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Diseases » Vision Impairment » Causes

Causes of Vision Impairment

Contents

Causes of Vision Impairment (Diseases Database):

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

Source: Diseases Database

Vision Impairment Causes: Book Excerpts

Vision Impairment as a complication of other conditions:

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

Vision Impairment as a symptom:

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

Medical news summaries relating to Vision Impairment:

The following medical news items are relevant to causes of Vision Impairment:

Related information on causes of Vision Impairment:

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

Hidden causes of Vision Impairment

Causes of Vision Impairment: Online Medical Books

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

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

Binocular diplopia

Decompensated phoria (ocular deviation)

Third nerve palsy (vertical and horizontal diplopia)
–Compressive lesions (especially if pupil is involved), including aneurysm, cavernous sinus or orbit tumor, pituitary apoplexy, and uncal herniation
–Ischemic microvascular disease (e.g., diabetes mellitus, hypertension)
–Midbrain infarct
–Giant cell arteritis
–Herpes zoster
–Leukemia
–Meningitis
–Subarachnoid hemorrhage
–Ophthalmoplegic migraine
–Trauma
Fourth nerve palsy (vertical diplopia): Etiologies include trauma, ischemic microvascular disease, congenital, multiple sclerosis, and other causes as above
Sixth nerve palsy (horizontal diplopia): Etiologies include ischemic microvascular disease, trauma, increased ICP (bilateral palsy), tumor, multiple sclerosis, post-LP, sarcoidosis/vasculitis, pontine infarct, and other causes as above
Myasthenia gravis
Orbital disease (e.g., Graves’ orbitopathy, orbital inflammation, tumor)
Cavernous sinus or superior orbital fissure syndrome (multiple CN involvement)
Postocular surgery
Trauma
Brown's syndrome (restriction of superior oblique tendon)
Internuclear ophthalmoplegia (MS, CVA)
Vertebrobasilar insufficiency (vertigo)
Botulism
Monocular diplopia
Refractive error (high astigmatism)
Corneal opacity or irregularity
Cataract
Dislocated lens or lens implant
Extrapupillary openings
Macular disease
Retinal detachment
Nonphysiologic

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

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

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

Monocular diplopia
–Rare, usually associated with the cornea, lens, vitreous, or refractive anomalies such as high uncorrected astigmatism
–May occur in lens implant dislocation
–Neurologic disorders may present as monocular diplopia with repetitive images

Binocular, decompensated phoria with
concomitant strabismus, nonpathologic
–Recent ocular surgery
–Ocular myasthenia (may be transient)

Binocular with proptosis, gaze restriction
–Thyroid disease, orbital pseudotumor, cavernous sinus thrombosis or fistula

Binocular with isolated third nerve
–Atherosclerosis, hypertension, diabetes, tumor, aneurysm

Binocular with isolated sixth nerve
–Trauma, atherosclerosis, hypertension, diabetes, tumor, increased intracranial pressure, sinus disease

Binocular with isolated fourth nerve
–Trauma, stroke, thyroid eye disease, atherosclerosis, hypertension, diabetes

Binocular with multiple muscle weakness in one eye
–Cavernous sinus lesion

Binocular with multiple muscle weakness in both eyes
–Progressive supranuclear palsy, CPEO, acute postinfectious disorders

Adduction weakness or abducting nystagmus
–Inner nuclear ophthalmolplegia (INO), brainstem disease, stroke, MS, posterior fossa mass

Vertical diplopia with no fourth or third palsy
–Stroke, multiple sclerosis, posterior fossa mass

» READ BOOK EXCERPT ONLINE »

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

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

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

Alcohol intoxication

Diplopia is a common symptom of alcohol intoxication. It's accompanied by confusion, slurred speech, halitosis, a staggering gait, behavior changes, nausea, vomiting and, possibly, conjunctival injection.

Botulism

Hallmark signs of botulism include diplopia, dysarthria, dysphagia, and ptosis. Early findings include a dry mouth, a sore throat, vomiting, and diarrhea. Later, descending weakness or paralysis of extremity and trunk muscles causes hyporeflexia and dyspnea.

Brain tumor

Diplopia may be an early symptom of a brain tumor. Accompanying signs and symptoms vary with the tumor's size and location, but may include eye deviation, emotional lability, a decreased LOC, a headache, vomiting, absence or generalized tonic-clonic seizures, hearing loss, visual field deficits, abnormal pupillary responses, nystagmus, motor weakness, and paralysis.

