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{{CMG}}; '''Associate Editor-In-Chief:''' {{MUT}}, {{MK}}
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== Overview ==
==Overview==
Blurred vision is a common [[ocular]] [[symptom]] which is define as a sudden or gradual loss of clarity or [[sharpness of vision]] and difficulty to see fine details.It can present [[ unilateral]] or [[bilateral]].
==Historical Perspective==
There is not much information regarding the historical perspective of blurred vision.
==Classification==
There is no established system for the classification of blurred vision.
==Pathophysiology==
Blurred vision may result from [[refractive errors]], opacity of structures ([[lens]], [[cornea]], [[vitreous]]), [[retina]] disorder or [[optic nerve]] disease.


Blurry vision is a common ophthalmic symptom where vision becomes less sharp and there is an inability to see small details.Alterations of the optical surfaces or media for which the visual axis travels typically causes blurred vision. Refractive errors, such as near-sightedness and far-sightedness cause the majority of blurred vision complaints. Most vision complaints can be corrected with glasses
==[[blurred vision|Causes]]==
Blurred vision can be  caused by a wide range of eye conditions which include:<REF>Quillen DA. Common causes of vision loss in elderly patients. Am Fam Physician. 1999 Jul;60(1):99-108. PMID: 10414631.</REF> <REF>Flaxman SR, Bourne RRA, Resnikoff S, Ackland P, Braithwaite T, Cicinelli MV, Das A, Jonas JB, Keeffe J, Kempen JH, Leasher J, Limburg H, Naidoo K, Pesudovs K, Silvester A, Stevens GA, Tahhan N, Wong TY, Taylor HR; Vision Loss Expert Group of the Global Burden of Disease Study. Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis. Lancet Glob Health. 2017 Dec;5(12):e1221-e1234. doi: 10.1016/S2214-109X(17)30393-5. Epub 2017 Oct 11. PMID: 29032195.</REF>


==Causes by Organ System==
*[[ Refractive errors]] (most common)
*[[Age-related macular degeneration]]
*[[Cataracts]]
*[[Presbyopia]]
*[[Diabetes retinopathy]]
*[[Glaucoma]]
*[[Corneal abrasion]] or scarring; [[keratitis]]
*[[conjunctivitis]]
*[[Uveitis]]
*[[Iritis]]
*[[Retinal detachment]]
*[[Retinitis]]
*[[Eye trauma]] ([[Hyphema]])
*[[Migraine]]
*[[Malignancy]] and tumor ([[Brain tumor]], [[Lung cancer]] [[metastasis]] <ref> Asteriou C, Konstantinou D, Kleontas A, et al. Blurred vision due to choroidal metastasis as the first manifestation of lung cancer: a case report. World J Surg Oncol. 2010;8:2. Published 2010 Jan 8. doi:10.1186/1477-7819-8-2 </ref>  ,[[Leukemia]])
*[[Optic neuritis]]
*[[Cerebrovascular disease]] ([[TIA]], [[stroke]])
*[[Vasculitis]] ([[Temporal arteritis]],[[SLE]])
*[[High blood pressure]]
*Medication


{|style="width:80%; height:100px" border="1"
==Epidemiology and Demographics==
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
Patients of all age groups may develop blurred vision.By the age of 65,approximately one in three people  has some form of vision-reducing eye disorder .<ref> Ganley JP, Roberts J. Eye conditions and related need for medical care. Vital Health Stat 11. 1983;(228):1-69. PMID: 6880057.</ref>
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |
[[Hypertension]],
[[Neurocardiogenic Syncope]],


|-
==[[Risk Factors]]==
|-bgcolor="LightSteelBlue"
Risk factors in the development of blurred vision include [[Genetic]],[[Nutritional]],[[Family history]],[[Diabetes mellitus]],Age,[[Hyperlipidemia]],[[Hypertension]],Toxins, Exposure to [[ultraviolet light]].<REF>Gupta VB, Rajagopala M, Ravishankar B. Etiopathogenesis of cataract: an appraisal. Indian J Ophthalmol. 2014 Feb;62(2):103-10. doi: 10.4103/0301-4738.121141. PMID: 24618482; PMCID: PMC4005220.</REF> <REF>Hyman L. Epidemiology of eye disease in the elderly. Eye (Lond). 1987;1 ( Pt 2):330-41. doi: 10.1038/eye.1987.53. PMID: 3653439.</REF>
| '''Chemical / poisoning'''
|bgcolor="Beige"|
[[Hawaiian baby woodrose]],
[[Monocrotophos]],
[[Mushroom poisoning]],


