphasia, behavior disturbances, and unilateral hypoesthesia.

    Occipital lobe lesion

    The most common symptoms arising from a lesion of one occipital lobe are incomplete homonymous hemianopsia, scotomas, and impaired color vision. The patient may also experience visual hallucinations: flashes of light or color, or visions of objects, people, animals, or geometric forms. These may appear in the defective field or may move toward it from the intact field.

    Parietal lobe lesion

    A parietal lobe lesion produces homonymous hemianopsia and sensory deficits, such as an inability to perceive body position or passive movement or to localize tactile, thermal, or vibratory stimuli. It may also cause apraxia and visual or tactile agnosia.

    Pituitary tumor

    A tumor that compresses nerve fibers supplying the nasal half of both retinas causes complete or partial bitemporal hemianopsia that first occurs in the upper visual fields but later can progress to blindness. Related findings include blurred vision, diplopia, and headache.

    Stroke

    Hemianopsia can result when stroke affects any part of the optic pathway. Associated signs and symptoms vary according to the location and size of the stroke but may include decreased LOC; intellectual deficits, such as memory loss and poor judgment; personality changes; emotional lability; headache; and seizures. The patient may also develop contralateral hemiplegia, dysarthria, dysphagia, ataxia, a unilateral sensory loss, apraxia, agnosia, aphasia, blurred vision, decreased visual acuity, and diplopia. He may also experience urine retention or incontinence, constipation, and vomiting.

    » READ BOOK EXCERPT ONLINE »

    Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

    Scotoma: Medical causes
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Chorioretinitis

    Chorioretinitis, inflammation of the choroid and retina, produces a paracentral scotoma. Ophthalmoscopic examination reveals clouding and cells in the vitreous, subretinal hemorrhage, and neovascularization. The patient may have photophobia along with blurred vision.

    Glaucoma

    With glaucoma, prolonged elevation of IOP can cause an arcuate scotoma. Poorly controlled glaucoma can also cause cupping of the optic disk, loss of peripheral vision, and reduced visual acuity. The patient may also see rainbow-colored halos around lights.

    Macular degeneration

    Macular degeneration results in a central scotoma. Ophthalmoscopic examination reveals changes in the macular area. The patient may notice subtle changes in visual acuity, in color perception, and in the size and shape of objects.

    Migraine headache

    Transient scintillating scotomas, usually bilateral and typically homonymous, can occur during a classic migraine aura. Besides pain, characteristic associated symptoms include paresthesia of the lips, face, or hands; slight confusion; dizziness; and photophobia.

    Optic neuritis

    Inflammation, degeneration, or demyelination of the optic nerve produces a central, circular, or centrocecal scotoma. The scotoma may be unilateral with involvement of one nerve, or bilateral with involvement of both nerves. It can vary in size, density, and symmetry. The patient may report severe vision loss or blurring, lasting up to 3 weeks, and pain — especially with eye movement. Common ophthalmoscopic findings include hyperemia of the optic disk, retinal vein distention, blurred disk margins, and filling of the physiologic cup.

    Retinitis pigmentosa

    Retinitis pigmentosa initially involves loss of peripheral rods; the resulting annular scotoma progresses concentrically until only a central field of vision (tunnel vision) remains. The earliest symptom — impaired night vision — appears during adolescence. Associated signs include narrowing of the retinal blood vessels and pallor of the optic disk. Eventually, with invasion of the macula, blindness may occur.

    » READ BOOK EXCERPT ONLINE »

    Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

    Vision loss: Medical causes
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Amaurosis fugax

    With amaurosis fugax, recurrent attacks of unilateral vision loss may last from a few seconds to a few minutes. Vision is normal at other times. Transient unilateral weakness, hypertension, and elevated intraocular pressure (IOP) in the affected eye may also occur.

    Cataract

    With a cataract, usually, painless and gradual visual blurring precedes vision loss. As the cataract progresses, the pupil turns milky white. Night blindness and halo vision may be early signs of this disorder.

