Blurred vision: Difference between revisions
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==Overview== | ==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. | 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]]. | ||
==Historical Perspective== | ==Historical Perspective== | ||
There is not much information regarding the historical perspective of blurred vision. | There is not much information regarding the historical perspective of blurred vision. | ||
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There is no established system for the classification of blurred vision. | There is no established system for the classification of blurred vision. | ||
==Pathophysiology== | ==Pathophysiology== | ||
Blurred vision may result from refractive errors, opacity of structures (lens, cornea, vitreous), retina disorder or optic nerve disease. | Blurred vision may result from [[refractive errors]], opacity of structures ([[lens]], [[cornea]], [[vitreous]]), [[retina]] disorder or [[optic nerve]] disease. | ||
==[[blurred vision|Causes]]== | ==[[blurred vision|Causes]]== | ||
Blurred vision can be caused by a wide range of eye conditions which include: | Blurred vision can be caused by a wide range of eye conditions which include:<REF>Quillen DA. Common causes of vision loss in elderly patients. Am Fam Physician. 1999 Jul;60(1):99-108. PMID: 10414631.</REF> <REF>Flaxman SR, Bourne RRA, Resnikoff S, Ackland P, Braithwaite T, Cicinelli MV, Das A, Jonas JB, Keeffe J, Kempen JH, Leasher J, Limburg H, Naidoo K, Pesudovs K, Silvester A, Stevens GA, Tahhan N, Wong TY, Taylor HR; Vision Loss Expert Group of the Global Burden of Disease Study. Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis. Lancet Glob Health. 2017 Dec;5(12):e1221-e1234. doi: 10.1016/S2214-109X(17)30393-5. Epub 2017 Oct 11. PMID: 29032195.</REF> | ||
*[[Refractive errors]] (most common) | *[[ Refractive errors]] (most common) | ||
*[[Age-related macular]] | *[[Age-related macular degeneration]] | ||
*[[Cataracts]] | *[[Cataracts]] | ||
*[[Presbyopia]] | *[[Presbyopia]] | ||
*[[Diabetes retinopathy]] | *[[Diabetes retinopathy]] | ||
*[[Glaucoma]] | *[[Glaucoma]] | ||
*Corneal abrasion or scarring; keratitis | *[[Corneal abrasion]] or scarring; [[keratitis]] | ||
*conjunctivitis | *[[conjunctivitis]] | ||
*Uveitis | *[[Uveitis]] | ||
*Iritis | *[[Iritis]] | ||
*[[Retinal detachment]] | *[[Retinal detachment]] | ||
*Retinitis | *[[Retinitis]] | ||
*Eye trauma ([[Hyphema]]) | *[[Eye trauma]] ([[Hyphema]]) | ||
*[[Migraine]] | *[[Migraine]] | ||
*Malignancy and tumor (Brain tumor, Lung cancer metastasis <ref> Asteriou C, Konstantinou D, Kleontas A, et al. Blurred vision due to choroidal metastasis as the first manifestation of lung cancer: a case report. World J Surg Oncol. 2010;8:2. Published 2010 Jan 8. doi:10.1186/1477-7819-8-2 </ref> ,Leukemia) | *[[Malignancy]] and tumor ([[Brain tumor]], [[Lung cancer]] [[metastasis]] <ref> Asteriou C, Konstantinou D, Kleontas A, et al. Blurred vision due to choroidal metastasis as the first manifestation of lung cancer: a case report. World J Surg Oncol. 2010;8:2. Published 2010 Jan 8. doi:10.1186/1477-7819-8-2 </ref> ,[[Leukemia]]) | ||
*[[Optic neuritis]] | *[[Optic neuritis]] | ||
*Cerebrovascular disease ([[TIA]], stroke) | *[[Cerebrovascular disease]] ([[TIA]], [[stroke]]) | ||
*Vasculitis ([[Temporal arteritis]],[[SLE]]) | *[[Vasculitis]] ([[Temporal arteritis]],[[SLE]]) | ||
*High blood pressure | *[[High blood pressure]] | ||
*Medication | *Medication | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
Patients of all age groups may develop blurred vision. | Patients of all age groups may develop blurred vision.Approximately one in three persons by the age of 65 has some form of vision-reducing eye disorder .<ref> Ganley JP, Roberts J. Eye conditions and related need for medical care. Vital Health Stat 11. 1983;(228):1-69. PMID: 6880057.</ref> | ||
==Risk Factors== | ==[[Risk Factors]]== | ||
Risk factors in the development of blurred vision include Genetic, | Risk factors in the development of blurred vision include [[Genetic]],[[Nutritional]],[[Family history]],[[Diabetes mellitus]],Age,[[Hyperlipidemia]],[[Hypertension]],Toxins, Exposure to [[ultraviolet light]].<REF>Gupta VB, Rajagopala M, Ravishankar B. Etiopathogenesis of cataract: an appraisal. Indian J Ophthalmol. 2014 Feb;62(2):103-10. doi: 10.4103/0301-4738.121141. PMID: 24618482; PMCID: PMC4005220.</REF> <REF>Hyman L. Epidemiology of eye disease in the elderly. Eye (Lond). 1987;1 ( Pt 2):330-41. doi: 10.1038/eye.1987.53. PMID: 3653439.</REF> | ||
Family history, | |||
Diabetes mellitus, | |||
Age, | |||
Hyperlipidemia, | |||
Hypertension | |||
==Screening== | ==Screening== | ||
