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==Historical Perspective==
==Historical Perspective==
*Visual function assessment and [[blurred vision]] detection in particular has been susceptible to invention of [[snellen chart]]. [[Snellen chart]] is an eye chart that can be used to measure visual acuity. [[Snellen chart]] is named after the Dutch ophthalmologist Herman Snellen, who developed the chart in 1862 who began diagnosing vision problems by asking people to look at a chart on a wall and tell him what they could see. Dr Snellen also created a chart called the Tumbling E chart, which can be used by people who cannot read, or by young children who don’t know the alphabet. Instead of using different letters, the Tumbling E eye chart uses a capital letter E that faces in different directions.<ref name="Keeler2002">{{cite journal|last1=Keeler|first1=C. Richard|title=The Ophthalmoscope in the Lifetime of Hermann von Helmholtz|journal=Archives of Ophthalmology|volume=120|issue=2|year=2002|pages=194|issn=0003-9950|doi=10.1001/archopht.120.2.194}}</ref>
*The other chart testing visual acuity is [[logMAR chart]] which also called [[Bailey-Lovie chart]] or [[ETDRS chart]]. The chart was developed at the National Vision Research Institute of Australia in 1976, and is designed to enable a more accurate estimate of acuity than the other one. Visual acuity measurements using a [[logMAR chart]] have been shown to be twice as repeatable as those from a [[snellen chart]].<ref name="Rosser2001">{{cite journal|last1=Rosser|first1=D A|title=The development of a "reduced logMAR" visual acuity chart for use in routine clinical practice|journal=British Journal of Ophthalmology|volume=85|issue=4|year=2001|pages=432–436|issn=00071161|doi=10.1136/bjo.85.4.432}}</ref>
==Classification==
==Classification==
Template:Search infobox
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor-In-Chief:
Overview
Blurred 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 can be due to multiple issues but mostly present in neurologic and ophthalmologic diseases.
Historical Perspective
Visual function assessment and blurred vision detection in particular has been susceptible to invention of snellen chart . Snellen chart is an eye chart that can be used to measure visual acuity. Snellen chart is named after the Dutch ophthalmologist Herman Snellen, who developed the chart in 1862 who began diagnosing vision problems by asking people to look at a chart on a wall and tell him what they could see. Dr Snellen also created a chart called the Tumbling E chart, which can be used by people who cannot read, or by young children who don’t know the alphabet. Instead of using different letters, the Tumbling E eye chart uses a capital letter E that faces in different directions.[ 1]
The other chart testing visual acuity is logMAR chart which also called Bailey-Lovie chart or ETDRS chart . The chart was developed at the National Vision Research Institute of Australia in 1976, and is designed to enable a more accurate estimate of acuity than the other one. Visual acuity measurements using a logMAR chart have been shown to be twice as repeatable as those from a snellen chart .[ 2]
Classification
Pathophysiology
Causes
Causes by Organ System
Cardiovascular
Hypertension ,
Neurocardiogenic Syncope ,
Chemical / poisoning
Hawaiian baby woodrose ,
Monocrotophos ,
Mushroom poisoning ,
Dermatologic
No underlying causes
Drug Side Effect
3-Quinuclidinyl benzilate ,
Acetazolamide ,
Acetohexamide (patient information) ,
Aclidinium bromide ,
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 ,
Apraclonidine ,
Aripiprazole (patient information) ,
Atropine ,
Avacor ,
Azelastine Ophthalmic (patient information) ,
Benzatropine ,
Benzodiazepine ,
Bepridil (patient information) ,
Besifloxacin ,
Bimatoprost ,
Biperiden ,
Bismuth Subsalicylate, Metronidazole, and Tetracycline Combination (patient information) ,
Bortezomib (patient information) ,
Botulinum toxin ,
Brinzolamide Ophthalmic (patient information) ,
Bupivacaine ,
Butanethiol ,
Butorphanol ,
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) ,Clobazam ,
Colistimethate Injection (patient information) , Crizotinib ,
Cyclizine ,
Cetirizine hydrochloride ,
Cyclopentolate ,
Cyclosporine Ophthalmic (patient information) ,
Cytarabine (patient information) ,
Cytarabine ,
Dapiprazole Ophthalmic (patient information) ,
Darifenacin (patient information) ,
Darunavir (patient information) ,
Dapsone ,
Desipramine (patient information) ,
Dexmethylphenidate ,
Dextromethorphan ,
Diazepam ,
Diazinon ,
Diclofenac Ophthalmic (patient information) ,
Dicyclomine (patient information) ,
Didanosine (patient information) ,
Diethylcathinone ,
Diethylpropion (patient information) ,
Diflunisal ,
Difluoroethane ,
Digoxin ,
Diphenhydramine ,
Dipivefrin Ophthalmic (patient information) ,
Disopyramide (patient information) ,
Disulfiram ,
Dorzolamide and Timolol Ophthalmic (patient information) ,
Dosulepin hydrochloride ,
Duloxetine ,
Enfuvirtide Injection (patient information) ,
Ergoloid Mesylates (patient information) ,
Eslicarbazepine acetate ,
Estazolam (patient information) ,
Ethcathinone ,
Ethchlorvynol ,
Etodolac ,
Etonogestrel and Ethinyl Estradiol Vaginal Ring ,
Exenatide Injection (patient information) ,
Fenoprofen (patient information) ,
Fexofenadine and Pseudoephedrine (patient information) ,
Flavoxate ,
Flumazenil ,
Fluphenazine (patient information) , Flurazepam ,
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 ,
Granisetron (patient information) ,
Haloperidol ,
