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ULY CLINIC

20 Septemba 2025, 02:12:28

Visual blurring

Visual blurring is a common symptom defined as the loss of visual acuity with indistinct visual details. It may result from ocular or neurologic disorders, systemic vascular disease (e.g., diabetes mellitus), trauma, refractive errors, corneal mucus, improperly fitted contact lenses, or certain medications. The severity may range from mild distortion to severe vision impairment. Prompt evaluation is necessary to identify treatable causes and prevent permanent vision loss.

History and Physical Examination

History

Onset: sudden, acute, or gradual.
Timing: intermittent vs persistent; time of day or activity-related.
Associated symptoms: eye pain, discharge, photophobia, floaters, halos, double vision.
History of trauma: details of injury, timing of visual impairment.
Medical history: hypertension, diabetes, neurological disease, previous ocular disorders.
Medication history: cycloplegics, reserpine, clomiphene, phenylbutazone, thiazide diuretics, antihistamines, anticholinergics, phenothiazines.

Emergency signs: sudden severe eye pain, acute vision loss, or penetrating/perforating eye trauma warrants immediate ophthalmology consultation.

Physical Examination

Inspect eyelids, conjunctiva, and sclera for edema, redness, or discharge.
Note iris irregularities suggesting previous trauma.
Observe excessive blinking, which may indicate corneal damage.
Assess pupillary size, shape, and reactions to light.
Test visual acuity in both eyes using Snellen letter or symbol charts.
Perform slit-lamp or tonometry if indicated.

Medical causes

Cause	Onset	Key Features	Associated Findings	Pathophysiology	Management
Brain tumor	Gradual	Visual blurring	LOC changes, headache, behavioral changes, seizures, ataxia	Mass effect, raised ICP	Neuroimaging, surgery, chemotherapy/radiotherapy
Cataract	Gradual	Painless blurring, halo vision	Gray/milky white pupil, glare in bright light	Lens opacity	Surgical extraction
Concussion	Acute	Temporary blurred/double vision	LOC changes, headache, behavioral changes	CNS dysfunction post-trauma	Supportive care, monitoring
Corneal abrasions	Acute	Blurred vision with severe pain	Photophobia, redness, tearing	Epithelial disruption	Topical antibiotics, pain management
Corneal foreign body	Acute	Blurring, foreign-body sensation	Tearing, miosis, conjunctival injection, pain	Mechanical corneal injury	Foreign body removal, topical antibiotics
Diabetic retinopathy	Gradual	Blurring, progressive vision loss	Retinal hemorrhages, edema	Retinal vascular damage	Glycemic control, laser therapy, anti-VEGF
Dislocated lens	Acute/subacute	Visual distortion/blurring	Redness if traumatic	Lens displacement	Surgical reposition or removal
Eye tumor	Gradual	Blurring if macula involved	Visual field defects	Mass effect in retina	Ophthalmology referral, surgical or medical treatment
Glaucoma (acute angle-closure)	Acute	Sudden blurring, severe pain	Halo vision, dilated nonreactive pupil, nausea/vomiting	Sudden IOP elevation	Ophthalmology emergency, pressure-lowering drops, IV acetazolamide
Hereditary corneal dystrophies	Gradual	Progressive blurring	Photophobia, tearing, corneal opacities	Genetic corneal degeneration	Supportive care, surgery if needed
Hypertension	Acute/gradual	Blurring, morning headache	Confusion, nausea, vomiting, seizures	Hypertensive retinopathy	Blood pressure management
Hyphema	Acute	Blurring after trauma	Blood in anterior chamber, pain, lid ecchymoses	Anterior chamber hemorrhage	Ophthalmology consultation, protective eye shield
Iritis	Acute	Sudden blurring, moderate to severe pain	Constricted pupil, photophobia, conjunctival injection	Iris inflammation	Topical corticosteroids, cycloplegics
Optic neuritis	Acute/subacute	Blurring with eye pain	Scotomas, hyperemic optic disk, blurred disk margins	Optic nerve inflammation/demyelination	Corticosteroids, treat underlying cause
Retinal detachment	Acute	Blurred vision, shadow or curtain	Visual floaters, flashes of light	Separation of retina from RPE	Emergency surgical repair
Retinal vein occlusion	Gradual	Unilateral blurring	Variable vision loss	Retinal venous obstruction	Laser therapy, anti-VEGF
Senile macular degeneration	Gradual	Blurring, initially worse at night	Progressive central vision loss	Macular degeneration	Anti-VEGF therapy, low-vision aids
Stroke	Acute/brief	Transient bilateral blurring	Hemiplegia, aphasia, dysarthria, ataxia, seizures	Cerebrovascular ischemia	Stroke management, rehabilitation
Temporal arteritis	Acute	Sudden blurred vision, headache	Malaise, weight loss, tender temporal arteries	Vascular inflammation	High-dose corticosteroids
Vitreous hemorrhage	Acute	Blurred vision, floaters	Variable vision loss	Intraocular bleeding	Treat underlying cause, vitrectomy if needed