*According to the American Diabetes Association’s patients with type 1 and type 2 diabetes should have comprehensive eye examination within 5 years after the onset of diabetes and at the time of diagnosis ,respectively. <ref>Diabetes Care. Introduction. Diabetes Care. 2010 Jan;33 Suppl 1(Suppl 1):S1-2. doi: 10.2337/dc10-S001. PMID: 20042770; PMCID: PMC2797380.</ref> The eye examination should be considered at least annually thereafter. | *According to the [[American Diabetes Association’s]] patients with type 1 and type 2 diabetes should have comprehensive eye examination within 5 years after the onset of diabetes and at the time of diagnosis ,respectively. <ref>Diabetes Care. Introduction. Diabetes Care. 2010 Jan;33 Suppl 1(Suppl 1):S1-2. doi: 10.2337/dc10-S001. PMID: 20042770; PMCID: PMC2797380.</ref> The eye examination should be considered at least annually thereafter. | ||
*There is insufficient evidence to recommend routine screening for Glaucoma. USPSTF suggests that patients at increased risk, especially African Americans and older adults, talk to their primary care clinician or eye care specialist for advice about glaucoma screening. | *There is insufficient evidence to recommend routine screening for [[Glaucoma]]. [[USPSTF]] suggests that patients at increased risk, especially African Americans and older adults, talk to their primary care clinician or eye care specialist for advice about [[glaucoma screening]]. | ||
*The USPSTF<REF>Screening for High Blood Pressure in Adults: Recommendation Statement. Am Fam Physician. 2016 Feb 15;93(4):300-2. PMID: 26926818</ref>. recommends annual screening for adults aged 40 years or older and for those who are at increased risk for high blood pressure.[3] Persons at increased risk include those who have high-normal blood pressure (130 to 139/85 to 89 mm Hg), those who are overweight or obese, and African Americans. Adults aged 18 to 39 years with normal blood pressure (<130/85 mm Hg) who do not have other risk factors should be rescreened every 3 to 5 years. | *The USPSTF<REF>Screening for High Blood Pressure in Adults: Recommendation Statement. Am Fam Physician. 2016 Feb 15;93(4):300-2. PMID: 26926818</ref>. recommends annual screening for adults aged 40 years or older and for those who are at increased risk for [[high blood pressure]].[3] Persons at increased risk include those who have high-normal blood pressure (130 to 139/85 to 89 mm Hg), those who are [[overweight]] or obese, and African Americans. Adults aged 18 to 39 years with normal blood pressure (<130/85 mm Hg) who do not have other risk factors should be rescreened every 3 to 5 years. | ||
==Natural History, Complications, and Prognosis== | ==Natural History, [[Complications]], and Prognosis== | ||
Prognosis of blurred vision depends on the underlying cause. | Prognosis of blurred vision depends on the underlying cause. | ||
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There are no established criteria for the diagnosis of blurred vision. | There are no established criteria for the diagnosis of blurred vision. | ||
The diagnosis of blurred vision is based on taking detailed medical history and eye examination.Patient Should be asked about the onset, duration, associated symptoms and whether blurred vision is bilateral or unilateral. | The diagnosis of blurred vision is based on taking detailed [[medical history]] and eye examination.Patient Should be asked about the onset, duration, associated symptoms and whether blurred vision is bilateral or unilateral. | ||
'''History and Symptoms''' | '''History and Symptoms''' | ||
*The common symptoms which accompany blurred vision include Redness of the eye,Eye pain,[[Epiphoria]],Headache,[[Photophobia]],Halos,Nausea, | *The common symptoms which accompany blurred vision include [[Redness of the eye]],[[Eye pain]],[[Epiphoria]],[[Headache]],[[Photophobia]],[[Halos]],[[Nausea]],[[Polydipsi]]a and [[polyuria]],[[Dizziness]],[[Numbness]]. | ||
'''Physical Examination''' | '''[[Physical Examination]]''' | ||
*Eye examination of patients with blurred vision includes Visual acuity test,Visual fields examination,Slit lamp,Ophthalmoscopy,[[Tonometry]],Angle Test (Gonioscopy) | *[[Eye examination]] of patients with blurred vision includes [[Visual acuity test]],[[Visual fields examination]],[[Slit lamp]],[[Ophthalmoscopy]],[[Tonometry]],[[Angle Test]] ([[Gonioscopy]]) | ||
*The presence of sudden hemiplegia ,abnormal gait,ataxia and dysarthria is diagnostic of cerebrovascular accident. | *The presence of sudden[[hemiplegia]] ,[[abnormal gait]],[[ataxia]] and [[dysarthria]] is diagnostic of [[cerebrovascular accident]]. | ||
'''Laboratory Findings''' | '''Laboratory Findings''' | ||
*Patients with systemic disorders should have appropriate testing. | *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. | *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. | *[[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. | *[[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]]) | *[[CBC]] with differential count and other tests are needed in some cases( [[Leukemia]], [[Multiple myeleoma]]) | ||
'''CT scan''' | '''[[CT scan]]''' | ||
