Sandbox: Golnaz Holm

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

Fahimeh review comments:

this is your template: https://www.wikidoc.org/index.php/Abc

1. Please write the page 100% according to this template. For example in ABC page we have historical perspective after overview. If you don't find any historical perspective, don't delete the topic, just write: There is not much information regarding the historical perspective of blurred vision.
2. In the causes, if you look at the ABC page, the first sentence starts like this: "{Disease name] may be caused by [cause1], [cause2], or [cause3]", or " Common causes of [disease] include [cause1], [cause2], and [cause3]". Try to use the exact sentences.

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.

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:

• 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, Leukemia)
• Optic neuritis
• Cerebrovascular disease (TIA, stroke)
• Vasculitis (Temporal arteritis,SLE)
• High blood pressure
• Medication

Epidemiology and Demographics

Depends on the cause, patients of different age groups may develop blurred vision.

Risk Factors

Genetic, Family history, Diabetes mellitus, Age, Hyperlipidemia, Hypertension

Screening

• Screening for Diabetic retinopathy
• Screening for Glaucoma

Natural History, Complications, and Prognosis

The prognosis of blurred vision depends on the underlying cause.

Diagnosis

The diagnosis of blurred vision is based on taking detailed medical history and eye examination.

There are no established criteria for the diagnosis of blurred visin.

History and Symptoms

Patient Should be asked about the onset, duration,associated symptoms and whether blurred vision is bilateral or unilateral. Symptoms which can accompany blurred vision are: Redness of the eye, Eye pain, Epiphoria, Headache, Photophobia, Halos, Nausea, Polydipsia and polyuria, Dizziness, Numbness.

Physical Examination

Eye examination of patients with blurred vision includes :

• [[Visual acuity test
• Visual fields examination
• Slit lamp
• Ophtalmoscopy
• Tonometry

Laboratory Findings

Patients with systemic disorders should have appropriate testing: An elevated concentration of blood sugar and HgA1C is seen in blurred vision due to diabetes mellitus. Urinalysis and renal function testing should be considered in patients with high blood pressure. Antinuclear antibodies and elevated ESR are associated with SLE and vasculitis. CBC with differential count and other tests are needed in some cases( Leukemia, Multiple myeleoma)

CT scan

CT scan of brain may be helpful in diagnosis of mass occupying lesions or Ischemic and hemorrhagic stroke.

Other Diagnostic Studies

There are no other diagnostic studies associated with [disease name].

Treatment

Depends upon the cause, underlying disorders should be addressed.

• Corrective lenses and eyeglasses may correct visual acuity in refractive errors.

Medical Therapy

• Direct injections or intravitreal anti-inflammatory and antiangiogenesis agents(anti-VEGF drugs ) are widely used pharmacotherapy to effectively treat DR and diabetic macular edema (DME).PMCID: PMC5822768
• Glaucoma is usually controlled with eyedrop medicine
• Antibacterial, antiviral and anti parasite agents are the main treatment in infectious causes.
• Corticosteroids are used in the treatment of some kinds of uveitis, iritis and optic neuritis.
• Laser treatment is an option in treatment of diabetic retinopathy.

Surgery

• Surgical intervention like LASIK is commonly used to correct a refractive error.
• Surgery is the mainstay of treatment for cataract.
• Vitrectomy is used in treatment of Diabetic retinopathy
• Different types of surgeries to treat glaucoma are: Trabeculoplasty ,Iridotomy and Trabeculectomy

Primary Prevention

Keeping the glucose level close to the normal level in diabetic patients is the best way to lower the risk of diabetic retinopathy.

Secondary Prevention

There are no established measures for the secondary prevention of [disease name].

References

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Cause of blurred vision	Unilateral	Bilateral	Pain	Onset	Associated symptoms	Eye examination!
Refractive errors	+	+	-	gradual
Glaucoma	+		+		red eye, Headache, Nausea
Age-related macular degeneration		+	-	grdual
Cataracts	+	+	-	gradual
Diabetes retinopathy		+	-	gradual
Presbyopia
keratitis	+		+
conjunctivitis	+	+	+/-
Uveitis	+		+
Iritis	+		+		light sensitivity
Retinal detachment	+		-	sudden	curtain
Infectious Retinitis	+	+	+/-		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	+	+
Migrain	+	+		sudden	aura,headache ,nausea
Central retinal artery occlusion	+		-	sudden	complete sight loss
Central retinal vein occlusion	+		-	sudden	complete sight loss
Brain tumor	+	+
Optic neuritis	+		+
stroke		+	-
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
Medication like anticholinergic		+	-
Sjögren's syndrome	+		-	gradual	Eye dryness, redness,Burning eyes