|-
==Screening==
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"|
[[3-Quinuclidinyl benzilate]],
[[Acetazolamide]],
[[Acetohexamide (patient information)]],
[[Aldicarb]],
[[Alfuzosin (patient information)]],
[[Alpha-Methyltryptamine]],
[[Amantadine (patient information)]],
[[Amitriptyline (patient information)]],
[[Amitriptyline and Perphenazine (patient information)]],
[[Amphotericin B Injection (patient information)]],
[[Amprenavir (patient information)]],
[[Anastrozole (patient information)]],
[[Anticholinergic]],
[[Antihistamine]],
[[Aripiprazole (patient information)]],
[[Atropine]],
[[Avacor]],
[[Azelastine Ophthalmic (patient information)]],
[[Benzatropine]],
[[Benzodiazepine]],
[[Bepridil (patient information)]],
[[Bimatoprost]],
[[Biperiden]],
[[Bismuth Subsalicylate, Metronidazole, and Tetracycline Combination (patient information)]],
[[Bortezomib (patient information)]],
[[Brimonidine Ophthalmic (patient information)]],
[[Brinzolamide Ophthalmic (patient information)]],
[[Bupivacaine]],
[[Butanethiol]],
[[Carvedilol (patient information)]],
[[Cetuximab Injection (patient information)]],
[[Cevimeline]],
[[Chlordiazepoxide (patient information)]],
[[Chlordiazepoxide and Clidinium Bromide (patient information)]],
[[Chloroquine Phosphate Oral (patient information)]],
[[Chlorpropamide (patient information)]],
[[Clonazepam (patient information)]],
[[Clorazepate (patient information)]],
[[Colistimethate Injection (patient information)]],
[[Cyclizine]],
[[Cyclosporine Ophthalmic (patient information)]],
[[Cytarabine (patient information)]],
[[Dapiprazole Ophthalmic (patient information)]],
[[Darifenacin (patient information)]],
[[Darunavir (patient information)]],
[[Desipramine (patient information)]],
[[Dexmethylphenidate]],
[[Dextromethorphan]],
[[Diazepam]],
[[Diazinon]],
[[Diclofenac Ophthalmic (patient information)]],
[[Dicyclomine (patient information)]],
[[Didanosine (patient information)]],
[[Diethylcathinone]],
[[Diethylpropion (patient information)]],
[[Difluoroethane]],
[[Digoxin]],
[[Diphenhydramine]],
[[Dipivefrin Ophthalmic (patient information)]],
[[Disopyramide (patient information)]],
[[Disulfiram (patient information)]],
[[Dorzolamide and Timolol Ophthalmic (patient information)]],
[[Dosulepin hydrochloride]],
[[Duloxetine]],
[[Enfuvirtide Injection (patient information)]],
[[Ergoloid Mesylates (patient information)]],
[[Estazolam (patient information)]],
[[Ethcathinone]],
[[Ethchlorvynol]],
[[Etodolac (patient information)]],
[[Etonogestrel and Ethinyl Estradiol Vaginal Ring (patient information)]],
[[Exenatide Injection (patient information)]],
[[Fenoprofen (patient information)]],
[[Fexofenadine and Pseudoephedrine (patient information)]],
[[Flavoxate (patient information)]],
[[Fluphenazine (patient information)]],
[[Fosamprenavir (patient information)]],
[[Furosemide (patient information)]],
[[Gabapentin (patient information)]],
[[Gamma-Hydroxybutyric acid]],
[[Gatifloxacin (patient information)]],
[[Gemfibrozil (patient information)]],
[[Glimepiride (patient information)]],
[[Glipizide (patient information)]],
[[Glyburide (patient information)]],
[[Glyburide and Metformin (patient information)]],
[[Glycopyrrolate (patient information)]],
[[Granisetron (patient information)]],
[[Hydrocortisone, Neomycin, and Polymyxin (patient information)]],
[[Hydroxychloroquine (patient information)]],
[[Hyoscyamine (patient information)]],
[[Imipramine (patient information)]],
[[Indapamide (patient information)]],
[[Indomethacin (patient information)]],
[[Infliximab Injection (patient information)]],
[[Insulin Aspart (rDNA Origin) Injection (patient information)]],
[[Insulin Detemir (rDNA Origin) Injection (patient information)]],
[[Insulin Glargine (rDNA origin) Injection (patient information)]],
[[Insulin Glulisine (rDNA origin) Injection (patient information)]],
[[Insulin Human (rDNA Origin) Inhalation (patient information)]],
[[Insulin Injection (patient information)]],
[[Insulin lispro injection (patient information)]],
[[Ipratropium and Albuterol Inhalation (patient information)]],
[[Ipratropium Oral Inhalation (patient information)]],
[[Isosorbide (patient information)]],
[[Ivabradine]],
[[Ketorolac Ophthalmic (patient information)]],
[[Ketotifen Ophthalmic (patient information)]],
[[Lamotrigine (patient information)]],
[[Lanthanum (patient information)]],
[[Levobupivacaine]],
[[Lidocaine Viscous (patient information)]],
[[Lodoxamide Ophthalmic (patient information)]],
[[Lofepramine]],
[[Lomotil]],
[[Lorazepam (patient information)]],
[[Loxapine Oral (patient information)]],
[[Meclofenamate (patient information)]],
[[Medroxyprogesterone (patient information)]],
[[Mefenamic acid]],
[[Megestrol (patient information)]],
[[Meperidine (patient information)]],
[[Metformin (patient information)]],
[[Methocarbamol Oral (patient information)]],
[[Methotrexate (patient information)]],
[[Methylphenidate Transdermal (patient information)]],
[[Metipranolol Ophthalmic (patient information)]],
[[Miconazole Injection (patient information)]],
[[Miglitol (patient information)]],
[[Minocycline Oral (patient information)]],
[[Minoxidil]],
[[Moclobemide]],
[[Moricizine (patient information)]],
[[Morphine Oral (patient information)]],
[[Morphine rectal (patient information)]],
[[Motofen]],
[[Moxifloxacin ophthalmic (patient information)]],
[[Nalbuphine]],
[[Naltrexone (patient information)]],
[[Nateglinide oral (patient information)]],
[[Nedocromil ophthalmic (patient information)]],
[[Nefazodone (patient information)]],
[[Nepafenac ophthalmic (patient information)]],
[[Nitroglycerin ointment (patient information)]],
[[Nitroglycerin skin patches (patient information)]],
[[Nitroglycerin Tablets, Capsules, and Sprays (patient information)]],
[[Norethindrone (patient information)]],
[[Nortriptyline (patient information)]],
[[Ofloxacin ophthalmic (patient information)]],
[[Olanzapine (patient information)]],
[[Olopatadine ophthalmic (patient information)]],
[[Ondansetron injection (patient information)]],
[[Orphenadrine (patient information)]],
[[Oxazepam (patient information)]],
[[Oxcarbazepine]],
[[Oxybutynin (patient information)]],
[[Oxybutynin transdermal (patient information)]],
[[Paliperidone (patient information)]],
[[Peginterferon alfa-2a (patient information)]],
[[Pentamidine Isethionate]],
[[Perphenazine oral (patient information)]],
[[Phentermine]],
[[Phenytoin oral (patient information)]],
[[Pilocarpine ophthalmic (patient information)]],
[[Pioglitazone (patient information)]],
[[Prazepam (patient information)]],
[[Prazosin and polythiazide (patient information)]],
[[Prednisolone ophthalmic (patient information)]],
[[Pregabalin (patient information)]],
[[Primaquine (patient information)]],
[[Primidone (patient information)]],
[[Procyclidine (patient information)]],
[[Prograf]],
[[Promethazine (patient information)]],
[[Propafenone (patient information)]],
[[Propantheline (patient information)]],
[[Protriptyline (patient information)]],
[[Pyridostigmine (patient information)]],
[[Quetiapine (patient information)]],
[[Quinidine Oral (patient information)]],
[[Rasagiline (patient information)]],
[[Repaglinide (patient information)]],
[[Risperidone (patient information)]],
[[Rituximab injection (patient information)]],
[[Rivastigmine (patient information)]],
[[Rogaine (drug)]],
[[Ropivacaine]],
[[Rosiglitazone (patient information)]],
[[Salmeterol oral inhalation (patient information)]],
[[Scopolamine]],
[[Scopolamine patch (patient information)]],
[[Sildenafil (patient information)]],
[[Sodium oxybate (patient information)]],
[[Solifenacin (patient information)]],
[[Spironolactone (patient information)]],
[[Sulindac (patient information)]],
[[Tacrolimus]],
[[Tadalafil (patient information)]],
[[Tamsulosin (patient information)]],
[[Tartrazine]],
[[Tegaserod (patient information)]],
[[Telithromycin (patient information)]],
[[Temazepam (patient information)]],
[[Terazosin (patient information)]],
[[Tetrahydrozoline Ophthalmic (patient information)]],
[[Thioridazine (patient information)]],
[[Thiothixene Oral (patient information)]],
[[Tiludronate (patient information)]],
[[Tiotropium Oral Inhalation (patient information)]],
[[Tipranavir (patient information)]],
[[Tobramycin Ophthalmic (patient information)]],
[[Tolazamide (patient information)]],
[[Tolbutamide (patient information)]],
[[Tranylcypromine (patient information)]],
[[Travoprost Ophthalmic (patient information)]],
[[Trazodone (patient information)]],
[[Triazolam (patient information)]],
[[Tricyclic antidepressant]],
[[Trifluoperazine Oral (patient information)]],
[[Trihexyphenidyl (patient information)]],
[[Trimethobenzamide (patient information)]],
[[Trimipramine (patient information)]],
[[Trospium (patient information)]],
[[Valproic Acid (patient information)]],
[[Vardenafil (patient information)]],
[[Venlafaxine]],
[[Verteporfin]],
[[Voriconazole (patient information)]],
[[Vorinostat (patient information)]],
[[Ziprasidone (patient information)]],
[[Zolpidem (patient information)]],
[[Zopiclone]],


|-
*According to the [[American Diabetes Association’s]] patients with type 1 and type 2 diabetes should have [[comprehensive eye examination]] within 5 years after the onset of diabetes and at the time of diagnosis ,respectively. <ref>Diabetes Care. Introduction. Diabetes Care. 2010 Jan;33 Suppl 1(Suppl 1):S1-2. doi: 10.2337/dc10-S001. PMID: 20042770; PMCID: PMC2797380.</ref> The eye examination should be considered at least annually thereafter.
|-bgcolor="LightSteelBlue"
*There is insufficient evidence to recommend routine screening for [[Glaucoma]]. [[USPSTF]] suggests that patients at increased risk, especially African Americans and older adults, talk to their primary care clinician or eye care specialist for advice about [[glaucoma screening]].
| '''Ear Nose Throat'''
*The USPSTF<REF>Screening for high blood pressure in Adults: Recommendation Statement. Am Fam Physician. 2016 Feb 15;93(4):300-2. PMID: 26926818</ref>. recommends annual screening for adults aged 40 years or older and for those who are at increased risk for [[high blood pressure]].[3] Persons at increased risk include those who have high-normal blood pressure (130 to 139/85 to 89 mm Hg), those who are [[overweight]] or [[obese]], and African Americans. Adults aged 18 to 39 years with [[normal blood pressure]] (<130/85 mm Hg) who do not have other risk factors should be re-screened every 3 to 5 years.
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"|
[[Diabetes insipidus]],
[[Diabetes mellitus]],
[[Graves ophthalmopathy]],
[[Prediabetes]],


|-
==Natural History, [[Complications]], and Prognosis==
|-bgcolor="LightSteelBlue"
Prognosis of blurred vision depends on the underlying cause.
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"|
[[Insulinoma]],


|-
==Diagnosis==
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Hyperviscosity]]


|-
There are no established criteria for the diagnosis of blurred vision.
|-bgcolor="LightSteelBlue"
The diagnosis of blurred vision is based on taking detailed [[medical history]] and eye examination.Patient Should be asked about the onset, duration, [[associated symptoms]] and whether blurred vision is bilateral or unilateral.
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"|
[[Botulism]],
[[Cryptococcosis]],
[[Cysticercosis]],
[[Cytomegalovirus retinitis]],
[[Henipavirus]],


|-
'''History and Symptoms'''  
|-bgcolor="LightSteelBlue"
*The common symptoms which accompany blurred vision include [[Redness of the eye]],[[Eye pain]],[[Epiphoria]],[[Headache]],[[Photophobia]],[[Halos]],[[Nausea]],[[Polydipsi]]a and [[polyuria]],[[Dizziness]],[[Numbness]].
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"|
[[Cerebral arteriovenous malformation]],
[[Hwabyeong]],
[[Machado-Joseph disease]],
[[Migraine]],
[[Multiple sclerosis]],
[[Neuroglycopenia]],
[[Post-concussion syndrome]],
[[Subdural hematoma]],
[[Vertebrobasilar insufficiency]],
Chiasma syndrome,


