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blurred_vision

the patient with acute blurred vision or visual loss / blindness

introduction

  • acute non-traumatic blurred vision is a relatively common presentation to ED
  • patients may use the term blurred vision to cover a number of different symptoms such as:
    • actual decreased acuity
    • transient visual loss (eg. amaurosis fugax)
    • “double vision”
    • photopsia (flashes of light as occurs in migraine aura, retinal detachment, occipital lobe infarction, etc)
    • floaters
    • visual field defect
    • watery eyes
  • patients should be explicitly evaluated to exclude an time-critical ocular emergency such as:
  • other causes which should be considered but are not as time critical include

photopsia

  • flashes of light
  • may be caused by pathologic stimulation of the retina and production of phosphenes

aetiology

floaters

  • new onset of floaters associated with flashing lights is highly suggestive of a retinal tear

aetiology

  • sudden onset of large floaters in the center of the visual axis may indicate posterior_vitreous_detachment (PVD)
    • circular floater when the vitreous detaches from its annular ring surrounding the optic nerve
  • hundreds of tiny black specks is suggestive of a vitreous hemorrhage, resulting from disruption of a retinal vessel caused by a retinal tear or mechanical traction of a vitreoretinal adhesion
    • a few hours later, cobwebs may develop due to formatio of irregular blood clots

acute visual field defect

aetiology

acute non-traumatic monocular persistent vision loss

painless causes

painful vision loss

  • acute glaucoma
  • endophthamitis
  • uveitis
  • keratoconus acute deterioration

amaurosis fugax

  • painless transient visual loss due to reduced blood flow to the eye - may be both eyes or one eye
  • amaurosis fugax preceding persistent loss of vision suggests branch retinal artery occlusion (BRAO) or temporal arteritis
  • consider transient smartphone blindness due to only using one eye to look at smartphone in dark bedroom resulting in transient blindness while both eyes take time to adjust to a subsequent change in ambient lighting
blurred_vision.txt · Last modified: 2019/03/29 10:25 (external edit)