*CT scan of brain may be helpful in diagnosis of mass occupying lesions or Ischemic and hemorrhagic stroke. | *CT scan of brain may be helpful in diagnosis of mass [[occupying lesions]] or [[Ischemic and hemorrhagic stroke]]. | ||
'''MRI''' | '''[[MRI]]''' | ||
*A magnetic resonance imaging (MRI) study of the brain and orbits may confirm inflammation of the optic nerve. | *A magnetic resonance imaging (MRI) study of the [[brain]] and [[orbits]] may confirm inflammation of the [[optic nerve]]. | ||
==Treatment== | ==Treatment== | ||
Depends upon the cause, underlying disorders should be addressed. | Depends upon the cause, underlying disorders should be addressed. | ||
*Patients with refractive errors and presbyopia can be treated with Corrective lenses and eyeglasses. | *Patients with [[refractive errors]] and [[presbyopia]]<ref>Charman WN. Developments in the correction of presbyopia I: spectacle and contact lenses. Ophthalmic Physiol Opt. 2014 Jan;34(1):8-29. doi: 10.1111/opo.12091. Epub 2013 Nov 10. PMID: 24205890.</ref> can be treated with [[Corrective lenses]]<ref>Sankaridurg P. Contact lenses to slow progression of myopia. Clin Exp Optom. 2017 Sep;100(5):432-437. doi: 10.1111/cxo.12584. Epub 2017 Jul 28. PMID: 28752898.</ref> and [[eyeglasses]]<ref>Shane TS, Knight O, Shi W, Schiffman JC, Alfonso EC, Lee RK. Treating uncorrected refractive error in adults in the developing world with autorefractors and ready-made spectacles. Clin Exp Ophthalmol. 2011 Nov;39(8):729-33. doi: 10.1111/j.1442-9071.2011.02546.x. Epub 2011 Apr 21. PMID: 22050561; PMCID: PMC4139100.</ref>. | ||
*Supportive therapy for hyphema includes raising the head of the bed, wearing eye shield and cut back on physical activity. | *[[Supportive therapy]] for [[hyphema]]<ref>Gragg J, Blair K, Baker MB. Hyphema. [Updated 2020 Dec 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507802/</ref> includes raising the head of the bed, wearing [[eye shield]] and cut back on physical activity. | ||
*There is no treatment for dry macular degeneration.<ref>Waugh N, Loveman E, Colquitt J, Royle P, Yeong JL, Hoad G, Lois N. Treatments for dry age-related macular degeneration and Stargardt disease: a systematic review. Health Technol Assess. 2018 May;22(27):1-168. doi: 10.3310/hta22270. PMID: 29846169; PMCID: PMC5994642.</ref>Patients with wet macular degeneration may be treated with Anti-VEGF medications or Photodynamic therapy which help stop the growth of new blood vessels.<ref>Hernández-Zimbrón LF, Zamora-Alvarado R, Ochoa-De la Paz L, Velez-Montoya R, Zenteno E, Gulias-Cañizo R, Quiroz-Mercado H, Gonzalez-Salinas R. Age-Related Macular Degeneration: New Paradigms for Treatment and Management of AMD. Oxid Med Cell Longev. 2018 Feb 1;2018:8374647. doi: 10.1155/2018/8374647. PMID: 29484106; PMCID: PMC5816845.</ref> | *There is no treatment for [[dry macular degeneration]].<ref>Waugh N, Loveman E, Colquitt J, Royle P, Yeong JL, Hoad G, Lois N. Treatments for dry age-related macular degeneration and Stargardt disease: a systematic review. Health Technol Assess. 2018 May;22(27):1-168. doi: 10.3310/hta22270. PMID: 29846169; PMCID: PMC5994642.</ref>Patients with [[wet macular degeneration]] may be treated with [[Anti-VEGF]] medications or [[Photodynamic therapy]] which help stop the growth of new blood vessels.<ref>Hernández-Zimbrón LF, Zamora-Alvarado R, Ochoa-De la Paz L, Velez-Montoya R, Zenteno E, Gulias-Cañizo R, Quiroz-Mercado H, Gonzalez-Salinas R. Age-Related Macular Degeneration: New Paradigms for Treatment and Management of AMD. Oxid Med Cell Longev. 2018 Feb 1;2018:8374647. doi: 10.1155/2018/8374647. PMID: 29484106; PMCID: PMC5816845.</ref> | ||
===Medical Therapy=== | ===Medical Therapy=== | ||
*Medical therapy of diabetic retinopathy include direct injections or intravitreal administration of anti-inflammatory and antiangiogenesis agents(anti-VEGF drugs <ref>Zhao Y, Singh RP. The role of anti-vascular endothelial growth factor (anti-VEGF) in the management of proliferative diabetic retinopathy. Drugs Context. 2018 Aug 13;7:212532. doi: 10.7573/dic.212532. PMID: 30181760; PMCID: PMC6113746.</ref> <ref>Rios A, Lopez-Galvez M, Navarro-Gil R, Verges R. Diabetic Macular Edema Pathophysiology: Vasogenic versus Inflammatory. J Diabetes Res. 2016;2016:2156273. doi: 10.1155/2016/2156273. Epub 2016 Sep 28. PMID: 27761468; PMCID: PMC5059543.</ref>) which are widely used pharmacotherapy to effectively treat DR and diabetic macular edema (DME).<ref>Lu L, Jiang Y, Jaganathan R, Hao Y. Current Advances in Pharmacotherapy and Technology for Diabetic Retinopathy: A Systematic Review. J Ophthalmol. 2018 Jan 17;2018:1694187. doi: 10.1155/2018/1694187. Erratum in: J Ophthalmol. 2018 Dec 2;2018:5047142.</ref> | *Medical therapy of [[diabetic retinopathy]] include direct injections or [[intravitreal]] administration of [[anti-inflammatory]] and [[antiangiogenesis]] agents([[anti-VEGF]] drugs <ref>Zhao Y, Singh RP. The role of anti-vascular endothelial growth factor (anti-VEGF) in the management of proliferative diabetic retinopathy. Drugs Context. 2018 Aug 13;7:212532. doi: 10.7573/dic.212532. PMID: 30181760; PMCID: PMC6113746.</ref> <ref>Rios A, Lopez-Galvez M, Navarro-Gil R, Verges R. Diabetic Macular Edema Pathophysiology: Vasogenic versus Inflammatory. J Diabetes Res. 2016;2016:2156273. doi: 10.1155/2016/2156273. Epub 2016 Sep 28. PMID: 27761468; PMCID: PMC5059543.</ref>) which are widely used pharmacotherapy to effectively treat [[DR]] and [[diabetic macular edema]] (DME).<ref>Lu L, Jiang Y, Jaganathan R, Hao Y. Current Advances in Pharmacotherapy and Technology for Diabetic Retinopathy: A Systematic Review. J Ophthalmol. 2018 Jan 17;2018:1694187. doi: 10.1155/2018/1694187. Erratum in: J Ophthalmol. 2018 Dec 2;2018:5047142.</ref> | ||