Homatropine ,
Hydrocortisone, Neomycin, and Polymyxin (patient information) ,
Hydrochlorothiazide
Hydroxychloroquine (patient information) ,
Hydroxypropyl cellulose ,
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) ,
Lacosamide ,
Lamotrigine (patient information) ,
Lanthanum (patient information) ,
Levobupivacaine ,
Lidocaine Viscous (patient information) ,
Lodoxamide Ophthalmic (patient information) ,
Lofepramine , Lorcaserin ,
Lomotil ,
Lorazepam (patient information) ,
Loxapine Oral (patient information) ,
Meclofenamate (patient information) ,
Medroxyprogesterone (patient information) ,
Mefenamic acid ,
Megestrol (patient information) ,
Meperidine (patient information) ,
Mepenzolate bromide ,
Metformin (patient information) ,
Methocarbamol Oral (patient information) ,
Methotrexate (patient information) ,
Methylphenidate Transdermal (patient information) ,
Metipranolol ,
Metipranolol Ophthalmic (patient information) ,
Miconazole Injection (patient information) ,
Miglitol (patient information) ,
Minocycline Oral (patient information) ,
Minoxidil , Mitomycin ,
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) ,
Niacin ,
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) ,
Olsalazine ,
Ondansetron injection (patient information) ,
Oprelvekin ,
Orphenadrine (patient information) ,
Oxazepam (patient information) ,
Oxcarbazepine ,
Oxybutynin (patient information) ,
Oxybutynin transdermal (patient information) ,
Paliperidone (patient information) ,
Pegaptanib ,
Peginterferon alfa-2a (patient information) ,
Pentamidine Isethionate ,
Perphenazine oral (patient information) ,
Phentermine ,
Phenytoin oral (patient information) ,
Pilocarpine ophthalmic (patient information) ,
Pioglitazone (patient information) ,
Pralidoxime ,
Prazepam (patient information) ,
Prazosin and polythiazide (patient information) ,
Prednisolone ophthalmic (patient information) ,
Pregabalin (patient information) ,
Primaquine (patient information) ,
Primidone (patient information) ,
Prochlorperazine ,
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) ,
Rimexolone ,
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) ,
Thalidomide ,
Thallous Chloride Tl 201 ,
Thioridazine hydrochloride ,
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 ,
Trimethobenzamide (patient information) ,
Trimipramine (patient information) ,
Tropicamide ,
Trospium ,
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 ,
Ear Nose Throat
No underlying causes
Endocrine
Diabetes insipidus ,
Diabetes mellitus ,
Graves ophthalmopathy ,
multiple endocrine neoplasia type 1
Prediabetes ,
Environmental
No underlying causes
Gastroenterologic
Insulinoma ,
Genetic
No underlying causes
Hematologic
Hyperviscosity
Iatrogenic
No underlying causes
Infectious Disease
Botulism ,
Cryptococcosis ,
Cysticercosis ,
Cytomegalovirus retinitis ,
Henipavirus ,
Musculoskeletal / Ortho
No underlying causes
Neurologic
Cerebral arteriovenous malformation ,
Hwabyeong ,
Machado-Joseph disease ,
Migraine ,
Multiple sclerosis ,
Neuroglycopenia ,
Post-concussion syndrome ,
Subdural hematoma ,
Vertebrobasilar insufficiency ,
Chiasma syndrome,
Nutritional / Metabolic
Hypoglycemia ,
Ornithine translocase deficiency ,
Obstetric/Gynecologic
HELLP syndrome ,
Oncologic
Intraocular lymphoma ,
Opthalmologic
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
Overdose / Toxicity
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) ,
Oprelvekin ,
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 ,
Psychiatric
Panic attack ,
Pulmonary
No underlying causes
Renal / Electrolyte
No underlying causes
Rheum / Immune / Allergy
Temporal arteritis ,
Myasthenia
Sexual
No underlying causes
Trauma
Traumatic brain injury ,
Urologic
Reiter's Syndrome ,
Miscellaneous
Anesthesia ,
Computer vision syndrome ,
Orthostatic hypotension ,
Carbon dioxide narcosis ,
Causes in Alphabetical Order[ 3] [ 4]
Differentiating blurred vision from other diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Diagnosis
Diagnosis Study of Choice
History and Symptoms
Detailed history important, including the following:
Progression of symptoms
Duration of symptoms
Near or far sighted
Binocular or uniocular
Permanent or transient
Associated symptoms
Past medical history
Physical Examination
Eyes
Complete ophthalmologic exam including:
Dilated fundus exam
Slit lamp examination
Visual acuity
Dry or irritated eyes
Improvement of vision with pinhole
Ear Nose and Throat
For ENT palpate the temporal area to determine if there is pain in the temporal area to suggest temporal arteritis
Neurologic exam if necessary
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography or Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Treat underlying pathologies
For dry eyes, lubrication
Appropriate treatment for hyperviscosity
Antiseizure prophylaxis (seizure disorders)
Surgery
Glasses or contact lenses for blurred vision due to refractive errors
Possible surgical repair for retinal detachment
Temporal artery biopsy may be needed
Primary Prevention
Secondary Prevention
References
↑ Keeler, C. Richard (2002). "The Ophthalmoscope in the Lifetime of Hermann von Helmholtz". Archives of Ophthalmology . 120 (2): 194. doi :10.1001/archopht.120.2.194 . ISSN 0003-9950 .
↑ Rosser, D A (2001). "The development of a "reduced logMAR" visual acuity chart for use in routine clinical practice". British Journal of Ophthalmology . 85 (4): 432–436. doi :10.1136/bjo.85.4.432 . ISSN 0007-1161 .
↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
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