Cavernous sinus thrombosis

Cavernous sinus thrombosis may produce diplopia and limited eye movement. Associated signs and symptoms include proptosis, orbital and lid edema, diminished or absent pupillary responses, impaired visual acuity, papilledema, and a fever.

Diabetes mellitus

Among the long-term effects of diabetes mellitus may be diplopia due to isolated CN III palsy. Diplopia typically begins suddenly and may be accompanied by pain.

Encephalitis

Initially, encephalitis may cause a brief episode of diplopia and eye deviation. However, it usually begins with the sudden onset of a high fever, a severe headache, and vomiting. As the inflammation progresses, the patient may display signs of meningeal irritation, a decreased LOC, seizures, ataxia, and paralysis.

Head injury

Potentially life-threatening head injuries may cause diplopia, depending on the site and extent of the injury. Associated signs and symptoms include eye deviation, pupillary changes, a headache, a decreased LOC, altered vital signs, nausea, vomiting, and motor weakness or paralysis.

Intracranial aneurysm

Intracranial aneurysm is a life-threatening disorder that initially produces diplopia and eye deviation, perhaps accompanied by ptosis and a dilated pupil on the affected side. The patient complains of a recurrent, severe, unilateral, frontal headache. After the aneurysm ruptures, the headache becomes violent. Associated signs and symptoms include neck and spinal pain and rigidity, a decreased LOC, tinnitus, dizziness, nausea, vomiting, and unilateral muscle weakness or paralysis.

Multiple sclerosis (MS)

Diplopia, a common early symptom in MS, is usually accompanied by blurred vision and paresthesia. As MS progresses, signs and symptoms may include nystagmus, constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, gait ataxia, dysphagia, dysarthria, impotence, emotional lability, and urinary frequency, urgency, and incontinence.

Myasthenia gravis

Myasthenia gravis initially produces diplopia and ptosis, which worsen throughout the day. It then progressively involves other muscles, resulting in a blank facial expression; a nasal voice; difficulty chewing, swallowing, and making fine hand movements; and, possibly, signs of life-threatening respiratory muscle weakness.

Ophthalmologic migraine

Most common in young adults, ophthalmologic migraine results in diplopia that persists for days after the headache. Accompanying signs and symptoms include severe, unilateral pain; ptosis; and extraocular muscle palsies. Irritability, depression, or slight confusion may also occur.

Orbital blowout fracture

An orbital blowout fracture usually causes monocular diplopia affecting the upward gaze. However, with marked periorbital edema, diplopia may affect other directions of gaze. This fracture commonly causes periorbital ecchymosis, but doesn't affect visual acuity, although eyelid edema may prevent accurate testing. Subcutaneous crepitation of the eyelid and orbit is typical. Occasionally, the patient's pupil is dilated and unreactive, and he may have a hyphema.

Orbital cellulitis

Inflammation of the orbital tissues and eyelids causes sudden diplopia. Other findings are eye deviation and pain, purulent drainage, lid edema, chemosis and redness, proptosis, nausea, and a fever.

Orbital tumor

An enlarging orbital tumor can cause diplopia. Proptosis and possibly blurred vision may also occur.

Stroke

Diplopia characterizes stroke when it affects the vertebrobasilar artery. Other signs and symptoms include unilateral motor weakness or paralysis, ataxia, a decreased LOC, dizziness, aphasia, visual field deficits, circumoral numbness, slurred speech, dysphagia, and amnesia.

Thyrotoxicosis

Diplopia occurs when exophthalmos characterizes the disorder. It usually begins in the upper field of gaze because of infiltrative myopathy involving the inferior rectus muscle. It's accompanied by impaired eye movement, excessive tearing, lid edema and, possibly, an inability to close the lids. Other cardinal findings include tachycardia, palpitations, weight loss, diarrhea, tremors, an enlarged thyroid, dyspnea, nervousness, diaphoresis, and heat intolerance.

Transient ischemic attack (TIA)

TIA is generally accompanied by diplopia, dizziness, tinnitus, hearing loss, and numbness. It can last for a few seconds or up to 24 hours and may be a warning sign of a future stroke.

Other causes

Eye surgery

Fibrosis associated with eye surgery may restrict eye movement, resulting in diplopia.

