Blurred vision resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Wajeeha Aiman, M.D.[2]

Synonyms and Keywords:

Overview

Blurred vision is very common visual complaint with ophthalmologic or neurologic conditions. This is an inability to see small details clearly and sharply. Decreased visual clarity can develop gradually or suddenly depending on the cause of symptom. Refractory errors are the major causes of blurred vision complaints. Therefore most of these vision issues can be corrected with glasses. Any disease affecting eyes can cause blurriness in vision. To guide the diagnosis of blurred vision it is important to know the details like duration, progression, near or far sighted, permanent or transient, uniocular or binocular and associated symptoms.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

• Eye Trauma
• Glaucoma
• Stroke
• Brain tumor
• Retinal detachment
• Optic neuritis
• Transient ischemic attack

Common Causes

• Age related macular degeneration
• Cataract
• Diabetic retinopathy
• Myopia
• Migraines
• Dry eyes
• Presbyopia
• Need for corrective lenses
• Uveitis
• iritis
• Adverse effect (medicine)

Diagnosis

Shown below is an algorithm summarizing the diagnosis of blurred vision according to the [...] guidelines.

Individual with blurry vision

Characterize • Onset (sudden or gradual) • Duration of symptoms • Progression • Near or far sight • Binocular or uniocular • Permanent or transient

Associated symptoms

Symptoms suggestive of eye etiology • Dry eye •EOM paralysis • Headache • Double vision • Red eyes • Pain in the eyes • Squinting

Non specific symptoms • Tearing • Rhinorrhea • Fatigue • Nausea • Lethargy

Symptoms suggestive of neurologic etiology • Transient previous episodes • Unilateral headache • Nausea/vomiting • Loss of consciousness • Altered mental status

Inquiere about past medical risk factors

Other causes • Hypoglycemia • Medication side effects or overuse • Infectious diseases • Endocrinologic diseases • Hyperviscosity • HIV • Poisoning (mushrooms)

Ophthalmologic diseases • Keratitis • Refractory blurred vision • Diabetic retinopathy • Optic neuritis • Macular degeneration • Iritis

Neurologic disorders • AV malformations (AVF) • Previous history of migraine • Diagnosis of MS • Trauma leading to concussion or hematoma • Stroke

Examine the patient

Vital signs • Fever (when infection suspected) • Heart rate (tachycardia, bradycardia) • Blood pressure (hypertension) • Tachypnea General appearance • Pale • Diaphoretic • Severe distress Neck • JVD Eye examination • Dilated fundus exam • Slit lamp examination • Visual acuity • Dry or irritated eyes • Improvement of vision Ear, nose and throat Palpate temporal area to rule-out temporal arteritis Neurologic exam if necessary

Order labs and tests according to suspected etiology • CBC • Random and fasting blood sugar (repeat test if initial measure is elevated) • Partial thromboplastin time (PTT) • Prothrombin time (PT) • ESR (important to rule-out temporal arteritis) • EEG (if seizures are suspected)

Verify if blurred vision has any findings suggestive of ophthalmologic etiology • Squint • Dry eye • Pain • Refractory error • Floaters • Conjunctivitis (red eye)

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according to the [...] guidelines.

Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.