'''[[Physical Examination]]'''
*[[Eye examination]] of patients with blurred vision includes [[Visual acuity test]],[[Visual fields examination]],[[Slit lamp]],[[Ophthalmoscopy]],[[Tonometry]],[[Angle Test]] ([[Gonioscopy]])


|-
*The presence of sudden[[hemiplegia]] ,[[abnormal gait]],[[ataxia]] and [[dysarthria]] is diagnostic of [[cerebrovascular accident]].
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"|
[[Hypoglycemia]],
[[Ornithine translocase deficiency]],


|-
'''Laboratory Findings'''
|-bgcolor="LightSteelBlue"
*Patients with [[systemic disorders]] should have appropriate testing.
| '''Obstetric/Gynecologic'''
*An elevated concentration of [[blood sugar]] and [[ Hemoglobin A1C ]] is seen in blurred vision due to [[diabetes mellitus]].
|bgcolor="Beige"|
*[[Urinalysis]] and [[renal function]] testing should be considered in patients with [[high blood pressure]].
[[HELLP syndrome]],
*[[Antinuclear antibodies]] and elevated [[ESR]] are associated with [[SLE]] and [[vasculitis]].<ref>Birtane M, Yavuz S, Taştekin N. Laboratory evaluation in rheumatic diseases. World J Methodol. 2017 Mar 26;7(1):1-8. doi: 10.5662/wjm.v7.i1.1. PMID: 28396844; PMCID: PMC5366934.</ref> <ref>Siva C, Larson EC, Barnett M. Rational use of blood tests in the evaluation of rheumatic diseases. Mo Med. 2012 Jan-Feb;109(1):59-63. PMID: 22428449; PMCID: PMC6181688</ref>
*[[CBC]] with differential count and other tests are needed in some cases( [[Leukemia]], [[Multiple myeleoma]])


|-
'''[[CT scan]]'''
|-bgcolor="LightSteelBlue"
*CT scan of brain may be helpful in diagnosis of mass [[occupying lesions]] or [[Ischemic and hemorrhagic stroke]].
| '''Oncologic'''
|bgcolor="Beige"|
[[Intraocular lymphoma]],


|-
'''[[MRI]]'''
|-bgcolor="LightSteelBlue"
*A magnetic resonance imaging (MRI) study of the [[brain]] and [[orbits]] may confirm [[inflammation]] of the [[optic nerve]].
| '''Opthalmologic'''
|bgcolor="Beige"|
[[Acute posterior multifocal placoid pigment epitheliopathy]],
[[Asthenopia]],
[[Astigmatism (eye)]],
[[Central serous retinopathy]],
[[Coats disease]],
[[Convergence insufficiency]],
[[Corneal abrasion]],
[[Diabetic retinopathy]],
[[Fuchs' dystrophy]],
[[Fungal keratitis]],
[[Hyperopia]],
[[Iritis]],
[[Macular degeneration]],
[[Optic neuritis]],
[[Refractive error]],
[[Reiter's Syndrome]],
[[Thygeson's superficial punctate keratopathy]],
[[Uveitis]],
Dry eye, poor tear film,
Extraocular muscle paralysis


==Treatment==
Depends upon the cause, underlying disorders should be addressed.


|-
*Patients with [[refractive errors]] and [[presbyopia]]<ref>Charman WN. Developments in the correction of presbyopia I: spectacle and contact lenses. Ophthalmic Physiol Opt. 2014 Jan;34(1):8-29. doi: 10.1111/opo.12091. Epub 2013 Nov 10. PMID: 24205890.</ref> can be  treated with [[Corrective lenses]]<ref>Sankaridurg P. Contact lenses to slow progression of myopia. Clin Exp Optom. 2017 Sep;100(5):432-437. doi: 10.1111/cxo.12584. Epub 2017 Jul 28. PMID: 28752898.</ref> and [[eyeglasses]]<ref>Shane TS, Knight O, Shi W, Schiffman JC, Alfonso EC, Lee RK. Treating uncorrected refractive error in adults in the developing world with autorefractors and ready-made spectacles. Clin Exp Ophthalmol. 2011 Nov;39(8):729-33. doi: 10.1111/j.1442-9071.2011.02546.x. Epub 2011 Apr 21. PMID: 22050561; PMCID: PMC4139100.</ref>.
|-bgcolor="LightSteelBlue"
*[[Supportive therapy]] for [[hyphema]]<ref>Gragg J, Blair K, Baker MB. Hyphema. [Updated 2020 Dec 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507802/</ref> includes raising the head of the bed, wearing [[eye shield]] and cut back on physical activity.
| '''Overdose / Toxicity'''
*There is no treatment for [[dry macular degeneration]].<ref>Waugh N, Loveman E, Colquitt J, Royle P, Yeong JL, Hoad G, Lois N. Treatments for dry age-related macular degeneration and Stargardt disease: a systematic review. Health Technol Assess. 2018 May;22(27):1-168. doi: 10.3310/hta22270. PMID: 29846169; PMCID: PMC5994642.</ref>Patients with [[wet macular degeneration]] may be treated with [[Anti-VEGF]] medications or [[Photodynamic therapy]] which help stop the growth of new blood vessels.<ref>Hernández-Zimbrón LF, Zamora-Alvarado R, Ochoa-De la Paz L, Velez-Montoya R, Zenteno E, Gulias-Cañizo R, Quiroz-Mercado H, Gonzalez-Salinas R. Age-Related Macular Degeneration: New Paradigms for Treatment and Management of AMD. Oxid Med Cell Longev. 2018 Feb 1;2018:8374647. doi: 10.1155/2018/8374647. PMID: 29484106; PMCID: PMC5816845.</ref>
|bgcolor="Beige"|
===Medical Therapy===
[[Aliskiren (patient information)]],
[[Amiodarone Oral (patient information)]],
[[Atenolol (patient information)]],
[[Benztropine Mesylate Oral (patient information)]],
[[Bisoprolol (patient information)]],
[[Bosentan (patient information)]],
[[Buprenorphine Sublingual and Buprenorphine and Naloxone Sublingual (patient information)]],
[[Buspirone (patient information)]],
[[Carbamazepine (patient information)]],
[[Clitocybe dealbata]],
[[Clomiphene (patient information)]],
[[Deadly nightshade]],
[[Dextroamphetamine and Amphetamine (patient information)]],
[[Dihydroergotamine Injection and Nasal Spray (patient information)]],
[[Doxepin Topical (patient information)]],
[[Eplerenone (patient information)]],
[[Esomeprazole (patient information)]],
[[Fluticasone and Salmeterol Oral Inhalation (patient information)]],
[[Isocarboxazid (patient information)]],
[[Levalbuterol Oral Inhalation (patient information)]],
[[Lidocaine Transdermal (patient information)]],
[[Lisinopril and Hydrochlorothiazide (patient information)]],
[[Meperidine (patient information)]],
[[Morphine Oral (patient information)]],
[[Muscarine]],
[[Niacin]],
[[Olmesartan (patient information)]],
[[Omeprazole (patient information)]],
[[Pamidronate injection (patient information)]],
[[Pergolide (patient information)]],
[[Pimozide (patient information)]],
[[Primaquine (patient information)]],
[[Risperidone (patient information)]],
[[Rivastigmine (patient information)]],
[[Salmeterol oral inhalation (patient information)]],
[[Sulindac (patient information)]],
[[Tamsulosin (patient information)]],
[[Temik]],
[[Tiotropium Oral Inhalation (patient information)]],
[[Topiramate]],
[[Vardenafil (patient information)]],
[[Hypervitaminosis A]],