» READ BOOK EXCERPT ONLINE »

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

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

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

Alcohol intoxication

Diplopia, a common symptom of this disorder, may be accompanied by confusion, slurred speech, halitosis, staggering gait, behavior changes, nausea, vomiting and, possibly, conjunctival injection.

Botulism

The hallmark signs of botulism are diplopia, dysarthria, dysphagia, and ptosis. Early findings include dry mouth, sore throat, vomiting, and diarrhea. Later, descending weakness or paralysis of extremity and trunk muscles causes hyporeflexia and dyspnea.

Brain tumor

Diplopia may be an early symptom of a brain tumor. Associated signs and symptoms vary with the tumor’s size and location but may include eye deviation, emotional lability, decreased LOC, headache, vomiting, absence or generalized tonic-clonic seizures, hearing loss, visual field deficits, abnormal pupillary responses, nystagmus, motor weakness, and paralysis.

Cavernous sinus thrombosis

This disorder may produce diplopia and limited eye movement. Associated signs and symptoms include exophthalmos, orbital and eyelid edema, diminished or absent pupillary responses, impaired visual acuity, papilledema, and fever.

Diabetes mellitus

Among the long-term effects of this disorder may be diplopia due to isolated third cranial nerve palsy. Diplopia typically begins suddenly and may be accompanied by pain.

Encephalitis

Initially, this disorder may cause a brief episode of diplopia and eye deviation. However, it usually begins with sudden onset of high fever, severe headache, and vomiting. As the inflammation progresses, the patient may display signs of meningeal irritation, decreased LOC, seizures, ataxia, and paralysis.

Head injury

Potentially life-threatening head injuries may cause diplopia, depending on the site and extent of the injury. Associated signs and symptoms include eye deviation, pupillary changes, headache, decreased LOC, altered vital signs, nausea, vomiting, and motor weakness or paralysis.

Intracranial aneurysm

This life-threatening disorder initially produces diplopia and eye deviation, perhaps accompanied by ptosis and a dilated pupil on the affected side. The patient complains of a recurrent, severe, unilateral, frontal headache. After the aneurysm ruptures, the headache becomes violent. Associated signs and symptoms include neck and spinal pain and rigidity, decreased LOC, tinnitus, dizziness, nausea, vomiting, and unilateral muscle weakness or paralysis.

Multiple sclerosis (MS)

Diplopia, a common early symptom of MS, is usually accompanied by blurred vision and paresthesia. As MS progresses, signs and symptoms may include nystagmus, constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, gait ataxia, dysphagia, dysarthria, impotence, emotional lability, and urinary frequency, urgency, and incontinence.

Myasthenia gravis

This disorder initially produces diplopia and ptosis, which worsen throughout the day. It then progressively involves other muscles, resulting in blank facial expression; nasal voice; difficulty chewing, swallowing, and making fine hand movements and, possibly, signs of life-threatening respiratory muscle weakness.

Ophthalmologic migraine

Most common in young adults, this disorder results in diplopia that persists for days after the headache resolves. Accompanying signs and symptoms include severe unilateral pain, ptosis, and extraocular muscle palsies. Irritability, depression, or slight confusion may also occur.

Orbital blowout fracture

This fracture usually causes monocular diplopia affecting the upward gaze. However, with marked periorbital edema, diplopia may affect other directions of gaze. This fracture commonly causes periorbital ecchymosis but doesn’t affect visual acuity, although eyelid edema may prevent accurate testing. Subcutaneous crepitation of the eyelid and orbit is typical. Occasionally, the patient’s pupil is dilated and unreactive, and he may have a hyphema.

Orbital cellulitis

Inflammation of the orbital tissues and eyelids causes sudden diplopia as well as eye deviation and pain, purulent drainage, eyelid edema, chemosis and redness, exophthalmos, nausea, and fever.

Orbital tumor

An enlarging tumor can cause diplopia, exophthalmos and, possibly, blurred vision.

Stroke

Diplopia characterizes this life-threatening disorder when it affects the vertebrobasilar artery. Other signs and symptoms include unilateral motor weakness or paralysis, ataxia, decreased LOC, dizziness, aphasia, visual field deficits, circumoral numbness, slurred speech, dysphagia, and amnesia.