*Laser treatment is an option in treatment of diabetic retinopathy.<ref>Wang W, Lo ACY. Diabetic Retinopathy: Pathophysiology and Treatments. Int J Mol Sci. 2018 Jun 20;19(6):1816. doi: 10.3390/ijms19061816. PMID: 29925789; PMCID: PMC6032159.</ref> | *[[Laser treatment]] is an option in treatment of [[diabetic retinopathy]].<ref>Wang W, Lo ACY. Diabetic Retinopathy: Pathophysiology and Treatments. Int J Mol Sci. 2018 Jun 20;19(6):1816. doi: 10.3390/ijms19061816. PMID: 29925789; PMCID: PMC6032159.</ref> | ||
*Pharmacologic medical therapy with eye | *Pharmacologic medical therapy with [[eye drop]]s is recommended among patients with [[Glaucoma]].<ref>Dreer LE, Girkin C, Mansberger SL. Determinants of medication adherence to topical glaucoma therapy. J Glaucoma. 2012 Apr-May;21(4):234-40. doi: 10.1097/IJG.0b013e31821dac86. PMID: 21623223; PMCID: PMC3183317.</ref> <ref>Maier PC, Funk J, Schwarzer G, Antes G, Falck-Ytter YT. Treatment of ocular hypertension and open angle glaucoma: meta-analysis of randomised controlled trials. BMJ. 2005 Jul 16;331(7509):134. doi: 10.1136/bmj.38506.594977.E0. Epub 2005 Jul 1. PMID: 15994659; PMCID: PMC558697.</ref> <ref>Li T, Lindsley K, Rouse B, Hong H, Shi Q, Friedman DS, Wormald R, Dickersin K. Comparative Effectiveness of First-Line Medications for Primary Open-Angle Glaucoma: A Systematic Review and Network Meta-analysis. Ophthalmology. 2016 Jan;123(1):129-40. doi: 10.1016/j.ophtha.2015.09.005. Epub 2015 Oct 31. PMID: 26526633; PMCID: PMC4695285.</ref> | ||
*The mainstay of treatment for treatment in infectious causes include | *The mainstay of treatment for treatment in infectious causes include a[[ntibacterial]], [[antiviral]] or [[anti parasite]] agents. | ||
*Patients with uveitis, iritis and optic neuritis can be treated with corticosteroids. | *Patients with [[uveitis]], [[iritis]] and [[optic neuritis]] can be treated with [[corticosteroids]]. | ||
*Patients with temporal arteritis are treated with high dose of corticosteroids. | *Patients with [[temporal arteritis]] are treated with high dose of [[corticosteroids]].<ref>Fraser JA, Weyand CM, Newman NJ, Biousse V. The treatment of giant cell arteritis. Rev Neurol Dis. 2008 Summer;5(3):140-52. PMID: 18838954; PMCID: PMC3014829.</ref><ref>Chan CC, Paine M, O'Day J. Steroid management in giant cell arteritis. Br J Ophthalmol. 2001 Sep;85(9):1061-4. doi: 10.1136/bjo.85.9.1061. PMID: 11520757; PMCID: PMC1724128.</ref> | ||
*Treatment of high blood pressure is medical therapy with anti hypertensive | *Treatment of [[high blood pressure]] is medical therapy with [[anti hypertensive medication]]s. | ||
===Surgery=== | ===Surgery=== | ||
*Surgical intervention like LASIK is commonly used to correct a refractive error. | *[[Surgical intervention]] like [[LASIK]] is commonly used to correct a [[refractive error]]. | ||
*Surgery is the mainstay of treatment for cataract and retinal detachment. | * Laser treatments and surgical procedures for presbyopia haven't yet been well studied .<ref>InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. How can presbyopia be corrected? [Updated 2020 Jun 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK423827/</ref> | ||
*Vitrectomy is used in treatment of Diabetic retinopathy.<ref> Oellers P, Mahmoud TH. Surgery for Proliferative Diabetic Retinopathy: New Tips and Tricks. J Ophthalmic Vis Res. 2016 Jan-Mar;11(1):93-9. doi: 10.4103/2008-322X.180697. PMID: 27195092; PMCID: PMC4860995.</ref> | *Surgery is the mainstay of treatment for [[cataract]] and [[retinal detachment]]. | ||
*Different types of surgeries to treat glaucoma are Trabeculoplasty ,Iridotomy and Trabeculectomy.<ref>Garg A, Gazzard G. Selective laser trabeculoplasty: past, present, and future. Eye (Lond). 2018 May;32(5):863-876. doi: 10.1038/eye.2017.273. Epub 2018 Jan 5. Erratum in: Eye (Lond). 2020 Aug;34(8):1487. PMID: 29303146; PMCID: PMC5944654.</ref> | *[[Vitrectomy]] is used in treatment of [[Diabetic retinopathy]].<ref> Oellers P, Mahmoud TH. Surgery for Proliferative Diabetic Retinopathy: New Tips and Tricks. J Ophthalmic Vis Res. 2016 Jan-Mar;11(1):93-9. doi: 10.4103/2008-322X.180697. PMID: 27195092; PMCID: PMC4860995.</ref> | ||