    Concussion

    Immediately or shortly after blunt head trauma, which causes a concussion, vision may be blurred, double, or lost. Generally, vision loss is temporary. Other findings include headache, anterograde and retrograde amnesia, transient loss of consciousness, nausea, vomiting, dizziness, irritability, confusion, lethargy, and aphasia.

    Diabetic retinopathy

    With diabetic retinopathy, retinal edema and hemorrhage lead to visual blurring, which may progress to blindness. The patient may also have a loss of central vision and color vision.

    Endophthalmitis

    Typically, endophthalmitis follows penetrating trauma, I.V. drug use, or intraocular surgery, causing possibly permanent unilateral vision loss; a sympathetic inflammation may affect the other eye. The patient with endophthalmitis may also experience headache, photophobia, and ocular discharge.

    Glaucoma

    Glaucoma produces gradual visual blurring that may progress to total blindness. Acute angle-closure glaucoma is an ocular emergency that may produce blindness within 3 to 5 days. Findings are rapid onset of unilateral inflammation and pain, pressure over the eye, moderate pupil dilation, nonreactive pupillary response, a cloudy cornea, reduced visual acuity, photophobia, and perception of blue or red halos around lights. Nausea and vomiting may also occur.

    Chronic open-angle glaucoma is usually bilateral, with an insidious onset and a slowly progressive course. It causes peripheral vision loss, aching eyes, halo vision, and reduced visual acuity (especially at night).

    Herpes zoster

    When herpes zoster affects the nasociliary nerve, bilateral vision loss is accompanied by eyelid lesions, conjunctivitis, skin lesions that usually appear on the nose, and ocular muscle palsies.

    Hyphema

    With a hyphema, blood in the anterior chamber can reduce vision to light perception only. Other effects include moderate pain, conjunctival injection, and eyelid edema. Most hyphemas are the direct result of blunt trauma to the normal eye.

    Keratitis

    Keratitis (inflammation of the cornea) may lead to complete unilateral vision loss. Other findings include an opaque cornea, increased tearing, irritation, and photophobia.

    Ocular trauma

    Following eye injury, sudden unilateral or bilateral vision loss may occur. Vision loss may be total or partial and permanent or temporary. The eyelids may be reddened, edematous, and lacerated; intraocular contents may be extruded.

    Optic atrophy

    Optic atrophy (degeneration of the optic nerve) can develop spontaneously or follow inflammation or edema of the nerve head, causing irreversible loss of the visual field with changes in color vision. Pupillary reactions are sluggish, and optic disk pallor is evident.

    Optic neuritis

    Optic neuritis usually produces temporary but severe unilateral vision loss. Pain around the eye occurs, especially with movement of the globe. This may occur with visual field defects and a sluggish pupillary response to light. Ophthalmoscopic examination commonly reveals hyperemia of the optic disk, blurred disk margins, and filling of the physiologic cup.

    Paget’s disease

    With Paget’s disease, bilateral vision loss may develop as a result of bony impingements on the cranial nerves. This occurs with hearing loss, tinnitus, vertigo, and severe, persistent bone pain. Cranial enlargement may be noticeable frontally and occipitally, and headaches may occur. Sites of bone involvement are warm and tender, and impaired mobility and pathologic fractures are common.

    Papilledema

    Papilledema is characterized by swelling of the optic disk from increased intracranial pressure; both optic disks are affected. Acute papilledema may lead to momentary blurring or transiently obscured vision, whereas chimeric papilledema may lead to vision loss.

    Pituitary tumor

    As a pituitary adenoma grows, blurred vision progresses to hemianopia and, possibly, unilateral blindness. Double vision, nystagmus, ptosis, limited eye movement, and headaches may also occur.

    Retinal artery occlusion (central)

    Retinal artery occlusion is a painless ocular emergency that causes sudden unilateral vision loss, which may be partial or complete. Pupil examination reveals a sluggish direct pupillary response and a normal consensual response. Permanent blindness may occur within hours.