*Medical therapy of [[diabetic retinopathy]] include direct injections or [[intravitreal]] administration of  [[anti-inflammatory]] and [[antiangiogenesis]] agents([[anti-VEGF]] drugs <ref>Zhao Y, Singh RP. The role of anti-vascular endothelial growth factor (anti-VEGF) in the management of proliferative diabetic retinopathy. Drugs Context. 2018 Aug 13;7:212532. doi: 10.7573/dic.212532. PMID: 30181760; PMCID: PMC6113746.</ref> <ref>Rios A, Lopez-Galvez M, Navarro-Gil R, Verges R. Diabetic Macular Edema Pathophysiology: Vasogenic versus Inflammatory. J Diabetes Res. 2016;2016:2156273. doi: 10.1155/2016/2156273. Epub 2016 Sep 28. PMID: 27761468; PMCID: PMC5059543.</ref>) which are widely used pharmacotherapy to effectively treat [[DR]] and [[diabetic macular edema]] (DME).<ref>Lu L, Jiang Y, Jaganathan R, Hao Y. Current Advances in Pharmacotherapy and Technology for Diabetic Retinopathy: A Systematic Review. J Ophthalmol. 2018 Jan 17;2018:1694187. doi: 10.1155/2018/1694187. Erratum in: J Ophthalmol. 2018 Dec 2;2018:5047142.</ref>
*[[Laser treatment]]  is an option in treatment of [[diabetic retinopathy]].<ref>Wang W, Lo ACY. Diabetic Retinopathy: Pathophysiology and Treatments. Int J Mol Sci. 2018 Jun 20;19(6):1816. doi: 10.3390/ijms19061816. PMID: 29925789; PMCID: PMC6032159.</ref>
*Pharmacologic medical therapy with [[eye drop]]s is recommended among patients with [[Glaucoma]].<ref>Dreer LE, Girkin C, Mansberger SL. Determinants of medication adherence to topical glaucoma therapy. J Glaucoma. 2012 Apr-May;21(4):234-40. doi: 10.1097/IJG.0b013e31821dac86. PMID: 21623223; PMCID: PMC3183317.</ref> <ref>Maier PC, Funk J, Schwarzer G, Antes G, Falck-Ytter YT. Treatment of ocular hypertension and open angle glaucoma: meta-analysis of randomised controlled trials. BMJ. 2005 Jul 16;331(7509):134. doi: 10.1136/bmj.38506.594977.E0. Epub 2005 Jul 1. PMID: 15994659; PMCID: PMC558697.</ref> <ref>Li T, Lindsley K, Rouse B, Hong H, Shi Q, Friedman DS, Wormald R, Dickersin K. Comparative Effectiveness of First-Line Medications for Primary Open-Angle Glaucoma: A Systematic Review and Network Meta-analysis. Ophthalmology. 2016 Jan;123(1):129-40. doi: 10.1016/j.ophtha.2015.09.005. Epub 2015 Oct 31. PMID: 26526633; PMCID: PMC4695285.</ref>
*The mainstay of treatment in infectious cases include a[[ntibacterial]], [[antiviral]] or [[anti parasite]] agents.<ref>Wilhelmus KR. Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis. Cochrane Database Syst Rev. 2015 Jan 9;1:CD002898. doi: 10.1002/14651858.CD002898.pub5. PMID: 25879115; PMCID: PMC4443501.</ref> <ref>Shimomura Y. [Herpes simplex virus latency, reactivation, and a new antiviral therapy for herpetic keratitis]. Nippon Ganka Gakkai Zasshi. 2008 Mar;112(3):247-64; discussion 265. Japanese. PMID: 18411713.</ref> <ref>Ng P, McCluskey PJ. Treatment of ocular toxoplasmosis. Aust Prescr 2002;25:88-90.</ref>
*Patients with [[uveitis]], [[iritis]] and [[optic neuritis]] can be treated with [[corticosteroids]].<ref> Dick AD, Azim M, Forrester JV. Immunosuppressive therapy for chronic uveitis: optimising therapy with steroids and cyclosporin A. Br J Ophthalmol. 1997 Dec;81(12):1107-12. doi: 10.1136/bjo.81.12.1107. PMID: 9497474; PMCID: PMC1722078.</ref> <ref> Babu K, Mahendradas P. Medical management of uveitis - current trends. Indian J Ophthalmol. 2013 Jun;61(6):277-83. doi: 10.4103/0301-4738.114099. PMID: 23803479; PMCID: PMC3744780 </ref> <ref> Morrow SA, Fraser JA, Day C, Bowman D, Rosehart H, Kremenchutzky M, Nicolle M. Effect of Treating Acute Optic Neuritis With Bioequivalent Oral vs Intravenous Corticosteroids: A Randomized Clinical Trial. JAMA Neurol. 2018 Jun 1;75(6):690-696. doi: 10.1001/jamaneurol.2018.0024. PMID: 29507942; PMCID: PMC5885218.</ref> <ref> Morrow SA, Fraser JA, Day C, et al. Effect of Treating Acute Optic Neuritis With Bioequivalent Oral vs Intravenous Corticosteroids: A Randomized Clinical Trial. JAMA Neurol. 2018;75(6):690–696. doi:10.1001/jamaneurol.2018.0024 </ref>
*Patients with [[temporal arteritis]] are treated with high dose of [[corticosteroids]].<ref>Fraser JA, Weyand CM, Newman NJ, Biousse V. The treatment of giant cell arteritis. Rev Neurol Dis. 2008 Summer;5(3):140-52. PMID: 18838954; PMCID: PMC3014829.</ref><ref>Chan CC, Paine M, O'Day J. Steroid management in giant cell arteritis. Br J Ophthalmol. 2001 Sep;85(9):1061-4. doi: 10.1136/bjo.85.9.1061. PMID: 11520757; PMCID: PMC1724128.</ref>
*Treatment of [[high blood pressure]] is medical therapy with [[anti hypertensive medication]]s.


|-
===Surgery===
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"|
[[Panic attack]],


|-
*[[Surgical intervention]] like [[LASIK]] is commonly used to correct a [[refractive error]].
|-bgcolor="LightSteelBlue"
* Laser treatments and surgical procedures for presbyopia haven't yet been well studied .<ref>InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. How can presbyopia be corrected? [Updated 2020 Jun 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK423827/</ref>
| '''Pulmonary'''
*Surgery is the mainstay of treatment for [[cataract]] and [[retinal detachment]].
|bgcolor="Beige"| No underlying causes
*[[Vitrectomy]] is used in treatment of [[Diabetic retinopathy]].<ref> Oellers P, Mahmoud TH. Surgery for Proliferative Diabetic Retinopathy: New Tips and Tricks. J Ophthalmic Vis Res. 2016 Jan-Mar;11(1):93-9. doi: 10.4103/2008-322X.180697. PMID: 27195092; PMCID: PMC4860995.</ref>
|-
*Different types of surgeries  to treat [[glaucoma]] are [[Trabeculoplasty]] ,[[Iridotomy]] and [[Trabeculectomy]].<ref>Garg A, Gazzard G. Selective laser trabeculoplasty: past, present, and future. Eye (Lond). 2018 May;32(5):863-876. doi: 10.1038/eye.2017.273. Epub 2018 Jan 5. Erratum in: Eye (Lond). 2020 Aug;34(8):1487. PMID: 29303146; PMCID: PMC5944654.</ref>
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"|
[[Temporal arteritis]],
[[Myasthenia]]


|-
===[[Primary Prevention]]===
|-bgcolor="LightSteelBlue"
Preventive measures in developing [[diabetic retinopathy]] include a [[healthy lifestyle]], controlling hypertension, stringent [[lipid control]] and periodic [[ophthalmic examinations]]. <ref>Koura MR, Khairy AE, Abdel-Aal NM, Mohamed HF, Amin GA, Sabra AY. The role of primary health care in patient education for diabetes control. J Egypt Public Health Assoc. 2001;76(3-4):241-64. PMID: 17216945.</ref>. Studies have confirmed an increased risk of AMD among smokers; so,  smokers should be encouraged to quit.<ref>Cheng AC, Pang CP, Leung AT, Chua JK, Fan DS, Lam DS. The association between cigarette smoking and ocular diseases. Hong Kong Med J. 2000 Jun;6(2):195-202. PMID: 10895144</ref>
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"|
[[Traumatic brain injury]],


|-
===[[Secondary Prevention]]===
|-bgcolor="LightSteelBlue"
*Effective measures for the[[ secondary prevention]] of blurred vision due to [[refractive errors]] is early detection and treatment of [[refractive errors]] in [[school vision programs]].<ref>Evans JR, Morjaria P, Powell C. Vision screening for correctable visual acuity deficits in school-age children and adolescents. Cochrane Database Syst Rev. 2018 Feb 15;2(2):CD005023. doi: 10.1002/14651858.CD005023.pub3. PMID: 29446439; PMCID: PMC6491194</ref>
| '''Urologic'''
*Secondary Prevention of [[Atherosclerotic Cardiovascular]] Disease includes [[lifestyle interventions]],[[weight management]],[[anti hypertensive agents]], [[stain therapy]],[[Anti- platelet]] Therapy,[[diabetes treatment]] and [[Cigarette/Tobacco Cessation]].
|bgcolor="Beige"| [[Reiter's Syndrome]],


|-
==References==
|-bgcolor="LightSteelBlue"
{{reflist|2}}
| '''Miscellaneous'''
[[Category:Ophthalmology]]
|bgcolor="Beige"|
[[Category:Neurology]]
[[Anesthesia]],
[[Category:Symptoms]]
[[Computer vision syndrome]],
[[Category:Signs and symptoms]]
[[Orthostatic hypotension]],
[[Category: Rheumatology]]
[[Carbon dioxide narcosis]],


|-
{{WikiDoc Help Menu}}
|}
{{WikiDoc Sources}}
 
==Causes in Alphabetical Order<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>==