*Different types of surgeries to treat [[glaucoma]] are [[Trabeculoplasty]] ,[[Iridotomy]] and [[Trabeculectomy]].<ref>Garg A, Gazzard G. Selective laser trabeculoplasty: past, present, and future. Eye (Lond). 2018 May;32(5):863-876. doi: 10.1038/eye.2017.273. Epub 2018 Jan 5. Erratum in: Eye (Lond). 2020 Aug;34(8):1487. PMID: 29303146; PMCID: PMC5944654.</ref> | |||
===Primary Prevention=== | ===[[Primary Prevention]]=== | ||
Preventive measures in developing diabetic retinopathy include a healthy lifestyle, controlling hypertension, stringent lipid control and periodic ophthalmic examinations. PMID: 17216945 | Preventive measures in developing [[diabetic retinopathy]] include a [[healthy lifestyle]], controlling hypertension, stringent [[lipid control]] and periodic [[ophthalmic examinations]]. <ref>Koura MR, Khairy AE, Abdel-Aal NM, Mohamed HF, Amin GA, Sabra AY. The role of primary health care in patient education for diabetes control. J Egypt Public Health Assoc. 2001;76(3-4):241-64. PMID: 17216945.</ref>. Studies have confirmed an increased risk of AMD among smokers; so, smokers should be encouraged to quit.<ref>Cheng AC, Pang CP, Leung AT, Chua JK, Fan DS, Lam DS. The association between cigarette smoking and ocular diseases. Hong Kong Med J. 2000 Jun;6(2):195-202. PMID: 10895144</ref> | ||
===Secondary Prevention=== | |||
*Effective measures for the secondary prevention of blurred vision due to refractive errors is early detection and treatment of refractive errors in school vision programs. | ===[[Secondary Prevention]]=== | ||
*Secondary Prevention of Atherosclerotic Cardiovascular Disease includes lifestyle interventions,weight management,anti hypertensive agents, stain therapy,Anti- platelet Therapy,diabetes treatment and Cigarette/Tobacco Cessation. | *Effective measures for the[[ secondary prevention]] of blurred vision due to [[refractive errors]] is early detection and treatment of [[refractive errors]] in [[school vision programs]].<ref>Evans JR, Morjaria P, Powell C. Vision screening for correctable visual acuity deficits in school-age children and adolescents. Cochrane Database Syst Rev. 2018 Feb 15;2(2):CD005023. doi: 10.1002/14651858.CD005023.pub3. PMID: 29446439; PMCID: PMC6491194</ref> | ||
*Secondary Prevention of [[Atherosclerotic Cardiovascular]] Disease includes [[lifestyle interventions]],[[weight management]],[[anti hypertensive agents]], [[stain therapy]],[[Anti- platelet]] Therapy,[[diabetes treatment]] and [[Cigarette/Tobacco Cessation]]. | |||
==References== | ==References== | ||
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!Cause of blurred vision!!Unilateral!!Bilateral!!Eye pain!!Onset!!Associated symptoms! | !Cause of blurred vision!!Unilateral!!Bilateral!!Eye pain!!Onset!!Associated symptoms! | ||
|- | |- | ||
|'''Refractive errors'''||+||+||-||gradual||headache,head tilt, rubbing eye | |'''[[Refractive errors]]'''||+||+||-||gradual||[[headache]],[[head tilt]], rubbing eye | ||
|- | |- | ||
|'''[[Glaucoma]]'''||+|| ||+|| ||red eye, Headache, Nausea | |'''[[Glaucoma]]'''||+|| ||+|| ||[[red eye]], [[Headache]], [[Nausea]] | ||
|- | |- | ||
|'''[[Age-related macular degeneration]]'''|| ||+||-|| | |'''[[Age-related macular degeneration]]'''|| ||+||-||gradual||extra sensitivity to glare | ||
|- | |- | ||
|'''[[Cataracts]]'''||+||+||-||gradual|| loss of Night Vision, halos | |'''[[Cataracts]]'''||+||+||-||gradual|| loss of [[Night Vision]], [[halos]] | ||
|- | |- | ||
|'''[[Diabetes retinopathy]]'''|| ||+||-||gradual||Polyuria, Polydipsia, polyphagia | |'''[[Diabetes retinopathy]]'''|| ||+||-||gradual||[[Polyuria]], [[Polydipsia]], [[polyphagia]] | ||
|- | |- | ||
|'''[[Presbyopia]]'''|| +||+ || -|| gradual|| | |'''[[Presbyopia]]'''|| +||+ || -|| gradual|| | ||
|- | |- | ||
|'''keratitis'''||+|| ||+||sudden ||eye redness,photophobia,A feeling that something is in the eye | |'''[[keratitis]]'''||+|| ||+||sudden ||[[eye redness]],[[photophobia]],A feeling that something is in the eye | ||
|- | |- | ||
|'''conjunctivitis'''||+||+||+/-|| sudden|| eye redness,photophobia,A feeling that something is in the eye,Increased lacrimation | |'''[[conjunctivitis]]'''||+||+||+/-|| sudden|| [[eye redness]][[,photophobia]],A feeling that something is in the eye,Increased [[lacrimation ]] | ||
|- | |- | ||
|'''Uveitis'''||+|| ||+||sudden || eye redness, floaters,photophobia,Increased lacrimation | |'''[[Uveitis]]'''||+|| ||+||sudden || [[eye redness]], [[floaters]],[[photophobia]],Increased [[lacrimation ]] | ||
|- | |- | ||
|'''Iritis'''||+|| ||+||sudden ||light sensitivity | |'''[[Iritis]]'''||+|| ||+||sudden ||[[light sensitivity]] | ||
|- | |- | ||
|'''[[Retinal detachment]]'''||+|| ||-||sudden||curtain | |'''[[Retinal detachment]]'''||+|| ||-||sudden||curtain | ||
|- | |- | ||
|'''Infectious Retinitis'''||+||+||+/-||gradual ||Loss of night vision,tunnel vision | |'''[[Infectious Retinitis]]'''||+||+||+/-||gradual ||Loss of [[night vision]],[[tunnel vision]] | ||
|- | |- | ||
|'''Eye trauma''' ([[Hyphema]])||+|| ||+||sudden||bleeding in the front of the eye,light sensitivity | |'''[[Eye trauma]]''' ([[Hyphema]])||+|| ||+||sudden||bleeding in the front of the eye,[[light sensitivity]] | ||