    Retinal detachment

    Depending on the degree and location of retinal detachment, painless vision loss may be gradual or sudden and total or partial. Macular involvement causes total blindness.

    With partial vision loss, the patient may describe visual field defects or a shadow or curtain over the visual field as well as visual floaters.

    Retinal vein occlusion (central)

    Most common in geriatric patients, retinal vein occlusion is a painless disorder that causes a unilateral decrease in visual acuity with variable vision loss. IOP may be elevated in both eyes.

    Senile macular degeneration

    Occurring in elderly patients, senile macular degeneration causes painless blurring or loss of central vision. Vision loss may proceed slowly or rapidly, eventually affecting both eyes. Visual acuity may be worse at night.

    Temporal arteritis

    Vision loss and visual blurring with a throbbing, unilateral headache characterize temporal arteritis. Other findings include malaise, anorexia, weight loss, weakness, low-grade fever, generalized muscle aches, and confusion.

    Uveitis

    Inflammation of the uveal tract may result in unilateral vision loss. Anterior uveitis produces moderate to severe eye pain, severe conjunctival injection, photophobia, and a small, nonreactive pupil. Posterior uveitis may produce insidious onset of blurred vision, conjunctival injection, visual floaters, pain, and photophobia. Associated posterior scar formation distorts the shape of the pupil.

    Vitreous hemorrhage

    With vitreous hemorrhage, sudden unilateral vision loss may result from intraocular trauma, ocular tumors, or systemic disease (especially diabetes, hypertension, sickle cell anemia, or leukemia). Visual floaters and partial vision with a reddish haze may occur. The patient’s vision loss may be permanent.

    Other causes

    Drugs

    Chloroquine therapy may cause patchy retinal pigmentation that typically leads to blindness. Phenylbutazone may cause vision loss and increased susceptibility to retinal detachment. Cardiac glycoside derivatives, indomethacin, ethambutol, quinine sulfate, and methanol toxicity may also cause vision loss.

    » READ BOOK EXCERPT ONLINE »

    Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

    Night blindness: Medical causes
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Cataracts

    Night blindness and halo vision occur early in senile-type cataract formation. As the cataract matures, it causes gradual, painless visual blurring and vision loss, sometimes with visible lens opacity.

    Glaucoma

    Night blindness occurs late in chronic open-angle glaucoma, with halo vision, gradually impaired bilateral visual acuity, loss of peripheral vision and, possibly, slight eye pain.

    Optic nerve atrophy

    Optic nerve atrophy may cause night blindness, visual field and color vision defects, and decreased visual acuity. Pupillary reactions are sluggish, and optic disk pallor is evident.

    Retinitis pigmentosa

    Retinitis pigmentosa is usually a hereditary retinal degeneration in which night blindness is characteristically the first symptom, typically arising in adolescence. Scattered black pigmentary bodies form in a characteristic “bone-spicule” arrangement on the retina. As the disease progresses, the visual field gradually constricts, causing tunnel or “gun barrel” vision and, eventually, total blindness.

    Vitamin A deficiency

    Night blindness is typically the first symptom of vitamin A deficiency. Associated findings include xerophthalmia (conjunctival dryness) and Bitot’s spots (gray-white conjunctival plaques). The patient may complain of visual blurring or vision loss. His skin may be dry and scaly. His mucous membranes may be shrunken and hardened.