Thyrotoxicosis

Diplopia occurs when exophthalmos characterizes the disorder. It usually begins in the upper field of gaze because of infiltrative myopathy involving the inferior rectus muscle. It’s accompanied by impaired eye movement, excessive tearing, eyelid edema and, possibly, inability to close the eyelids. Other cardinal findings include tachycardia, palpitations, weight loss, diarrhea, tremors, an enlarged thyroid, dyspnea, nervousness, diaphoresis, and heat intolerance.

Transient ischemic attack (TIA)

A TIA, which may be a warning sign of a future stroke, is generally accompanied by diplopia, dizziness, tinnitus, hearing loss, and numbness. It can last for a few seconds or up to 24 hours.

Other causes

Eye surgery

Fibrosis associated with eye surgery may restrict eye movement, resulting in diplopia.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth 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

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

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

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

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

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

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Source: Field Guide to Bedside Diagnosis, 2007

Diplopia/Nystagmus: Differential Overview
(Field Guide to Bedside Diagnosis)

Diplopia

❑ Alcohol

❑ Diabetes

❑ Brainstem ischemia/lesion

❑ Grave disease

❑ Multiple sclerosis

❑ Ophthalmoplegic migraine

❑ Myasthenia gravis

❑ Wernicke encephalopathy

❑ Zygoma fracture

❑ Basilar meningitis

❑ Posterior communicating artery aneurysm

❑ Cavernous sinus thrombosis

❑ Syphilis

❑ Guillain-Barré variant

❑ Botulism

Nystagmus

❑ Labyrinthitis

❑ Multiple sclerosis

❑ Oculogyric crisis

❑ Cerebellar lesion

❑ Brainstem lesion

❑ Frontal lesion

❑ Occipital lesion

❑ Dorsal midbrain lesion

❑ Heavy metal intoxication

❑ Congenital

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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

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

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.

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

Optic atrophy

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

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

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

Other causes

Drugs

» READ BOOK EXCERPT ONLINE »

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

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

Brain tumor

Diplopia may be an early symptom of a brain tumor. Accompanying signs and symptoms vary with the tumor’s size and location but may include eye deviation, emotional lability, decreased LOC, headache, vomiting, absence or generalized tonic-clonic seizures, hearing loss, visual field deficits, abnormal pupillary responses, nystagmus, motor weakness, and paralysis.

Diabetes mellitus

Diplopia due to isolated third cranial nerve palsy may be among the long-term effects of diabetes mellitus. It typically begins suddenly and may be accompanied by intense periorbital or head pain. The patient may display the typical signs and symptoms of diabetes to varying degrees.

Encephalitis

Initially, encephalitis may cause a brief episode of diplopia and eye deviation. However, it usually begins with sudden onset of high fever, severe headache, and vomiting. As the inflammation progresses, the patient may display signs of meningeal irritation, decreased LOC, seizures, ataxia, and paralysis.

Head injury

Potentially life-threatening head injuries may cause diplopia, depending on the site and extent of the injury. Associated signs and symptoms include eye deviation, pupillary changes, headache, decreased LOC, altered vital signs, nausea, vomiting, and motor weakness or paralysis.

Intracranial aneurysm

Intracranial aneurysm is a life-threatening disorder that initially produces diplopia and eye deviation, perhaps accompanied by ptosis and a dilated pupil on the affected side. The patient complains of a recurrent, severe, unilateral, frontal headache. After the aneurysm ruptures, the headache becomes violent. Associated signs and symptoms include neck and spinal pain and rigidity, decreased LOC, tinnitus, dizziness, nausea, vomiting, and unilateral muscle weakness or paralysis.

Multiple sclerosis

Diplopia, a common early symptom in multiple sclerosis (MS), is usually accompanied by blurred vision and paresthesia. As MS progresses, signs and symptoms may include nystagmus, constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, gait ataxia, dysphagia, dysarthria, impotence, emotional lability, and urinary frequency, urgency, and incontinence.

Myasthenia gravis

Myasthenia gravis initially produces diplopia and ptosis, which worsen throughout the day. It then progressively involves other muscles, resulting in blank facial expression; nasal voice; difficulty chewing, swallowing, and making fine hand movements; and possibly signs of life-threatening respiratory muscle weakness.

Ophthalmologic migraine

Orbital blowout fracture

An orbital blowout fracture usually causes monocular diplopia affecting the upward gaze. However, with marked periorbital edema, diplopia may affect other directions of gaze. This fracture commonly causes periorbital ecchymosis but doesn’t affect visual acuity, although eyelid edema may prevent accurate testing. Subcutaneous crepitation of the eyelid and orbit is typical. Occasionally, the patient’s pupil is dilated and unreactive, and he may have a hyphema.