|- | |- | ||
|'''[[Vitreous hemorrhage]]'''||+|| ||- ||sudden||Floaters | |'''[[Vitreous hemorrhage]]'''||+|| ||- ||sudden||[[Floaters]] | ||
|- | |- | ||
|'''Lung cancer metastasis'''||+||+||- || ||depends on the site of metastasis | |'''[[ Lung cancer metastasis ]]'''||+||+||- || ||depends on the site of [[metastasis]] | ||
|- | |- | ||
|'''[[ | |'''[[Migraine]]'''||+||+||- ||sudden||[[aura]],[[headache]] [[,nausea]] | ||
|- | |- | ||
|'''[[Central retinal artery occlusion]]'''||+|| ||-||sudden||complete sight loss | |'''[[ Central retinal artery occlusion ]]'''||+|| ||-||sudden||[[complete sight loss]] | ||
|- | |- | ||
|'''[[Central retinal vein occlusion]]'''||+|| ||-||sudden||complete sight loss | |'''[[ Central retinal vein occlusion ]]'''||+|| ||-||sudden||[[complete sight loss]] | ||
|- | |- | ||
|'''Brain tumor'''||+||+|| -|| || headache, focal neurological symptoms | |'''[[Brain tumor]]'''||+||+|| -|| || [[headache]], [[focal neurological symptoms]] | ||
|- | |- | ||
|'''[[Optic neuritis]]'''||+|| ||+||sudden/gradual || Flashing lights | |'''[[Optic neuritis]]'''||+|| ||+||sudden/gradual || [[Flashing lights]] | ||
|- | |- | ||
|'''stroke'''|| ||+||-|| sudden|| ataxia, hemiplegia, [[dysarthria]] | |'''[[stroke]]'''|| ||+||-|| sudden|| [[ataxia]], [[hemiplegia]], [[dysarthria]] | ||
|- | |- | ||
|'''[[Papilloedema]]'''|| ||+||-||sudden||Headache,nausea | |'''[[Papilloedema]]'''|| ||+||-||sudden||[[Headache]],[[nausea]] | ||
|- | |- | ||
|'''[[Temporal arteritis]]'''||Mostly|| || -||sudden||[[Amaurosis fugax]], headache,Diplopia | |'''[[Temporal arteritis]]'''||Mostly|| || -||sudden||[[Amaurosis fugax]], [[headache]],[[Diplopia]] | ||
|- | |- | ||
|'''[[High blood pressure]]'''||+||+|| - ||sudden|||headache,nausea | |'''[[High blood pressure]]'''||+||+|| - ||sudden|||[[headache]],[[nausea]] | ||
|- | |- | ||
|'''[[Orbital cellulitis]]'''||+|| || + ||sudden|||Swollen eye,red eyes, fever | |'''[[Orbital cellulitis]]'''||+|| || + ||sudden|||[[ Swollen eye ]],[[red eyes]], [[fever]] | ||
|- | |- | ||
|'''drugs-induced''' || ||+||-|| || symptoms related to the medication | |'''drugs-induced''' || ||+||-|| || symptoms related to the medication | ||
|- | |- | ||
|'''[[Sjögren's syndrome]]'''|||| +||-||gradual||Eye dryness, redness,Burning eyes | |'''[[Sjögren's syndrome]]'''|||| +||-||gradual||[[Eye dryness]], redness,[[Burning eyes]] | ||
|} | |} | ||
Revision as of 13:19, 11 April 2021
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief:
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.
Historical Perspective
There is not much information regarding the historical perspective of blurred vision.
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:[1] [2]
- 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 [3] ,Leukemia)
- Optic neuritis
- Cerebrovascular disease (TIA, stroke)
- Vasculitis (Temporal arteritis,SLE)
- High blood pressure
- Medication
Epidemiology and Demographics
Patients of all age groups may develop blurred vision.Approximately one in three persons by the age of 65 has some form of vision-reducing eye disorder .[4]
Risk Factors
Risk factors in the development of blurred vision include Genetic,Nutritional,Family history,Diabetes mellitus,Age,Hyperlipidemia,Hypertension,Toxins, Exposure to ultraviolet light.[5] [6]
Screening
- According to the American Diabetes Association’s patients with type 1 and type 2 diabetes should have comprehensive eye examination within 5 years after the onset of diabetes and at the time of diagnosis ,respectively. [7] The eye examination should be considered at least annually thereafter.
- There is insufficient evidence to recommend routine screening for Glaucoma. USPSTF suggests that patients at increased risk, especially African Americans and older adults, talk to their primary care clinician or eye care specialist for advice about glaucoma screening.
- The USPSTF[8]. recommends annual screening for adults aged 40 years or older and for those who are at increased risk for high blood pressure.[3] Persons at increased risk include those who have high-normal blood pressure (130 to 139/85 to 89 mm Hg), those who are overweight or obese, and African Americans. Adults aged 18 to 39 years with normal blood pressure (<130/85 mm Hg) who do not have other risk factors should be rescreened every 3 to 5 years.
Natural History, Complications, and Prognosis
Prognosis of blurred vision depends on the underlying cause.
Diagnosis
There are no established criteria for the diagnosis of blurred vision. The diagnosis of blurred vision is based on taking detailed medical history and eye examination.Patient Should be asked about the onset, duration, associated symptoms and whether blurred vision is bilateral or unilateral.
History and Symptoms
- The common symptoms which accompany blurred vision include Redness of the eye,Eye pain,Epiphoria,Headache,Photophobia,Halos,Nausea,Polydipsia and polyuria,Dizziness,Numbness.