{{MultiCol}}
*[[3-Quinuclidinyl benzilate]]
*[[Acetazolamide]]
*[[Acetohexamide ]]
*[[Acute angle-closure glaucoma]]
*[[Acute posterior multifocal placoid pigment epitheliopathy]]
*[[Aldicarb]]
*[[Alfuzosin ]]
*[[Aliskiren ]]
*[[Alpha-Methyltryptamine]]
*[[Amantadine ]]
*[[Amiodarone Oral ]]
*[[Amitriptyline ]]
*[[Amphotericin B Injection ]]
*[[Amprenavir ]]
*[[Anastrozole ]]
*[[Anesthesia]]
*[[Anticholinergic]]
*[[Antihistamine]]
*[[Aripiprazole ]]
*[[Asthenopia]]
*[[Astigmatism (eye)]]
*[[Atenolol ]]
*[[Atropine]]
*[[Avacor]]
*[[Azelastine Ophthalmic ]]
*[[Belladonna Alkaloid Combinations and Phenobarbital ]]
*[[Benzatropine]]
*[[Benzodiazepine]]
*[[Benztropine Mesylate Oral ]]
*[[Bepridil ]]
*[[Bimatoprost]]
*[[Biperiden]]
*[[Bismuth Subsalicylate, Metronidazole, and Tetracycline Combination ]]
*[[Bisoprolol ]]
*[[Bortezomib ]]
*[[Bosentan ]]
*[[Botulism]]
*[[Brimonidine Ophthalmic ]]
*[[Brinzolamide Ophthalmic ]]
*[[Bupivacaine]]
*[[Buprenorphine Sublingual and Buprenorphine and Naloxone Sublingual ]]
*[[Buspirone ]]
*[[Butanethiol]]
*[[Carbamazepine ]]
*[[Carbon dioxide narcosis]]
*[[Carvedilol ]]
*[[Cataracts]]
*[[Central serous retinopathy]]
*[[Cerebral arteriovenous malformation]]
*[[Cetuximab Injection ]]
*[[Cevimeline]]
*Chiasma syndrome
*[[Chlordiazepoxide ]]
*[[Chloroquine]]
*[[Chlorpropamide ]]
*[[Clitocybe dealbata]]
*[[Clomiphene ]]
*[[Clonazepam ]]
*[[Clorazepate ]]
*[[Coats disease]]
*[[Colistimethate Injection ]]
*[[Computer vision syndrome]]
*Congenital disorders
*[[Conjunctivitis]]
*[[Convergence insufficiency]]
*[[Corneal abrasion]]
*[[Corneal irregularity or abrasion]]
*[[Cryptococcosis]]
*[[Cyclizine]]
*[[Cyclosporine Ophthalmic ]]
*[[Cysticercosis]]
*[[Cytarabine ]]
*[[Cytomegalovirus retinitis]]
*[[Dapiprazole Ophthalmic ]]
*[[Darifenacin ]]
*[[Darunavir ]]
*[[Deadly nightshade]]
*[[Desipramine ]]
*[[Dexmethylphenidate]]
*[[Dextroamphetamine and Amphetamine ]]
*[[Dextromethorphan]]
*[[Diabetes insipidus]]
*[[Diabetes mellitus]]
*[[Diabetic retinopathy]]
*[[Diazepam]]
*[[Diazinon]]
*[[Diclofenac Ophthalmic ]]
*[[Dicyclomine ]]
*[[Didanosine ]]
*[[Diethylcathinone]]
*[[Diethylpropion ]]
*[[Difluoroethane]]
*[[Digoxin]]
*[[Dihydroergotamine Injection and Nasal Spray ]]
*[[Diphenhydramine]]
*[[Dipivefrin Ophthalmic ]]
*[[Disopyramide ]]
*[[Disulfiram ]]
*[[Dorzolamide and Timolol Ophthalmic ]]
*[[Dosulepin hydrochloride]]
*[[Doxepin ]]
*Dry eye, poor tear film
*[[Duloxetine]]
*[[Enfuvirtide Injection ]]
*[[Eplerenone ]]
*[[Ergoloid Mesylates ]]
*[[Esomeprazole ]]
*[[Estazolam ]]
*[[Ethcathinone]]
*[[Ethchlorvynol]]
*[[Etodolac ]]
*[[Exenatide Injection ]]
{{ColBreak}}
*Extraocular muscle paralysis
*[[Fatigue]]
*[[Fenoprofen ]]
*[[Fexofenadine and Pseudoephedrine ]]
*[[Flavoxate ]]
*[[Fluphenazine ]]
*[[Fluticasone and Salmeterol Oral Inhalation ]]
*[[Fosamprenavir ]]
*[[Fuchs' dystrophy]]
*[[Fungal keratitis]]
*[[Furosemide ]]
*[[Gabapentin ]]
*[[Gamma-Hydroxybutyric acid]]
*[[Gatifloxacin ]]
*[[Gemfibrozil ]]
*[[Glaucoma]]
*[[Glimepiride ]]
*[[Glipizide ]]
*[[Glyburide ]]
*[[Glycopyrrolate ]]
*[[Granisetron ]]
*[[Graves ophthalmopathy]]
*[[Guanfacine]]
*[[H1 antihistamine]]
*[[Hawaiian baby woodrose]]
*[[Head trauma]]
*[[HELLP syndrome]]
*[[Henipavirus]]
*[[Homatropine]]
*[[Hwabyeong]]
*[[Hydrocortisone, Neomycin, and Polymyxin ]]
*[[Hydroxychloroquine ]]
*[[Hyoscyamine ]]
*[[Hyperbaric medicine]]
*[[Hypercoagulation]]
*[[Hyperglycemia]]
*[[Hyperopia]]
*[[Hypertension]]
*[[Hyperviscosity]]
*[[Hypervitaminosis A]]
*[[Hypoglycemia]]
*[[Imipramine ]]
*[[Indapamide ]]
*[[Indometacin]]
*[[Indomethacin ]]
*Infection, inflammation or injury of cornea
*[[Infliximab Injection ]]
*[[Insulin Aspart (rDNA Origin) Injection ]]
*Insulin lispro injection
*[[Insulinoma]]
*[[Intraocular lymphoma]]
*[[Ipratropium Oral Inhalation ]]
*[[Iritis]]
*[[Isocarboxazid ]]
*[[Isosorbide ]]
*[[Ivabradine]]
*[[Ketorolac Ophthalmic ]]
*[[Ketotifen Ophthalmic ]]
*[[Lamotrigine ]]
*[[Lanthanum ]]
*[[Levalbuterol Oral Inhalation ]]
*[[Levobupivacaine]]
*[[Lidocaine Transdermal ]]
*[[Lisinopril and Hydrochlorothiazide ]]
*[[Lodoxamide Ophthalmic ]]
*[[Lofepramine]]
*[[Lomotil]]
*[[Loprazolam]]
*[[Lorazepam ]]
*[[Loxapine Oral ]]
*[[Machado-Joseph disease]]
*[[Macular degeneration]]
*Macular disease
*[[Meclofenamate ]]
*[[Medroxyprogesterone ]]
*[[Mefenamic acid]]
*[[Megestrol ]]
*[[Meperidine ]]
*[[Metformin ]]
*[[Methocarbamol Oral ]]
*[[Methotrexate ]]
*[[Methylphenidate Transdermal ]]
*[[Metipranolol Ophthalmic ]]
*[[Miconazole Injection ]]
*[[Miglitol ]]
*[[Migraine]]
*[[Minocycline Oral ]]
*[[Minoxidil]]
*[[Moclobemide]]
*[[Monocrotophos]]
*[[Moricizine ]]
*[[Morphine Oral ]]
*[[Motofen]]
*[[Moxifloxacin ophthalmic ]]
*[[Multiple sclerosis]]
*[[Muscarine]]
*[[Mushroom poisoning]]
*[[Myasthenia]]
*[[Nalbuphine]]
*[[Naltrexone ]]
*[[Nateglinide oral ]]
*[[Nedocromil ophthalmic ]]
*[[Nefazodone ]]
*[[Nepafenac ophthalmic ]]
*[[Neurocardiogenic Syncope]]
*[[Neuroglycopenia]]
*[[Niacin]]
*[[Nitroglycerin ointment ]]
*[[Norethindrone ]]
*[[Nortriptyline ]]
*Ocular media opacity
*[[Oculotect]]
*[[Ofloxacin ophthalmic ]]
*[[Olanzapine ]]
{{ColBreak}}
*[[Olmesartan ]]
*[[Olopatadine ophthalmic ]]
*[[Omeprazole ]]
*[[Ondansetron injection ]]
*[[Optic neuritis]]
*[[Ornithine translocase deficiency]]
*[[Orphenadrine ]]
*[[Orthostatic hypotension]]
*[[Orthostatic intolerance]]
*[[Oxazepam ]]
*[[Oxcarbazepine]]
*[[Oxybutynin ]]
*[[Paliperidone ]]
*[[Pamidronate injection ]]
*[[Panic disorder]]
*[[Parasites]]
*[[Peginterferon alfa-2a ]]
*[[Pentamidine Isethionate Injection ]]
*[[Pergolide ]]
*[[Periphlebitis retinae]]
*[[Perphenazine oral ]]
*[[Phentermine]]
*[[Phenytoin oral ]]
*[[Pilocarpine ophthalmic ]]
*[[Pimozide ]]
*[[Pioglitazone ]]
*[[PMA]]
*[[Post-concussion syndrome]]
*[[Prazepam ]]
*[[Prazosin and polythiazide ]]
*[[Prediabetes]]
*[[Prednisolone]]
*[[Pregabalin ]]
*[[Presbyopia]]
*[[Primaquine ]]
*[[Primidone ]]
*[[Procyclidine ]]
*[[Prograf]]
*Prolonged exposure to the outdoors
*[[Promethazine ]]
*[[Propafenone ]]
*[[Propantheline ]]
*[[Protriptyline ]]
*[[Pyridostigmine ]]
*[[Quetiapine ]]
*[[Quinidine Oral ]]
*[[Rasagiline ]]
*[[Refractive error]]
*[[Reiter's Syndrome]]
*[[Repaglinide ]]
*[[Retinal detachment]]
*[[Risperidone ]]
*[[Rituximab injection ]]
*[[Rivastigmine ]]
*[[Rogaine (drug)]]
*[[Ropivacaine]]
*[[Rosiglitazone ]]
*[[Salmeterol oral inhalation ]]
*[[Scopolamine]]
*Seizure disorders
*[[Sildenafil ]]
*[[Sleep deprivation]]
*[[Sodium oxybate ]]
*[[Solifenacin ]]
*[[Spironolactone ]]
*[[SSRI discontinuation syndrome]]
*[[Subdural hematoma]]
*[[Sulindac ]]
*[[Tacrolimus]]
*[[Tadalafil ]]
*[[Tamsulosin ]]
*[[Tartrazine]]
*[[Tegaserod ]]
*[[Telithromycin ]]
*[[Temazepam ]]
*[[Temik]]
*[[Temporal arteritis]]
*[[Terazosin ]]
*[[Tetrahydrozoline Ophthalmic ]]
*[[Thioridazine ]]
*[[Thiothixene Oral ]]
*[[Thygeson's superficial punctate keratopathy]]
*[[Tiludronate ]]
*[[Tiotropium Oral Inhalation ]]
*[[Tipranavir ]]
*[[Tobramycin Ophthalmic ]]
*[[Tolazamide ]]
*[[Tolbutamide ]]
*[[Topiramate]]
*[[Trachoma]]
*[[Tranylcypromine ]]
*[[Traumatic brain injury]]
*[[Travoprost Ophthalmic ]]
*[[Trazodone ]]
*[[Triazolam ]]
*[[Tricyclic antidepressant]]
*[[Trifluoperazine Oral ]]
*[[Trihexyphenidyl ]]
*[[Trimethobenzamide ]]
*[[Trimipramine ]]
*[[Trospium ]]
*[[Uveitis]]
*[[Valproic Acid ]]
*[[Vardenafil ]]
*Vasculopathy
*[[Vertebrobasilar insufficiency]]
*[[Verteporfin]]
*[[Viral]]
*[[Voriconazole ]]
*[[Vorinostat ]]
*[[Ziprasidone ]]
*[[Zolpidem ]]
*[[Zopiclone]]
{{EndMultiCol}}