Orbital cellulitis

Orbital cellulitis (inflammation of the orbital tissues and eyelids) causes sudden diplopia. Other findings are eye deviation and pain, purulent drainage, lid edema, chemosis and redness, proptosis, nausea, and fever.

Orbital tumors

Orbital tumors can cause diplopia. Proptosis and possibly blurred vision may also occur. One or both eyes may appear prominent. The patient may also report pain and redness and swelling of the lid of the affected eye.

Stroke

Diplopia characterizes stroke when it affects the vertebrobasilar artery. Other signs and symptoms of this life-threatening disorder include unilateral motor weakness or paralysis, ataxia, decreased LOC, dizziness, aphasia, visual field deficits, circumoral numbness, slurred speech, dysphagia, and amnesia.

Thyrotoxicosis

Diplopia accompanies exophthalmos in patients with thyrotoxicosis. It usually begins in the upper field of gaze because of infiltrative myopathy involving the inferior rectus muscle. It’s accompanied by impaired eye movement, excessive tearing, lid edema and, possibly, inability to close the lids. Other cardinal findings include tachycardia, palpitations, weight loss, diarrhea, tremors, an enlarged thyroid, dyspnea, nervousness, diaphoresis, and heat intolerance.

Transient ischemic attack

Transient ischemic attack is generally accompanied by diplopia, dizziness, tinnitus, hearing loss, and numbness. It can last for a few seconds or up to 24 hours and may be a warning sign for a future stroke.

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

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

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 neuritis

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.

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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

Occipital lobe lesion

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.

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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

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.

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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

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

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

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

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 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

Temporal arteritis

Uveitis

Vitreous hemorrhage

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.

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

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

Alcohol intoxication.Diplopia is a common symptom of alcohol intoxication. It's accompanied by confusion, slurred speech, halitosis, a staggering gait, behavior changes, nausea, vomiting and, possibly, conjunctival injection.

Botulism.Hallmark signs of botulism include diplopia, dysarthria, dysphagia, and ptosis. Early findings include a dry mouth, a sore throat, vomiting, and diarrhea. Later, descending weakness or paralysis of extremity and trunk muscles causes hyporeflexia and dyspnea.

Brain tumor.Diplopia may be an early symptom of a brain tumor. Accompanying signs and symptoms vary with the tumor's size and location, but may include eye deviation, emotional lability, a decreased LOC, a headache, vomiting, absence or generalized tonic-clonic seizures, hearing loss, visual field deficits, abnormal pupillary responses, nystagmus, motor weakness, and paralysis.

Cavernous sinus thrombosis.Cavernous sinus thrombosis may produce diplopia and limited eye movement. Associated signs and symptoms include proptosis, orbital and lid edema, diminished or absent pupillary responses, impaired visual acuity, papilledema, and a fever.

Diabetes mellitus.Among the long-term effects of diabetes mellitus may be diplopia due to isolated CN III palsy. Diplopia typically begins suddenly and may be accompanied by pain.

Encephalitis.Initially, encephalitis may cause a brief episode of diplopia and eye deviation. However, it usually begins with the sudden onset of a high fever, a severe headache, and vomiting. As the inflammation progresses, the patient may display signs of meningeal irritation, a decreased LOC, seizures, ataxia, and paralysis.

Head injury.Potentially life-threatening head injuries may cause diplopia, depending on the site and extent of the injury. Associated signs and symptoms include eye deviation, pupillary changes, a headache, a decreased LOC, altered vital signs, nausea, vomiting, and motor weakness or paralysis.

Intracranial aneurysm.Intracranial aneurysm is a life-threatening disorder that initially produces diplopia and eye deviation, perhaps accompanied by ptosis and a dilated pupil on the affected side. The patient complains of a recurrent, severe, unilateral, frontal headache. After the aneurysm ruptures, the headache becomes violent. Associated signs and symptoms include neck and spinal pain and rigidity, a decreased LOC, tinnitus, dizziness, nausea, vomiting, and unilateral muscle weakness or paralysis.

Multiple sclerosis (MS).Diplopia, a common early symptom in MS, is usually accompanied by blurred vision and paresthesia. As MS progresses, signs and symptoms may include nystagmus, constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, gait ataxia, dysphagia, dysarthria, impotence, emotional lability, and urinary frequency, urgency, and incontinence.