- Eye examination of patients with blurred vision includes Visual acuity test,Visual fields examination,Slit lamp,Ophthalmoscopy,Tonometry,Angle Test (Gonioscopy)
- The presence of suddenhemiplegia ,abnormal gait,ataxia and dysarthria is diagnostic of cerebrovascular accident.
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 of brain may be helpful in diagnosis of mass occupying lesions or Ischemic and hemorrhagic stroke.
- A magnetic resonance imaging (MRI) study of the brain and orbits may confirm inflammation of the optic nerve.
Treatment
Depends upon the cause, underlying disorders should be addressed.
- Patients with refractive errors and presbyopia[9] can be treated with Corrective lenses[10] and eyeglasses[11].
- Supportive therapy for hyphema[12] includes raising the head of the bed, wearing eye shield and cut back on physical activity.
- There is no treatment for dry macular degeneration.[13]Patients with wet macular degeneration may be treated with Anti-VEGF medications or Photodynamic therapy which help stop the growth of new blood vessels.[14]
Medical Therapy
- Medical therapy of diabetic retinopathy include direct injections or intravitreal administration of anti-inflammatory and antiangiogenesis agents(anti-VEGF drugs [15] [16]) which are widely used pharmacotherapy to effectively treat DR and diabetic macular edema (DME).[17]
- Laser treatment is an option in treatment of diabetic retinopathy.[18]
- Pharmacologic medical therapy with eye drops is recommended among patients with Glaucoma.[19] [20] [21]
- The mainstay of treatment for treatment in infectious causes include antibacterial, antiviral or anti parasite agents.
- Patients with uveitis, iritis and optic neuritis can be treated with corticosteroids.
- Patients with temporal arteritis are treated with high dose of corticosteroids.[22][23]
- Treatment of high blood pressure is medical therapy with anti hypertensive medications.
Surgery
- Surgical intervention like LASIK is commonly used to correct a refractive error.
- Laser treatments and surgical procedures for presbyopia haven't yet been well studied .[24]
- Surgery is the mainstay of treatment for cataract and retinal detachment.
- Vitrectomy is used in treatment of Diabetic retinopathy.[25]
- Different types of surgeries to treat glaucoma are Trabeculoplasty ,Iridotomy and Trabeculectomy.[26]
Primary Prevention
Preventive measures in developing diabetic retinopathy include a healthy lifestyle, controlling hypertension, stringent lipid control and periodic ophthalmic examinations. [27]. Studies have confirmed an increased risk of AMD among smokers; so, smokers should be encouraged to quit.[28]
Secondary Prevention
- Effective measures for thesecondary prevention of blurred vision due to refractive errors is early detection and treatment of refractive errors in school vision programs.[29]
- Secondary Prevention of Atherosclerotic Cardiovascular Disease includes lifestyle interventions,weight management,anti hypertensive agents, stain therapy,Anti- platelet Therapy,diabetes treatment and Cigarette/Tobacco Cessation.
References
- ↑ Quillen DA. Common causes of vision loss in elderly patients. Am Fam Physician. 1999 Jul;60(1):99-108. PMID: 10414631.
- ↑ Flaxman SR, Bourne RRA, Resnikoff S, Ackland P, Braithwaite T, Cicinelli MV, Das A, Jonas JB, Keeffe J, Kempen JH, Leasher J, Limburg H, Naidoo K, Pesudovs K, Silvester A, Stevens GA, Tahhan N, Wong TY, Taylor HR; Vision Loss Expert Group of the Global Burden of Disease Study. Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis. Lancet Glob Health. 2017 Dec;5(12):e1221-e1234. doi: 10.1016/S2214-109X(17)30393-5. Epub 2017 Oct 11. PMID: 29032195.
- ↑ Asteriou C, Konstantinou D, Kleontas A, et al. Blurred vision due to choroidal metastasis as the first manifestation of lung cancer: a case report. World J Surg Oncol. 2010;8:2. Published 2010 Jan 8. doi:10.1186/1477-7819-8-2
- ↑ Ganley JP, Roberts J. Eye conditions and related need for medical care. Vital Health Stat 11. 1983;(228):1-69. PMID: 6880057.
- ↑ Gupta VB, Rajagopala M, Ravishankar B. Etiopathogenesis of cataract: an appraisal. Indian J Ophthalmol. 2014 Feb;62(2):103-10. doi: 10.4103/0301-4738.121141. PMID: 24618482; PMCID: PMC4005220.
- ↑ Hyman L. Epidemiology of eye disease in the elderly. Eye (Lond). 1987;1 ( Pt 2):330-41. doi: 10.1038/eye.1987.53. PMID: 3653439.
- ↑ Diabetes Care. Introduction. Diabetes Care. 2010 Jan;33 Suppl 1(Suppl 1):S1-2. doi: 10.2337/dc10-S001. PMID: 20042770; PMCID: PMC2797380.
- ↑ Screening for High Blood Pressure in Adults: Recommendation Statement. Am Fam Physician. 2016 Feb 15;93(4):300-2. PMID: 26926818
- ↑ Charman WN. Developments in the correction of presbyopia I: spectacle and contact lenses. Ophthalmic Physiol Opt. 2014 Jan;34(1):8-29. doi: 10.1111/opo.12091. Epub 2013 Nov 10. PMID: 24205890.
- ↑ Sankaridurg P. Contact lenses to slow progression of myopia. Clin Exp Optom. 2017 Sep;100(5):432-437. doi: 10.1111/cxo.12584. Epub 2017 Jul 28. PMID: 28752898.