    » READ BOOK EXCERPT ONLINE »

    Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

    Vision Disturbances: Principal Causes of Vision Disturbances
    (The Diagnostic Approach to Symptoms and Signs in Pediatrics)

    1. Oculardisorders
      1. Congenitalanomalies
        1. Globe
        2. Lens
        3. Cornea
        4. Iris
        5. Vitreous
      2. Refractive errors
        1. Myopia
        2. Hyperopia
        3. Astigmatism
        4. Anisometropia
      3. Strabismus
      4. Amblyopia
      5. Trauma
      6. Infection
      7. Cataracts
      8. Glaucoma
      9. Uveitis
        1. Anterior uveitis
        2. Posterior uveitis
      10. Retinal disorders
        1. Retinopathyof prematurity
        2. Retinitis pigmentosa and other retinaldystrophies
        3. Retinal detachment
        4. Albinism
      11. Neoplasm
      12. Metabolic disorders
    2. Neurologic disorders
      1. Lesionsof optic nerve or chiasm
        1. Optic nerve aplasia
        2. Optic nerve hypoplasia
        3. Optic atrophy
        4. Optic neuritis
      2. Lesions of optic pathways
      3. Lesions of visual cortex

    » READ BOOK EXCERPT ONLINE »

    Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

    Hemianopsia: Medical causes
    (Nursing: Interpreting Signs and Symptoms)

    Carotid artery aneurysm.An aneurysm in the internal carotid artery can cause contralateral or bilateral defects in the visual fields. It can also cause hemiplegia, a decreased LOC, a headache, aphasia, behavior disturbances, and unilateral hypoesthesia.

    Occipital lobe lesion.The most common symptoms arising from a lesion of one occipital lobe are incomplete homonymous hemianopsia, scotomas, and impaired color vision. The patient may also experience visual hallucinations—flashes of light or color or visions of objects, people, animals, or geometric forms. These may appear in the defective field or may move toward it from the intact field.

    Parietal lobe lesion.Parietal lobe lesion produces homonymous hemianopsia and sensory deficits, such as an inability to perceive body position or passive movement or to localize tactile, thermal, or vibratory stimuli. It may also cause apraxia and visual or tactile agnosia.

    Pituitary tumor.A tumor that compresses nerve fibers supplying the nasal half of both retinas causes complete or partial bitemporal hemianopsia that first occurs in the upper visual fields but later can progress to blindness. Related findings include blurred vision, diplopia, a headache and, rarely, somnolence, hypothermia, and seizures.

    Stroke.Hemianopsia can result when a hemorrhagic, thrombotic, or embolic stroke affects part of the optic pathway. Associated signs and symptoms vary according to the location and size of the stroke, but may include a decreased LOC; intellectual deficits, such as memory loss and poor judgment; personality changes; emotional lability; a headache; and seizures. The patient may also develop contralateral hemiplegia, dysarthria, dysphagia, ataxia, a unilateral sensory loss, apraxia, agnosia, aphasia, blurred vision, decreased visual acuity, and diplopia. He may also experience urine retention or incontinence, constipation, and vomiting.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007

    Scotoma: Medical causes
    (Nursing: Interpreting Signs and Symptoms)

    Chorioretinitis.Inflammation of the choroid and retina produces a paracentral scotoma. Ophthalmoscopic examination reveals clouding and cells in the vitreous, subretinal hemorrhage, and neovascularization. The patient may have photophobia along with blurred vision.

    Macular degeneration.Any degenerative process or disorder affecting the fovea centralis results in a central scotoma. Ophthalmoscopic examination reveals changes in the macular area. The patient may notice subtle changes in visual acuity, in color perception, and in the size and shape of objects.

    Optic neuritis.Inflammation, degeneration, or demyelination of the optic nerve produces a central, circular, or centrocecal scotoma. The scotoma may be unilateral with involvement of one nerve, or bilateral with involvement of both nerves. It can vary in size, density, and symmetry. The patient may report severe vision loss or blurring, lasting up to 3 weeks, and pain—especially with eye movement. Common ophthalmoscopic findings include hyperemia of the optic disk, retinal vein distention, blurred disk margins, and filling of the physiologic cup.

