Blurred vision

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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]

Epidemiology and Demographics

Patients of all age groups may develop blurred vision.

Risk Factors

Risk factors in the development of blurred vision include Genetic,Nutritional,Family history,Diabetes mellitus,Age,Hyperlipidemia,Hypertension,Toxins.[3] [4]

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. [5] 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[6]. 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

Physical Examination

Laboratory Findings

CT scan

MRI

Treatment

Depends upon the cause, underlying disorders should be addressed.

Medical Therapy

Surgery

Primary Prevention

Preventive measures in developing diabetic retinopathy include a healthy lifestyle, controlling hypertension, stringent lipid control and periodic ophthalmic examinations. [20]

Secondary Prevention

References

  1. Quillen DA. Common causes of vision loss in elderly patients. Am Fam Physician. 1999 Jul;60(1):99-108. PMID: 10414631.
  2. 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
  3. 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.
  4. 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.
  5. Diabetes Care. Introduction. Diabetes Care. 2010 Jan;33 Suppl 1(Suppl 1):S1-2. doi: 10.2337/dc10-S001. PMID: 20042770; PMCID: PMC2797380.
  6. Screening for High Blood Pressure in Adults: Recommendation Statement. Am Fam Physician. 2016 Feb 15;93(4):300-2. PMID: 26926818
  7. 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.
  8. 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.
  9. 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.
  10. 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/
  11. 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.
  12. 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.
  13. 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.
  14. 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.
  15. 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.
  16. 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.
  17. 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/
  18. 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.
  19. 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.
  20. 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.
  21. 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


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[blurred vision causes]
Cause of blurred vision Unilateral Bilateral Eye pain Onset Associated symptoms!
Refractive errors + + - gradual headache,head tilt, rubbing eye
Glaucoma + + red eye, Headache, Nausea
Age-related macular degeneration + - gradual extra sensitivity to glare
Cataracts + + - gradual loss of Night Vision, halos
Diabetes retinopathy + - gradual Polyuria, Polydipsia, polyphagia
Presbyopia + + - gradual
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
Uveitis + + sudden eye redness, floaters,photophobia,Increased lacrimation
Iritis + + sudden light sensitivity
Retinal detachment + - sudden curtain
Infectious Retinitis + + +/- gradual 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 + + - depends on the site of metastasis
Migraine + + - sudden aura,headache ,nausea
Central retinal artery occlusion + - sudden complete sight loss
Central retinal vein occlusion + - sudden complete sight loss
Brain tumor + + - headache, focal neurological symptoms
Optic neuritis + + sudden/gradual Flashing lights
stroke + - sudden ataxia, hemiplegia, dysarthria
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
drugs-induced + - symptoms related to the medication
Sjögren's syndrome + - gradual Eye dryness, redness,Burning eyes