- ↑ Shane TS, Knight O, Shi W, Schiffman JC, Alfonso EC, Lee RK. Treating uncorrected refractive error in adults in the developing world with autorefractors and ready-made spectacles. Clin Exp Ophthalmol. 2011 Nov;39(8):729-33. doi: 10.1111/j.1442-9071.2011.02546.x. Epub 2011 Apr 21. PMID: 22050561; PMCID: PMC4139100.
- ↑ Gragg J, Blair K, Baker MB. Hyphema. [Updated 2020 Dec 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507802/
- ↑ Waugh N, Loveman E, Colquitt J, Royle P, Yeong JL, Hoad G, Lois N. Treatments for dry age-related macular degeneration and Stargardt disease: a systematic review. Health Technol Assess. 2018 May;22(27):1-168. doi: 10.3310/hta22270. PMID: 29846169; PMCID: PMC5994642.
- ↑ Hernández-Zimbrón LF, Zamora-Alvarado R, Ochoa-De la Paz L, Velez-Montoya R, Zenteno E, Gulias-Cañizo R, Quiroz-Mercado H, Gonzalez-Salinas R. Age-Related Macular Degeneration: New Paradigms for Treatment and Management of AMD. Oxid Med Cell Longev. 2018 Feb 1;2018:8374647. doi: 10.1155/2018/8374647. PMID: 29484106; PMCID: PMC5816845.
- ↑ Zhao Y, Singh RP. The role of anti-vascular endothelial growth factor (anti-VEGF) in the management of proliferative diabetic retinopathy. Drugs Context. 2018 Aug 13;7:212532. doi: 10.7573/dic.212532. PMID: 30181760; PMCID: PMC6113746.
- ↑ Rios A, Lopez-Galvez M, Navarro-Gil R, Verges R. Diabetic Macular Edema Pathophysiology: Vasogenic versus Inflammatory. J Diabetes Res. 2016;2016:2156273. doi: 10.1155/2016/2156273. Epub 2016 Sep 28. PMID: 27761468; PMCID: PMC5059543.
- ↑ Lu L, Jiang Y, Jaganathan R, Hao Y. Current Advances in Pharmacotherapy and Technology for Diabetic Retinopathy: A Systematic Review. J Ophthalmol. 2018 Jan 17;2018:1694187. doi: 10.1155/2018/1694187. Erratum in: J Ophthalmol. 2018 Dec 2;2018:5047142.
- ↑ Wang W, Lo ACY. Diabetic Retinopathy: Pathophysiology and Treatments. Int J Mol Sci. 2018 Jun 20;19(6):1816. doi: 10.3390/ijms19061816. PMID: 29925789; PMCID: PMC6032159.
- ↑ Dreer LE, Girkin C, Mansberger SL. Determinants of medication adherence to topical glaucoma therapy. J Glaucoma. 2012 Apr-May;21(4):234-40. doi: 10.1097/IJG.0b013e31821dac86. PMID: 21623223; PMCID: PMC3183317.
- ↑ Maier PC, Funk J, Schwarzer G, Antes G, Falck-Ytter YT. Treatment of ocular hypertension and open angle glaucoma: meta-analysis of randomised controlled trials. BMJ. 2005 Jul 16;331(7509):134. doi: 10.1136/bmj.38506.594977.E0. Epub 2005 Jul 1. PMID: 15994659; PMCID: PMC558697.
- ↑ Li T, Lindsley K, Rouse B, Hong H, Shi Q, Friedman DS, Wormald R, Dickersin K. Comparative Effectiveness of First-Line Medications for Primary Open-Angle Glaucoma: A Systematic Review and Network Meta-analysis. Ophthalmology. 2016 Jan;123(1):129-40. doi: 10.1016/j.ophtha.2015.09.005. Epub 2015 Oct 31. PMID: 26526633; PMCID: PMC4695285.
- ↑ Fraser JA, Weyand CM, Newman NJ, Biousse V. The treatment of giant cell arteritis. Rev Neurol Dis. 2008 Summer;5(3):140-52. PMID: 18838954; PMCID: PMC3014829.
- ↑ Chan CC, Paine M, O'Day J. Steroid management in giant cell arteritis. Br J Ophthalmol. 2001 Sep;85(9):1061-4. doi: 10.1136/bjo.85.9.1061. PMID: 11520757; PMCID: PMC1724128.
- ↑ InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. How can presbyopia be corrected? [Updated 2020 Jun 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK423827/
- ↑ Oellers P, Mahmoud TH. Surgery for Proliferative Diabetic Retinopathy: New Tips and Tricks. J Ophthalmic Vis Res. 2016 Jan-Mar;11(1):93-9. doi: 10.4103/2008-322X.180697. PMID: 27195092; PMCID: PMC4860995.
- ↑ Garg A, Gazzard G. Selective laser trabeculoplasty: past, present, and future. Eye (Lond). 2018 May;32(5):863-876. doi: 10.1038/eye.2017.273. Epub 2018 Jan 5. Erratum in: Eye (Lond). 2020 Aug;34(8):1487. PMID: 29303146; PMCID: PMC5944654.
- ↑ Koura MR, Khairy AE, Abdel-Aal NM, Mohamed HF, Amin GA, Sabra AY. The role of primary health care in patient education for diabetes control. J Egypt Public Health Assoc. 2001;76(3-4):241-64. PMID: 17216945.
- ↑ Cheng AC, Pang CP, Leung AT, Chua JK, Fan DS, Lam DS. The association between cigarette smoking and ocular diseases. Hong Kong Med J. 2000 Jun;6(2):195-202. PMID: 10895144
- ↑ Evans JR, Morjaria P, Powell C. Vision screening for correctable visual acuity deficits in school-age children and adolescents. Cochrane Database Syst Rev. 2018 Feb 15;2(2):CD005023. doi: 10.1002/14651858.CD005023.pub3. PMID: 29446439; PMCID: PMC6491194