Other causes

Drug-induced visual blurring: cycloplegics, reserpine, clomiphene, phenylbutazone, thiazides, antihistamines, anticholinergics, phenothiazines.

Special considerations

Prepare the patient for diagnostic tests: tonometry, slit-lamp exam, skull/orbit X-rays, CT/MRI for neurologic lesions.
Teach proper ophthalmic medication administration.
Provide emotional support for permanent visual loss and ensure patient safety.
Prepare for surgical intervention if indicated.

Patient counseling

Teach correct eye-drop instillation techniques.
Emphasize environmental safety to prevent injury.
Maintain orientation and independence for visually impaired patients.

Pediatric pointers

Causes include congenital cataracts, congenital infections (syphilis, rubella), refractive errors, eye injuries, increased intracranial pressure.
Test vision in children:
- Ages 3–6: Snellen symbol chart.
- Toddlers: Allen cards with familiar objects; record distance where at least 3 objects are correctly identified.
Refer promptly to pediatric ophthalmology for suspected pathology.

Geriatric pointers

Increased myopia due to lens changes.
Decreased near-vision acuity with age.
Monitor for cataract, glaucoma, macular degeneration, and age-related retinal changes.

References

Gerstenblith AT, Rabinowitz MP. The Wills Eye Manual. 7th ed. Philadelphia (PA): Lippincott Williams & Wilkins; 2012.
Holland EJ, Mannis MJ, Lee WB. Ocular Surface Disease: Cornea, Conjunctiva, and Tear Film. London (UK): Elsevier Saunders; 2013.
Roy FH. Ocular Differential Diagnosis. Clayton, Panama: Jaypee – Highlights Medical Publishers, Inc.; 2012.
Kanski JJ, Bowling B. Clinical Ophthalmology: A Systematic Approach. 9th ed. London (UK): Elsevier; 2011.
Biswas J, Krishnakumar S, Ahuja S. Manual of Ocular Pathology. New Delhi, India: Jaypee – Highlights Medical Publishers; 2010.
American Academy of Ophthalmology. AAO Basic and Clinical Science Course. San Francisco (CA): AAO; 2021.
Foroozan R. Visual blurring: Evaluation and management. Ophthalmol Clin North Am. 2018;31:13–28.
Morgan ML, Katsnelson J. Ophthalmology Review Manual. 5th ed. Philadelphia (PA): Wolters Kluwer; 2017.
Kanski JJ, Salmon JF. Clinical Ophthalmology: A Systematic Approach. 8th ed. Elsevier; 2016.
American Optometric Association. Comprehensive Eye and Vision Examination Guidelines. St. Louis (MO): AOA; 2020.
Wong TY, Mitchell P. The eye in systemic disease. Lancet. 2007;370:1361–1373.
Choudhury P, Choudhury A. Pediatric ocular emergencies. Indian J Ophthalmol. 2011;59:97–103.
Taylor D. Geriatric ophthalmology: Age-related changes in vision and ocular anatomy. Clin Geriatr Med. 2015;31:285–300.