blurred_vision
Table of Contents
the patient with acute blurred vision or visual loss / blindness
see also:
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:
- retinal detachment - may have photopsia, visual field defect, floaters
- temporal arteritis - high ESR or CRP with tender scalp artery - consider biopsy and high dose steroids ASAP
- other causes which should be considered but are not as time critical include
- RVO - no ED Rx currently available
photopsia
- flashes of light
- may be caused by pathologic stimulation of the retina and production of phosphenes
aetiology
- sensory deprivation (ophthalmopathic hallucinations)
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
- vitreous haemorrhage
- haemorrhage from macular degeneration
- internal carotid artery occlusion
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: 2019/03/28 23:25 by 127.0.0.1