== Diagnosis ==
=== History and Symptoms ===
* Detailed history important, including the following:
*:* Duration of symptoms
*:* Progression of symptoms
*:* Near or far sighted
*:* Permanent or transient
*:* Binocular or uniocular
* Past medical history
* Associated symptoms


=== Physical Examination ===


==== Eyes ====
* Complete ophthalmologic exam including:
*:* Slit lamp examination
*:* Dilated fundus exam
*:* Visual acuity
*:* Improvement of vision with pinhole
*:* Dry or irritated eyes


==== Ear Nose and Throat ====
Palpate the temporal area to determine if there is pain in the temporal area to suggest [[temporal arteritis]]


* Neurologic exam if necessary


=== Laboratory Findings ===
* [[Complete blood count]] ([[CBC]])
* Fasting or random [[blood sugar]]
*:* Repeat [[glucose]] (if initial [[glucose]] is elevated)
* [[Prothrombin time]] (PT)
* [[Partial thromboplastin time]] (PTT)
*[[Erythrocyte sedimentation rate]] to rule out [[temporal arteritis]]


=== Other Imaging Findings ===
* [[Electroencephalogram]] ([[EEG]]) if seizures are suspected


== Treatment ==
{| class="wikitable"
|+[blurred vision causes]
|-
!Cause of blurred vision!!Unilateral!!Bilateral!!Eye pain!!Onset!!Associated symptoms!
|-
|'''[[Refractive errors]]'''||+||+||-||gradual||[[headache]],[[head tilt]], rubbing eye
|-
|'''[[Glaucoma]]'''||+|| ||+|| ||[[red eye]], [[Headache]], [[Nausea]]
|-
|'''[[Age-related macular degeneration]]'''|| ||+||-||gradual||extra sensitivity to glare
|-
|'''[[Cataracts]]'''||+||+||-||gradual|| loss of [[Night Vision]], [[halos]]
|-
|'''[[Diabetes retinopathy]]'''|| ||+||-||gradual||[[Polyuria]], [[Polydipsia]], [[polyphagia]]
|-
|'''[[Presbyopia]]'''|| +||+ || -|| gradual||
|-
|'''[[keratitis]]'''||+|| ||+||sudden ||[[eye redness]],[[photophobia]],A feeling that something is in the eye
|-
|'''[[conjunctivitis]]'''||+||+||+/-|| sudden|| [[eye redness]][[,photophobia]],A feeling that something is in the eye,Increased [[lacrimation ]]
|-
|'''[[Uveitis]]'''||+|| ||+||sudden || [[eye redness]], [[floaters]],[[photophobia]],Increased [[lacrimation ]]
|-
|'''[[Iritis]]'''||+|| ||+||sudden ||[[light sensitivity]]
|-
|'''[[Retinal detachment]]'''||+|| ||-||sudden||curtain
|-
|'''[[Infectious Retinitis]]'''||+||+||+/-||gradual ||Loss of [[night vision]],[[tunnel vision]]
|-
|'''[[Eye trauma]]''' ([[Hyphema]])||+|| ||+||sudden||bleeding in the front of the eye,[[light sensitivity]]


=== Medical Therapy ===
|-
* Treat underlying pathologies
|'''[[Vitreous hemorrhage]]'''||+|| ||- ||sudden||[[Floaters]]
* For dry eyes, lubrication
|-
* Appropriate treatment for hyperviscosity
|'''[[ Lung cancer metastasis ]]'''||+||+||- || ||depends on the site of [[metastasis]]
* Antiseizure prophylaxis (seizure disorders)
|-
|'''[[Migraine]]'''||+||+||- ||sudden||[[aura]],[[headache]] [[,nausea]]


=== Surgery and Device Based Therapy ===
|-
* Glasses or contact lenses for blurred vision due to refractive errors
|'''[[ Central retinal artery occlusion ]]'''||+|| ||-||sudden||[[complete sight loss]]
* Possible surgical repair for retinal detachment
* Temporal artery biopsy may be needed


