Blurred vision

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: M.Umer Tariq [2], Maham Khan [3]

Overview

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

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[1] [2]


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

Other Imaging Findings

Treatment

Medical Therapy

  • Treat underlying pathologies
  • For dry eyes, lubrication
  • Appropriate treatment for hyperviscosity
  • Antiseizure prophylaxis (seizure disorders)

Surgery and Device Based Therapy

  • Glasses or contact lenses for blurred vision due to refractive errors
  • Possible surgical repair for retinal detachment
  • Temporal artery biopsy may be needed

References

  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X



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