    Retinal pigmentary degeneration.Retinal pigmentary degeneration causes premature retinal cell changes leading to cell death. One disorder, retinitis pigmentosa, initially involves loss of peripheral rods; the resulting annular scotoma progresses concentrically until only a central field of vision (tunnel vision) remains. The earliest symptom—impaired night vision—appears during adolescence. Associated signs include narrowing of the retinal blood vessels and pallor of the optic disk. Eventually, with invasion of the macula, blindness may occur.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007

    Vision loss: Medical causes
    (Nursing: Interpreting Signs and Symptoms)

    Amaurosis fugax.With amaurosis fugax, recurrent attacks of unilateral vision loss may last from a few seconds to a few minutes. Vision is normal at other times. Transient unilateral weakness, hypertension, and elevated intraocular pressure (IOP) in the affected eye may also occur.

    Cataract.With a cataract, painless and gradual visual blurring typically precede vision loss. As the cataract progresses, the pupil turns milky white.

    Concussion.Immediately or shortly after blunt head trauma, vision may be blurred, double, or lost. Generally, vision loss is temporary. Other findings include headache, anterograde and retrograde amnesia, transient loss of consciousness, nausea, vomiting, dizziness, irritability, confusion, lethargy, and aphasia.

    Diabetic retinopathy.With diabetic retinopathy, retinal edema and hemorrhage lead to visual blurring, which may progress to blindness.

    Endophthalmitis.Typically, endophthalmitis follows penetrating trauma, I.V. drug use, or intraocular surgery, causing possibly permanent unilateral vision loss; a sympathetic inflammation may affect the other eye.

    Glaucoma.Glaucoma produces gradual visual blurring that may progress to total blindness. Acute angle-closure glaucoma is an ocular emergency that may produce blindness within 3 to 5 days. Findings are rapid onset of unilateral inflammation and pain, pressure over the eye, moderate pupil dilation, nonreactive pupillary response, a cloudy cornea, reduced visual acuity, photophobia, and perception of blue or red halos around lights. Nausea and vomiting may also occur.

    Chronic angle-closure glaucoma has a gradual onset and usually produces no symptoms, although blurred or halo vision may occur. If untreated, it progresses to blindness and extreme pain.

    Chronic open-angle glaucoma is usually bilateral, with an insidious onset and a slowly progressive course. It causes peripheral vision loss, aching eyes, halo vision, and reduced visual acuity (especially at night).

    Ocular trauma.Following eye injury, sudden unilateral or bilateral vision loss may occur. Vision loss may be total or partial and permanent or temporary. The eyelids may be reddened, edematous, and lacerated; intraocular contents may be extruded.

    Optic atrophy.Optic atrophy can develop spontaneously or follow inflammation or edema of the nerve head, causing irreversible loss of the visual field with changes in color vision. Pupillary reactions are sluggish and optic disk pallor is evident.

    Optic neuritis.An umbrella term for inflammation, degeneration, or demyelinization of the optic nerve, optic neuritis usually produces temporary but severe unilateral vision loss. Pain around the eye occurs, especially with movement of the globe. This may occur with visual field defects and a sluggish pupillary response to light. Ophthalmoscopic examination commonly reveals hyperemia of the optic disk, blurred disk margins, and filling of the physiologic cup.

    Paget's disease.With Paget's disease, bilateral vision loss may develop as a result of bony impingements on the cranial nerves. This occurs with hearing loss, tinnitus, vertigo, and severe, persistent bone pain. Cranial enlargement may be noticeable frontally and occipitally, and headaches may occur. Sites of bone involvement are warm and tender and impaired mobility and pathologic fractures are common.

    Pituitary tumor.As a pituitary adenoma grows, blurred vision progresses to hemianopsia and, possibly, unilateral blindness. Double vision, nystagmus, ptosis, limited eye movement, and headaches may also occur.

    Retinal artery occlusion (central).Retinal artery occlusion is a painless ocular emergency that causes sudden unilateral vision loss, which may be partial or complete. Pupil examination reveals a sluggish direct pupillary response and a normal consensual response. Permanent blindness may occur within hours.

