Some Causes of Blurred Vision
Cause | Suggestive Findings | Diagnostic Approach |
|---|---|---|
Opacification of eye structures | ||
Gradual onset, often risk factors (eg, aging, corticosteroid use), loss of contrast, glare Lens opacification on ophthalmoscopy or slit-lamp examination | Ophthalmic evaluation | |
Corneal opacification (eg, posttraumatic or postinfectious scarring) | Corneal abnormalities on slit-lamp examination | Ophthalmic evaluation |
Disorders affecting the retina | ||
Sudden or gradual onset, central vision affected (central scotoma) without loss of peripheral vision, macular drusen or scarring, neovascular membrane | Fundoscopy | |
Infectious retinitis (eg, cytomegalovirus, Toxoplasma) | Usually HIV infection or other immunosuppressive disorder, often eye redness or pain, abnormal retinal findings | Fundoscopy Studies as clinically indicated (eg, anti-Toxoplasma antibodies) |
Primarily night blindness, gradual onset, pigmented retinal lesions | Fundoscopy Specialized testing by ophthalmologist (eg, dark adaptation, electroretinography) | |
Retinopathy associated with systemic disorders (eg, hypertension, systemic lupus erythematosus, diabetes, Waldenström macroglobulinemia, multiple myeloma, or other disorders that could cause hyperviscosity syndrome) | Risk factors, retinal abnormalities detected during ophthalmoscopy (see table Interpretation of Some Red Flag Eye Findings) | Testing as indicated for clinically suspected disorders |
Risk factors (eg, diabetic retinopathy, uveitis, retinal detachment or ocular injury) Blurry or distorted vision (eg, straight lines appear wavy) | Fundoscopy Optical coherence tomography | |
Macular hole | Blurry vision, initially central | Fundoscopy Optical coherence tomography |
Risk factors (eg, hypertension, age, glaucoma) Painless vision loss (usually sudden) Sometimes, blurry vision | Fundoscopy Sometimes, optical coherence tomography | |
Disorders affecting the optic nerve or neural pathways | ||
Gradual onset unless due to multiple sclerosis (in which onset of optic neuritis is rapid) Often unilateral or asymmetric Pain with eye movement, direct pupillary light reflex decreased more than consensual (afferent pupillary defect), sometimes loss of optic disk margins and/or globe tenderness | Often MRI of brain and orbits to rule out multiple sclerosis | |
Disorders affecting focus | ||
Visual acuity varying with distance from objects, acuity corrected with refraction | Clinical refraction by an optometrist or ophthalmologist | |