== References ==
|-
{{reflist|2}}
|'''[[ Central retinal vein occlusion ]]'''||+|| ||-||sudden||[[complete sight loss]]
|-
|'''[[Brain tumor]]'''||+||+|| -|| || [[headache]], [[focal neurological symptoms]]
|-
|'''[[Optic neuritis]]'''||+|| ||+||sudden/gradual || [[Flashing lights]]
|-
|'''[[stroke]]'''|| ||+||-|| sudden|| [[ataxia]], [[hemiplegia]], [[dysarthria]]


[[Category:Ophthalmology]]
|-
[[Category:Neurology]]
|'''[[Papilloedema]]'''|| ||+||-||sudden||[[Headache]],[[nausea]]
[[Category:Signs and symptoms]]
|-
[[Category:Rheumatology]]
|'''[[Temporal arteritis]]'''||Mostly|| || -||sudden||[[Amaurosis fugax]], [[headache]],[[Diplopia]]
 
|-
{{WikiDoc Help Menu}}
|'''[[High blood pressure]]'''||+||+|| - ||sudden|||[[headache]],[[nausea]]
{{WS}}
|-
|'''[[Orbital cellulitis]]'''||+|| || + ||sudden|||[[ Swollen eye ]],[[red eyes]], [[fever]]
|-
|'''drugs-induced''' || ||+||-|| || symptoms related to the medication
|-
|'''[[Sjögren's syndrome]]'''|||| +||-||gradual||[[Eye dryness]], redness,[[Burning eyes]]
|}

Latest revision as of 16:39, 24 June 2021


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief:

Overview

Blurred vision is a common ocular symptom which is define as a sudden or gradual loss of clarity or sharpness of vision and difficulty to see fine details.It can present unilateral or bilateral.

Historical Perspective

There is not much information regarding the historical perspective of blurred vision.

Classification

There is no established system for the classification of blurred vision.

Pathophysiology

Blurred vision may result from refractive errors, opacity of structures (lens, cornea, vitreous), retina disorder or optic nerve disease.

Causes

Blurred vision can be caused by a wide range of eye conditions which include:[1] [2]

Epidemiology and Demographics

Patients of all age groups may develop blurred vision.By the age of 65,approximately one in three people has some form of vision-reducing eye disorder .[4]

Risk Factors

Risk factors in the development of blurred vision include Genetic,Nutritional,Family history,Diabetes mellitus,Age,Hyperlipidemia,Hypertension,Toxins, Exposure to ultraviolet light.[5] [6]

Screening

  • According to the American Diabetes Association’s patients with type 1 and type 2 diabetes should have comprehensive eye examination within 5 years after the onset of diabetes and at the time of diagnosis ,respectively. [7] The eye examination should be considered at least annually thereafter.
  • There is insufficient evidence to recommend routine screening for Glaucoma. USPSTF suggests that patients at increased risk, especially African Americans and older adults, talk to their primary care clinician or eye care specialist for advice about glaucoma screening.
  • The USPSTF[8]. recommends annual screening for adults aged 40 years or older and for those who are at increased risk for high blood pressure.[3] Persons at increased risk include those who have high-normal blood pressure (130 to 139/85 to 89 mm Hg), those who are overweight or obese, and African Americans. Adults aged 18 to 39 years with normal blood pressure (<130/85 mm Hg) who do not have other risk factors should be re-screened every 3 to 5 years.

Natural History, Complications, and Prognosis

Prognosis of blurred vision depends on the underlying cause.

Diagnosis

There are no established criteria for the diagnosis of blurred vision. The diagnosis of blurred vision is based on taking detailed medical history and eye examination.Patient Should be asked about the onset, duration, associated symptoms and whether blurred vision is bilateral or unilateral.

History and Symptoms

Physical Examination

Laboratory Findings

CT scan

MRI

Treatment

Depends upon the cause, underlying disorders should be addressed.

Medical Therapy

Surgery

Primary Prevention

Preventive measures in developing diabetic retinopathy include a healthy lifestyle, controlling hypertension, stringent lipid control and periodic ophthalmic examinations. [36]. Studies have confirmed an increased risk of AMD among smokers; so, smokers should be encouraged to quit.[37]