    Retinal detachment.Depending on the degree and location of retinal detachment, painless vision loss may be gradual or sudden and total or partial. Macular involvement causes total blindness.

    With partial vision loss, the patient may describe visual field defects or a shadow or curtain over the visual field as well as visual floaters.

    Retinal vein occlusion (central).Retinal vein occlusion causes a unilateral decrease in visual acuity with variable vision loss. IOP may be elevated in both eyes.

    Rift Valley fever.Rift Valley fevercauses inflammation of the retina and may result in some permanent vision loss. Typical signs and symptoms include fever, myalgia, weakness, dizziness, and back pain. A small percentage of patients may develop encephalitis or may progress to hemorrhagic fever that can lead to shock and hemorrhage.

    Senile macular degeneration.Senile macular degeneration causes painless blurring or loss of central vision. Vision loss may proceed slowly or rapidly, eventually affecting both eyes. Visual acuity may be worse at night.

    Stevens-Johnson syndrome.With Stevens-Johnson syndrome, corneal scarring from associated conjunctival lesions produces marked vision loss. Purulent conjunctivitis, eye pain, and difficulty opening the eyes occur. Additional findings include widespread bullae, fever, malaise, cough, drooling, inability to eat, sore throat, chest pain, vomiting, diarrhea, myalgias, arthralgias, hematuria, and signs of renal failure.

    Temporal arteritis.Vision loss and visual blurring with a throbbing, unilateral headache characterize temporal arteritis. Other findings include malaise, anorexia, weight loss, weakness, low-grade fever, generalized muscle aches, and confusion.

    Vitreous hemorrhage.With vitreous hemorrhage, sudden unilateral vision loss may result from intraocular trauma, ocular tumors, or systemic disease (especially diabetes, hypertension, sickle cell anemia, or leukemia). Visual floaters and partial vision with a reddish haze may occur. The patient's vision loss may be permanent.

    Other causes

    Drugs.Chloroquine therapy may cause patchy retinal pigmentation that typically leads to blindness. Phenylbutazone may cause vision loss and increased susceptibility to retinal detachment. Digoxin, indomethacin, ethambutol, quinine sulfate, and methanol toxicity may also cause vision loss.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007

    Eye pain [Ophthalmalgia]: Medical causes
    (Nursing: Interpreting Signs and Symptoms)

    Acute angle-closure glaucoma.Blurred vision and sudden, excruciating pain in and around the eye characterize acute angle-closure glaucoma; the pain may be so severe that it causes nausea, vomiting, and abdominal pain. Other findings are halo vision, rapidly decreasing visual acuity, and a fixed, nonreactive, moderately dilated pupil.

    Blepharitis.Burning pain in both eyelids is accompanied by itching, sticky discharge, and conjunctival injection. Related findings include a foreign-body sensation, lid ulcerations, and loss of eyelashes.

    Burns.With chemical burns, sudden and severe eye pain may occur with erythema and blistering of the face and lids, photophobia, miosis, conjunctival injection, blurring, and an inability to keep the eyelids open. With ultraviolet radiation burns, moderate to severe pain occurs about 12 hours after exposure along with photophobia and vision changes.

    Chalazion.A chalazion causes localized tenderness and swelling on the upper or lower eyelid. Eversion of the lid reveals conjunctival injection and a small red lump.

    Conjunctivitis.Some degree of eye pain and excessive tearing occurs with four types of conjunctivitis. Allergic conjunctivitis causes mild, burning, bilateral pain accompanied by itching, conjunctival injection, and a characteristic ropey discharge. Bacterial conjunctivitis causes pain only when it affects the cornea. Otherwise, it produces burning and a foreign-body sensation. A purulent discharge and conjunctival injection are also typical.

    If the cornea is affected, fungal conjunctivitis may cause pain and photophobia. Even without corneal involvement, it produces itching, burning eyes; a thick, purulent discharge; and conjunctival injection.

