Blurred vision resident survival guide

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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.

Common Causes

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.

References

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