Blurred vision

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 the 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.

• 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.

Classification

• Based on the duration of symptoms, blurred vision may be classified as either acute or chronic.

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-Quinuclidinyl benzilate Acetazolamide Acetohexamide Acute angle-closure glaucoma Acute posterior multifocal placoid pigment epitheliopathy Aldicarb Alfuzosin Aliskiren Alpha-Methyltryptamine Amantadine Amiodarone Oral Amitriptyline Amphotericin B Injection Amprenavir Anastrozole Anesthesia Anticholinergic Antihistamine Aripiprazole Asthenopia Astigmatism (eye) Atenolol Atropine Avacor Azelastine Ophthalmic Belladonna Alkaloid Combinations and Phenobarbital Benzatropine Benzodiazepine Benztropine Mesylate Oral Bepridil Bimatoprost Biperiden Bismuth Subsalicylate, Metronidazole, and Tetracycline Combination Bisoprolol Bortezomib Bosentan Botulinum toxin Botulism Brimonidine Ophthalmic Brinzolamide Ophthalmic Bupivacaine Buprenorphine Sublingual and Buprenorphine and Naloxone Sublingual Buspirone Butanethiol Butorphanol Carbamazepine Carbon dioxide narcosis Carvedilol Cataracts Central serous retinopathy Cerebral arteriovenous malformation Cetuximab Injection Cevimeline Chiasma syndrome Chlordiazepoxide Chloroquine Chlorpropamide Clitocybe dealbata Clomiphene Clonazepam Clorazepate Coats disease Colistimethate Injection Computer vision syndrome Congenital disorders Conjunctivitis Convergence insufficiency Corneal abrasion Corneal irregularity or abrasion Cryptococcosis Cyclizine Cyclosporine Ophthalmic Cysticercosis Cytarabine Cytomegalovirus retinitis Dapiprazole Ophthalmic Darifenacin Darunavir Deadly nightshade Desipramine Dexmethylphenidate Dextroamphetamine and Amphetamine Dextromethorphan Diabetes insipidus Diabetes mellitus Diabetic retinopathy Diazepam Diazinon Diclofenac Ophthalmic Dicyclomine Didanosine Diethylcathinone Diethylpropion Difluoroethane Digoxin Dihydroergotamine Injection and Nasal Spray Diphenhydramine Dipivefrin Ophthalmic Disopyramide Disulfiram Dorzolamide and Timolol Ophthalmic Dosulepin hydrochloride Doxepin Dry eye, poor tear film Duloxetine Enfuvirtide Injection Eplerenone Ergoloid Mesylates Esomeprazole Estazolam Ethcathinone Ethchlorvynol Etodolac Exenatide Injection

Extraocular muscle paralysis Fatigue Fenoprofen Fexofenadine and Pseudoephedrine Flavoxate Flumazenil Fluphenazine Fluticasone and Salmeterol Oral Inhalation Fosamprenavir Fuchs' dystrophy Fungal keratitis Furosemide Gabapentin Gamma-Hydroxybutyric acid Gatifloxacin Gemfibrozil Glaucoma Glimepiride Glipizide Glyburide Glycopyrrolate Granisetron Graves ophthalmopathy Guanfacine H1 antihistamine Hawaiian baby woodrose Head trauma HELLP syndrome Henipavirus Homatropine Hwabyeong Hydrocortisone, Neomycin, and Polymyxin Hydroxychloroquine Hyoscyamine Hyperbaric medicine Hypercoagulation Hyperglycemia Hyperopia Hypertension Hyperviscosity Hypervitaminosis A Hypoglycemia Imipramine Indapamide Indometacin Indomethacin Infection, inflammation or injury of cornea Infliximab Injection Insulin Aspart (rDNA Origin) Injection Insulin lispro injection Insulinoma Intraocular lymphoma Ipratropium Oral Inhalation Iritis Isocarboxazid Isosorbide Ivabradine Ketorolac Ophthalmic Ketotifen Ophthalmic Lamotrigine Lanthanum Levalbuterol Oral Inhalation Levobupivacaine Lidocaine Transdermal Lisinopril and Hydrochlorothiazide Lodoxamide Ophthalmic Lofepramine Lomotil Loprazolam Lorazepam Loxapine Oral Machado-Joseph disease Macular degeneration Macular disease Meclofenamate Medroxyprogesterone Mefenamic acid Megestrol Meperidine Metformin Methocarbamol Oral Methotrexate Methylphenidate Transdermal Metipranolol Ophthalmic Miconazole Injection Miglitol Migraine Minocycline Oral Minoxidil Moclobemide Monocrotophos Moricizine Morphine Oral Motofen Moxifloxacin ophthalmic Multiple sclerosis Multiple endocrine neoplasia type 1 Muscarine Mushroom poisoning Myasthenia Nalbuphine Naltrexone Nateglinide oral Nedocromil ophthalmic Nefazodone Nepafenac ophthalmic Neurocardiogenic Syncope Neuroglycopenia Niacin Nitroglycerin ointment Norethindrone Nortriptyline Ocular media opacity Oculotect Ofloxacin ophthalmic Olanzapine