    Viral conjunctivitis produces itching, red eyes, a foreign-body sensation, visible conjunctival follicles, and eyelid edema.

    Corneal abrasions.With this type of injury, eye pain is characterized by a foreign-body sensation. Excessive tearing, photophobia, and conjunctival injection are also common.

    Corneal ulcers.Bacterial and fungal corneal ulcers cause severe eye pain. They may also cause a purulent eye discharge, sticky eyelids, photophobia, and impaired visual acuity. In addition, bacterial corneal ulcers produce a grayish white, irregularly shaped ulcer on the cornea; unilateral pupil constriction; and conjunctival injection. Fungal corneal ulcers produce conjunctival injection, eyelid edema and erythema, and a dense, cloudy, central ulcer surrounded by progressively clearer rings.

    Dacryocystitis.Pain and tenderness near the tear sac characterize acute dacryocystitis. Additional signs include excessive tearing, a purulent discharge, eyelid erythema, and swelling in the lacrimal punctum area.

    Episcleritis.Deep eye pain occurs as tissues over the sclera become inflamed. Related effects include photophobia, excessive tearing, conjunctival edema, and a red or purplish sclera.

    Erythema multiforme major.Erythema multiforme major commonly produces severe eye pain, entropion, trichiasis, purulent conjunctivitis, photophobia, and decreased tear formation.

    Foreign bodies in the cornea and conjunctiva.Sudden severe pain is common, but vision usually remains intact. Other findings include excessive tearing, photophobia, miosis, a foreign-body sensation, a dark speck on the cornea, and dramatic conjunctival injection.

    Hordeolum (stye).Hordeolum usually produces localized eye pain that increases as the stye grows. Eyelid erythema and edema are also common.

    Iritis (acute).Moderate to severe eye pain occurs with severe photophobia, dramatic conjunctival injection, and blurred vision. The constricted pupil may respond poorly to light.

    Lacrimal gland tumor.A lacrimal gland tumor is a neoplastic lesion that usually produces unilateral eye pain, impaired visual acuity, and some degree of exophthalmos.

    Migraine headache.Migraines can produce pain so severe that the eyes also ache. Additionally, nausea, vomiting, blurred vision, and light and noise sensitivity may occur.

    Ocular laceration and intraocular foreign bodies.Penetrating eye injuries usually cause mild to severe unilateral eye pain and impaired visual acuity. Eyelid edema, conjunctival injection, and an abnormal pupillary response may also occur.

    Optic neuritis.With optic neuritis, pain in and around the eye occurs with eye movement. Severe vision loss and tunnel vision develop but improve in 2 to 3 weeks. Pupils respond sluggishly to direct light but normally to consensual light.

    Scleritis.Scleritis produces severe eye pain and tenderness, along with conjunctival injection, a bluish purple sclera and, possibly, photophobia and excessive tearing.

    Sclerokeratitis.Inflammation of the sclera and cornea causes pain, burning, irritation, and photophobia.

    Subdural hematoma.Following head trauma, a subdural hematoma commonly causes severe eye ache and headache. Related neurologic signs depend on the hematoma's location and size.

    Trachoma.Along with pain in the affected eye, trachoma causes excessive tearing, photophobia, eye discharge, eyelid edema and redness, and visible conjunctival follicles.

    Uveitis.Anterior uveitis causes the sudden onset of severe pain, dramatic conjunctival injection, photophobia, and a small, nonreactive pupil.

    Posterior uveitis causes an insidious onset of similar features as well as gradual blurring of vision and distorted pupil shape.

    Lens-induced uveitis causes moderate eye pain, conjunctival injection, pupil constriction, and severely impaired visual acuity. In fact, the patient usually can perceive only light.

    Other causes

    Treatments and surgery.Contact lenses may cause eye pain and a foreign-body sensation. Ocular surgery may also produce eye pain, ranging from a mild ache to a severe pounding or stabbing sensation.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007


     » Next page: Risk Factors for Blindness

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