Secondary Prevention

References

  1. ↑ Quillen DA. Common causes of vision loss in elderly patients. Am Fam Physician. 1999 Jul;60(1):99-108. PMID: 10414631.
  2. ↑ Flaxman SR, Bourne RRA, Resnikoff S, Ackland P, Braithwaite T, Cicinelli MV, Das A, Jonas JB, Keeffe J, Kempen JH, Leasher J, Limburg H, Naidoo K, Pesudovs K, Silvester A, Stevens GA, Tahhan N, Wong TY, Taylor HR; Vision Loss Expert Group of the Global Burden of Disease Study. Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis. Lancet Glob Health. 2017 Dec;5(12):e1221-e1234. doi: 10.1016/S2214-109X(17)30393-5. Epub 2017 Oct 11. PMID: 29032195.
  3. ↑ Asteriou C, Konstantinou D, Kleontas A, et al. Blurred vision due to choroidal metastasis as the first manifestation of lung cancer: a case report. World J Surg Oncol. 2010;8:2. Published 2010 Jan 8. doi:10.1186/1477-7819-8-2
  4. ↑ Ganley JP, Roberts J. Eye conditions and related need for medical care. Vital Health Stat 11. 1983;(228):1-69. PMID: 6880057.
  5. ↑ Gupta VB, Rajagopala M, Ravishankar B. Etiopathogenesis of cataract: an appraisal. Indian J Ophthalmol. 2014 Feb;62(2):103-10. doi: 10.4103/0301-4738.121141. PMID: 24618482; PMCID: PMC4005220.
  6. ↑ Hyman L. Epidemiology of eye disease in the elderly. Eye (Lond). 1987;1 ( Pt 2):330-41. doi: 10.1038/eye.1987.53. PMID: 3653439.
  7. ↑ Diabetes Care. Introduction. Diabetes Care. 2010 Jan;33 Suppl 1(Suppl 1):S1-2. doi: 10.2337/dc10-S001. PMID: 20042770; PMCID: PMC2797380.
  8. ↑ Screening for high blood pressure in Adults: Recommendation Statement. Am Fam Physician. 2016 Feb 15;93(4):300-2. PMID: 26926818
  9. ↑ Birtane M, Yavuz S, Taştekin N. Laboratory evaluation in rheumatic diseases. World J Methodol. 2017 Mar 26;7(1):1-8. doi: 10.5662/wjm.v7.i1.1. PMID: 28396844; PMCID: PMC5366934.
  10. ↑ Siva C, Larson EC, Barnett M. Rational use of blood tests in the evaluation of rheumatic diseases. Mo Med. 2012 Jan-Feb;109(1):59-63. PMID: 22428449; PMCID: PMC6181688
  11. ↑ Charman WN. Developments in the correction of presbyopia I: spectacle and contact lenses. Ophthalmic Physiol Opt. 2014 Jan;34(1):8-29. doi: 10.1111/opo.12091. Epub 2013 Nov 10. PMID: 24205890.
  12. ↑ Sankaridurg P. Contact lenses to slow progression of myopia. Clin Exp Optom. 2017 Sep;100(5):432-437. doi: 10.1111/cxo.12584. Epub 2017 Jul 28. PMID: 28752898.
  13. ↑ Shane TS, Knight O, Shi W, Schiffman JC, Alfonso EC, Lee RK. Treating uncorrected refractive error in adults in the developing world with autorefractors and ready-made spectacles. Clin Exp Ophthalmol. 2011 Nov;39(8):729-33. doi: 10.1111/j.1442-9071.2011.02546.x. Epub 2011 Apr 21. PMID: 22050561; PMCID: PMC4139100.
  14. ↑ Gragg J, Blair K, Baker MB. Hyphema. [Updated 2020 Dec 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507802/
  15. ↑ Waugh N, Loveman E, Colquitt J, Royle P, Yeong JL, Hoad G, Lois N. Treatments for dry age-related macular degeneration and Stargardt disease: a systematic review. Health Technol Assess. 2018 May;22(27):1-168. doi: 10.3310/hta22270. PMID: 29846169; PMCID: PMC5994642.
  16. ↑ Hernández-Zimbrón LF, Zamora-Alvarado R, Ochoa-De la Paz L, Velez-Montoya R, Zenteno E, Gulias-Cañizo R, Quiroz-Mercado H, Gonzalez-Salinas R. Age-Related Macular Degeneration: New Paradigms for Treatment and Management of AMD. Oxid Med Cell Longev. 2018 Feb 1;2018:8374647. doi: 10.1155/2018/8374647. PMID: 29484106; PMCID: PMC5816845.
  17. ↑ Zhao Y, Singh RP. The role of anti-vascular endothelial growth factor (anti-VEGF) in the management of proliferative diabetic retinopathy. Drugs Context. 2018 Aug 13;7:212532. doi: 10.7573/dic.212532. PMID: 30181760; PMCID: PMC6113746.
  18. ↑ Rios A, Lopez-Galvez M, Navarro-Gil R, Verges R. Diabetic Macular Edema Pathophysiology: Vasogenic versus Inflammatory. J Diabetes Res. 2016;2016:2156273. doi: 10.1155/2016/2156273. Epub 2016 Sep 28. PMID: 27761468; PMCID: PMC5059543.
  19. ↑ Lu L, Jiang Y, Jaganathan R, Hao Y. Current Advances in Pharmacotherapy and Technology for Diabetic Retinopathy: A Systematic Review. J Ophthalmol. 2018 Jan 17;2018:1694187. doi: 10.1155/2018/1694187. Erratum in: J Ophthalmol. 2018 Dec 2;2018:5047142.
  20. ↑ Wang W, Lo ACY. Diabetic Retinopathy: Pathophysiology and Treatments. Int J Mol Sci. 2018 Jun 20;19(6):1816. doi: 10.3390/ijms19061816. PMID: 29925789; PMCID: PMC6032159.
  21. ↑ Dreer LE, Girkin C, Mansberger SL. Determinants of medication adherence to topical glaucoma therapy. J Glaucoma. 2012 Apr-May;21(4):234-40. doi: 10.1097/IJG.0b013e31821dac86. PMID: 21623223; PMCID: PMC3183317.
  22. ↑ Maier PC, Funk J, Schwarzer G, Antes G, Falck-Ytter YT. Treatment of ocular hypertension and open angle glaucoma: meta-analysis of randomised controlled trials. BMJ. 2005 Jul 16;331(7509):134. doi: 10.1136/bmj.38506.594977.E0. Epub 2005 Jul 1. PMID: 15994659; PMCID: PMC558697.
  23. ↑ Li T, Lindsley K, Rouse B, Hong H, Shi Q, Friedman DS, Wormald R, Dickersin K. Comparative Effectiveness of First-Line Medications for Primary Open-Angle Glaucoma: A Systematic Review and Network Meta-analysis. Ophthalmology. 2016 Jan;123(1):129-40. doi: 10.1016/j.ophtha.2015.09.005. Epub 2015 Oct 31. PMID: 26526633; PMCID: PMC4695285.
  24. ↑ Wilhelmus KR. Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis. Cochrane Database Syst Rev. 2015 Jan 9;1:CD002898. doi: 10.1002/14651858.CD002898.pub5. PMID: 25879115; PMCID: PMC4443501.
  25. ↑ Shimomura Y. [Herpes simplex virus latency, reactivation, and a new antiviral therapy for herpetic keratitis]. Nippon Ganka Gakkai Zasshi. 2008 Mar;112(3):247-64; discussion 265. Japanese. PMID: 18411713.
  26. ↑ Ng P, McCluskey PJ. Treatment of ocular toxoplasmosis. Aust Prescr 2002;25:88-90.
  27. ↑ Dick AD, Azim M, Forrester JV. Immunosuppressive therapy for chronic uveitis: optimising therapy with steroids and cyclosporin A. Br J Ophthalmol. 1997 Dec;81(12):1107-12. doi: 10.1136/bjo.81.12.1107. PMID: 9497474; PMCID: PMC1722078.
  28. ↑ Babu K, Mahendradas P. Medical management of uveitis - current trends. Indian J Ophthalmol. 2013 Jun;61(6):277-83. doi: 10.4103/0301-4738.114099. PMID: 23803479; PMCID: PMC3744780
  29. ↑ Morrow SA, Fraser JA, Day C, Bowman D, Rosehart H, Kremenchutzky M, Nicolle M. Effect of Treating Acute Optic Neuritis With Bioequivalent Oral vs Intravenous Corticosteroids: A Randomized Clinical Trial. JAMA Neurol. 2018 Jun 1;75(6):690-696. doi: 10.1001/jamaneurol.2018.0024. PMID: 29507942; PMCID: PMC5885218.
  30. ↑ Morrow SA, Fraser JA, Day C, et al. Effect of Treating Acute Optic Neuritis With Bioequivalent Oral vs Intravenous Corticosteroids: A Randomized Clinical Trial. JAMA Neurol. 2018;75(6):690–696. doi:10.1001/jamaneurol.2018.0024
  31. ↑ Fraser JA, Weyand CM, Newman NJ, Biousse V. The treatment of giant cell arteritis. Rev Neurol Dis. 2008 Summer;5(3):140-52. PMID: 18838954; PMCID: PMC3014829.
  32. ↑ Chan CC, Paine M, O'Day J. Steroid management in giant cell arteritis. Br J Ophthalmol. 2001 Sep;85(9):1061-4. doi: 10.1136/bjo.85.9.1061. PMID: 11520757; PMCID: PMC1724128.
  33. ↑ InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. How can presbyopia be corrected? [Updated 2020 Jun 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK423827/
  34. ↑ Oellers P, Mahmoud TH. Surgery for Proliferative Diabetic Retinopathy: New Tips and Tricks. J Ophthalmic Vis Res. 2016 Jan-Mar;11(1):93-9. doi: 10.4103/2008-322X.180697. PMID: 27195092; PMCID: PMC4860995.
  35. ↑ Garg A, Gazzard G. Selective laser trabeculoplasty: past, present, and future. Eye (Lond). 2018 May;32(5):863-876. doi: 10.1038/eye.2017.273. Epub 2018 Jan 5. Erratum in: Eye (Lond). 2020 Aug;34(8):1487. PMID: 29303146; PMCID: PMC5944654.
  36. ↑ Koura MR, Khairy AE, Abdel-Aal NM, Mohamed HF, Amin GA, Sabra AY. The role of primary health care in patient education for diabetes control. J Egypt Public Health Assoc. 2001;76(3-4):241-64. PMID: 17216945.
  37. ↑ Cheng AC, Pang CP, Leung AT, Chua JK, Fan DS, Lam DS. The association between cigarette smoking and ocular diseases. Hong Kong Med J. 2000 Jun;6(2):195-202. PMID: 10895144
  38. ↑ Evans JR, Morjaria P, Powell C. Vision screening for correctable visual acuity deficits in school-age children and adolescents. Cochrane Database Syst Rev. 2018 Feb 15;2(2):CD005023. doi: 10.1002/14651858.CD005023.pub3. PMID: 29446439; PMCID: PMC6491194


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[blurred vision causes]
Cause of blurred vision Unilateral Bilateral Eye pain Onset Associated symptoms!
Refractive errors + + - gradual headache,head tilt, rubbing eye
Glaucoma + + red eye, Headache, Nausea
Age-related macular degeneration + - gradual extra sensitivity to glare
Cataracts + + - gradual loss of Night Vision, halos
Diabetes retinopathy + - gradual Polyuria, Polydipsia, polyphagia
Presbyopia + + - gradual
keratitis + + sudden eye redness,photophobia,A feeling that something is in the eye
conjunctivitis + + +/- sudden eye redness,photophobia,A feeling that something is in the eye,Increased lacrimation
Uveitis + + sudden eye redness, floaters,photophobia,Increased lacrimation
Iritis + + sudden light sensitivity
Retinal detachment + - sudden curtain
Infectious Retinitis + + +/- gradual Loss of night vision,tunnel vision
Eye trauma (Hyphema) + + sudden bleeding in the front of the eye,light sensitivity
Vitreous hemorrhage + - sudden Floaters
Lung cancer metastasis + + - depends on the site of metastasis
Migraine + + - sudden aura,headache ,nausea
Central retinal artery occlusion + - sudden complete sight loss
Central retinal vein occlusion + - sudden complete sight loss
Brain tumor + + - headache, focal neurological symptoms
Optic neuritis + + sudden/gradual Flashing lights
stroke + - sudden ataxia, hemiplegia, dysarthria
Papilloedema + - sudden Headache,nausea
Temporal arteritis Mostly - sudden Amaurosis fugax, headache,Diplopia
High blood pressure + + - sudden headache,nausea
Orbital cellulitis + + sudden Swollen eye ,red eyes, fever
drugs-induced + - symptoms related to the medication
Sjögren's syndrome + - gradual Eye dryness, redness,Burning eyes
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