Olmesartan Olopatadine ophthalmic Omeprazole Ondansetron injection Optic neuritis Ornithine translocase deficiency Orphenadrine Orthostatic hypotension Orthostatic intolerance Oxazepam Oxcarbazepine Oxybutynin Paliperidone Pamidronate injection Panic disorder Parasites Peginterferon alfa-2a Pentamidine Isethionate Injection Pergolide Periphlebitis retinae Perphenazine oral Phentermine Phenytoin oral Pilocarpine ophthalmic Pimozide Pioglitazone PMA Post-concussion syndrome Pralidoxime Prazepam Prazosin and polythiazide Prediabetes Prednisolone Pregabalin Presbyopia Primaquine Primidone Prochlorperazine Procyclidine Prograf Prolonged exposure to the outdoors Promethazine Propafenone Propantheline Protriptyline Pyridostigmine Quetiapine Quinidine Oral Rasagiline Refractive error Reiter's Syndrome Repaglinide Retinal detachment Risperidone Rituximab injection Rivastigmine Rogaine (drug) Ropivacaine Rosiglitazone Salmeterol oral inhalation Scopolamine Seizure disorders Sildenafil Sleep deprivation Sodium oxybate Solifenacin Spironolactone SSRI discontinuation syndrome Subdural hematoma Sulindac Tacrolimus Tadalafil Tamsulosin Tartrazine Tegaserod Telithromycin Temazepam Temik Temporal arteritis Terazosin Tetrahydrozoline Ophthalmic Thioridazine hydrochloride Thiothixene Oral Thygeson's superficial punctate keratopathy Tiludronate Tiotropium Oral Inhalation Tipranavir Tobramycin Ophthalmic Tolazamide Tolbutamide Topiramate Trachoma Tranylcypromine Traumatic brain injury Travoprost Ophthalmic Trazodone Triazolam Tricyclic antidepressant Trifluoperazine Oral Trihexyphenidyl Trimethobenzamide Trimipramine Tropicamide Trospium Uveitis Valproic Acid Vardenafil Vasculopathy Vertebrobasilar insufficiency Verteporfin Viral Voriconazole Vorinostat Ziprasidone Zolpidem Zopiclone

Diagnosis

History and Symptoms

• Detailed history important, including the following:

  • Progression of symptoms
  • Duration of symptoms
  • Near or farsighted
  • 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 a pain in the temporal area to suggest temporal arteritis

• Neurologic exam if necessary

Laboratory Findings

• Complete blood count (CBC)
• Random or fasting blood sugar

  • Repeat glucose (if initial glucose is elevated)

• Partial thromboplastin time (PTT)
• Prothrombin time (PT)
• Erythrocyte sedimentation rate is very important to rule out temporal arteritis

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

References

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