Myasthenia gravis.Myasthenia gravis initially produces diplopia and ptosis, which worsen throughout the day. It then progressively involves other muscles, resulting in a blank facial expression; a nasal voice; difficulty chewing, swallowing, and making fine hand movements; and, possibly, signs of life-threatening respiratory muscle weakness.

Ophthalmologic migraine.Ophthalmologic migraine results in diplopia that persists for days after the headache. Accompanying signs and symptoms include severe, unilateral pain; ptosis; and extraocular muscle palsies. Irritability, depression, or slight confusion may also occur.

Orbital blowout fracture.An orbital blowout fracture usually causes monocular diplopia affecting the upward gaze. However, with marked periorbital edema, diplopia may affect other directions of gaze. This fracture commonly causes periorbital ecchymosis, but doesn't affect visual acuity, although eyelid edema may prevent accurate testing. Subcutaneous crepitation of the eyelid and orbit is typical. Occasionally, the patient's pupil is dilated and unreactive, and he may have a hyphema.

Orbital cellulitis.Inflammation of the orbital tissues and eyelids causes sudden diplopia. Other findings are eye deviation and pain, purulent drainage, lid edema, chemosis and redness, proptosis, nausea, and a fever.

Orbital tumor.An enlarging orbital tumor can cause diplopia. Proptosis and possibly blurred vision may also occur.

Stroke.Diplopia characterizes stroke when it affects the vertebrobasilar artery. Other signs and symptoms include unilateral motor weakness or paralysis, ataxia, a decreased LOC, dizziness, aphasia, visual field deficits, circumoral numbness, slurred speech, dysphagia, and amnesia.

Thyrotoxicosis.Diplopia occurs when exophthalmos characterizes the disorder. It usually begins in the upper field of gaze because of infiltrative myopathy involving the inferior rectus muscle. It's accompanied by impaired eye movement, excessive tearing, lid edema and, possibly, an inability to close the lids. Other cardinal findings include tachycardia, palpitations, weight loss, diarrhea, tremors, an enlarged thyroid, dyspnea, nervousness, diaphoresis, and heat intolerance.

Transient ischemic attack (TIA).TIA is generally accompanied by diplopia, dizziness, tinnitus, hearing loss, and numbness. It can last for a few seconds or up to 24 hours and may be a warning sign of a future stroke.

Other causes

Eye surgery.Fibrosis associated with eye surgery may restrict eye movement, resulting in diplopia.

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Source: Nursing: Interpreting Signs and Symptoms, 2007

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.

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.

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

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Causes of Vision Impairment

Causes of Vision Impairment (Diseases Database):

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

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

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

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

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

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

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

Alcohol intoxication

Botulism

Brain tumor

Cavernous sinus thrombosis

Diabetes mellitus

Encephalitis

Head injury

Intracranial aneurysm

Multiple sclerosis (MS)

Myasthenia gravis

Ophthalmologic migraine

Orbital blowout fracture

Orbital cellulitis

Orbital tumor

Stroke

Thyrotoxicosis

Transient ischemic attack (TIA)

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Eye surgery

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

Carotid artery aneurysm

Occipital lobe lesion

Parietal lobe lesion

Pituitary tumor

Stroke

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

Chorioretinitis

Macular degeneration

Optic neuritis

Retinal pigmentary degeneration

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

Amaurosis fugax

Cataract

Concussion

Diabetic retinopathy

Endophthalmitis

Glaucoma

Ocular trauma

Optic atrophy

Optic neuritis

Paget’s disease

Pituitary tumor

Retinal artery occlusion (central)

Retinal detachment

Retinal vein occlusion

Rift Valley fever

Senile macular degeneration

Stevens-Johnson syndrome

Temporal arteritis

Vitreous hemorrhage

Other causes

Drugs

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

Alcohol intoxication

Botulism

Brain tumor

Cavernous sinus thrombosis

Diabetes mellitus

Encephalitis

Head injury

Intracranial aneurysm

Multiple sclerosis (MS)

Myasthenia gravis

TREATMENTS &
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Dr. Huntley's
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Diplopia: Differential Diagnosis
(In a Page: Signs and Symptoms)

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

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

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

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

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

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

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

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

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

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

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

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

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

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