Blurred Vision

Blurred vision is one of the most common ophthalmic symptoms. It may be caused by any alteration of the optical surfaces (e.g., cataract) or the media through which the visual axis traverses (e.g., vitreous hemorrhage). History and physical examination will usually lead to a reasonable differential diagnosis. Treatment aims to restore the ideal refractive and transparent media and surfaces of the eye. Most commonly, blurred vision is due to a refractive error that can be corrected with glasses, but more serious pathology must not be missed.

Differential Diagnosis

• Refractive error
• Presbyopia (blurred near vision, starts around age 40)
• Conjunctivitis (e.g., heavy discharge)
• Macular disease
  –Age-related macular degeneration
  –Macular edema; diabetic retinopathy
  –Central serous chorioretinopathy
• Ocular media opacity
  –Corneal edema (decreased deturgescent
  capacity or increased intraocular pressure)
  –Uveitis (anterior or posterior)
  –Hyphema
  –Cataract
  –Vitreous hemorrhage
• Corneal irregularity or abrasion
• Dry eye; poor tear film
• Retinal detachment
• Migraine (transient blurred/absent vision)
• CNS abnormality; head trauma
• Hyperglycemia (blurring may vary from
  day-to-day or throughout the day)
  –Poorly controlled diabetes mellitus
  –Medication effects
  –Other (see “Hyperglycemia” entry)
• Medication or drug side effects
  –Anticholinergics
  –Antihypertensives
  –Psychotropic medications
  –Amphetamine abuse
• Vasculopathy
  –Retinal artery or vein occlusion
• Hyperviscosity; hypercoagulation
• Seizure disorders
• Extraocular muscle paralysis
  –Diplopia may be misinterpreted as blurred vision by the patient; however, this will clear with covering either eye
• Temporal arteritis
  –Blurring is variable and may be associated with superior or inferior field defects
• Acute angle-closure glaucoma
  –Associated pain and redness are common
• Myasthenia gravis
  –Ptosis, diplopia, and/or blurred vision
• Botulism
• CO₂ narcosis
• See also “Vision Loss” entry

Workup and Diagnosis

• History
  –Review the progression (sudden, gradual) and duration (minutes, days, or months) of symptoms, binocular or uniocular, near or far vision, transient or permanent
  –Past medical history (e.g., diabetes, eye or head trauma, cataracts)
  –History of associated symptoms (e.g., migraine headache, seizure activity or change in level of consciousness, stroke-like symptoms)
• Complete ophthalmologic exam
  –Best corrected visual acuity (Snellen chart or near card)
  –Improvement of vision with pinhole indicates a refractive error
  –Slit lamp exam
  –Dilated fundus exam
  –Irritated or dry eyes
• Neurologic and head and neck examination should be considered
• EEG if seizure disorder is suspected
• Initial laboratory tests may include fasting (or random) blood glucose (with a repeat glucose and Hgb_A1C if glucose is initially elevated), CBC, PT, and PTT

Treatment

• Glasses or contact lenses for refractive errors
• Treat underlying pathology if possible (e.g., correct hyperglycemia, cataract surgery)
• Lubrication for dry eyes
• Ocular media opacity requires medical or surgical correction
• Retinal detachment requires surgical repair
• Hyperviscosity should be treated appropriately (e.g., aspirin, discontinue cigarettes)
• Antiseizure prophylaxis for seizure disorders

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

Other Book Chapters Related to Blurred vision

Read excerpts from these other book chapters related to Blurred vision:

Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Blurred vision

• Back to symptom: Blurred vision: Introduction (review 811 causes)
• Next Book Extract About Blurred vision: Diplopia (In A Page: Pediatric Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Blurred vision

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

 » Next page: Diplopia (In A Page: Pediatric Signs and Symptoms)

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• EYE PAIN (Differential Diagnosis in Primary Care)
• PAPILLEDEMA (Differential Diagnosis in Primary Care)

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