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Vision, Blurred

By

Christopher J. Brady

, MD, Wilmer Eye Institute, Retina Division, Johns Hopkins University School of Medicine

Last full review/revision Jun 2021
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Blurred vision is the most common vision symptom. When doctors talk about blurred vision, they typically mean a decrease in sharpness or clarity that has developed gradually. Sudden, complete loss of vision in one or both eyes (blindness Vision Loss, Sudden Loss of vision is considered sudden if it develops within a few minutes to a couple of days. It may affect one or both eyes and all or part of a field of vision. Loss of only a small part of... read more ) is considered something different.

Causes

Blurred vision has four general mechanisms:

  • Disorders affecting the retina, the light-sensing structure at the back of the eye

  • Clouding of normally transparent eye structures (cornea, lens, and vitreous humor—the jellylike substance that fills the eyeball) that light rays must pass through to reach the retina

  • Disorders affecting the pathways of nerves that carry visual signals from the eye to the brain (such as the optic nerve)

  • Imperfect focusing of light rays on the retina (refractive errors)

An Inside Look at the Eye

An Inside Look at the Eye

Certain disorders can have more than one mechanism. For example, refraction can be impaired by early cataracts or by the reversible lens swelling caused by poorly controlled diabetes.

Common causes

The most common causes of blurred vision include

What Is Astigmatism?

Astigmatism is an irregularity in the curvature of the cornea or lens. That is, the cornea or lens is curved differently in different directions. This difference causes light traveling in different planes to be focused differently. For example, vertical lines may be in focus when horizontal lines are not (or vice versa). The irregularity can be in any plane, however, and is often different in each eye. A person with astigmatism (each eye should be tested separately) tends to see certain lines more boldly (that is, in better focus) than the others. Astigmatism can be corrected with prescription eyeglasses or contact lenses. It often occurs together with nearsightedness or farsightedness.

The diagram below is of a standard chart used to test for astigmatism in one eye at a time.

What Is Astigmatism?

Less common causes

Rare disorders that can cause blurred vision include

  • Inherited disorders affecting the optic nerve, called hereditary optic neuropathies (for example, dominant optic atrophy and Leber hereditary optic neuropathy)

  • Corneal scarring due to vitamin A deficiency (rare in developed nations)

Table
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Evaluation

The following information can help people decide when a doctor's evaluation is needed and help them know what to expect during the evaluation.

Warning signs

In people with blurred vision, certain symptoms and characteristics are cause for concern. They include

When to see a doctor

People who have warning signs should usually go to an emergency department right away. People who have a bodywide disorder that sometimes causes retinal damage (for example, diabetes, high blood pressure, or sickle cell disease) should see an eye doctor as soon as is practical, usually within a few days. However, if vision has been deteriorating gradually for months or years but has not been severely impaired and there are no warning signs, waiting a week or longer is usually not harmful.

Eye examinations should be done by an ophthalmologist or optometrist. Ophthalmologists are medical doctors who specialize in the evaluation and treatment (surgical and nonsurgical) of all types of eye disorders. Optometrists are health care practitioners who specialize in the diagnosis and treatment of refractive errors (which are treated by prescribing glasses or contact lenses). However, optometrists can often diagnose certain other eye problems and then refer people to an ophthalmologist for treatment. People should usually see an ophthalmologist if they have warning signs.

What the doctor does

Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the blurred vision and the tests that may need to be done (see table Some Causes and Features of Blurred Vision Some Causes and Features of Blurred Vision Blurred vision is the most common vision symptom. When doctors talk about blurred vision, they typically mean a decrease in sharpness or clarity that has developed gradually. Sudden, complete... read more Some Causes and Features of Blurred Vision ).

Doctors ask many questions about the person's symptoms because it is important to understand exactly what the person means by blurred vision. For example, people who have actually lost vision in part of their visual field (visual field defect) may describe this sensation only as blurred vision. The presence of other eye symptoms, such as eye redness, sensitivity to light, floaters, a sensation of sudden flashes of light that can look like lightning, spots, or stars (photopsias), and pain at rest or with eye movement, helps doctors determine the cause. Doctors also ask about the effects of darkness (night vision) and bright lights (for example, causing blur, star bursts, or halos) and whether the person wears corrective lenses.

Doctors also ask questions about symptoms of possible causes and about the presence of disorders that are known to be risk factors for eye disorders (for example, high blood pressure, diabetes, HIV infection or AIDS, and sickle cell disease).

Examination of the eyes may be all that is necessary.

Testing visual acuity (sharpness of vision) is the first step. Ideally, acuity is measured while the person stands about 20 feet (6 meters) from a standard eye chart (Snellen chart) posted or projected on a wall. Each eye is measured separately while the other eye is covered. Visual acuity is measured with and without the person's own glasses. Sometimes the doctor has the person look through a device that has a pinhole. This device can usually correct refractive errors almost completely but does not correct vision that is blurred due to other causes.

Symptoms and findings during the eye examination often help suggest a cause. For example, if visual acuity returns while corrective lenses or a pinhole device is used and the remainder of the eye exam is normal, simple refractive error is usually the cause of blurring.

Testing

Testing depends on the suspected cause of the blurred vision (see table Some Causes and Features of Blurred Vision Some Causes and Features of Blurred Vision Blurred vision is the most common vision symptom. When doctors talk about blurred vision, they typically mean a decrease in sharpness or clarity that has developed gradually. Sudden, complete... read more Some Causes and Features of Blurred Vision ). People with symptoms of bodywide disorders should have appropriate testing. For example, testing might include blood tests for diabetes, systemic lupus erythematosus, or HIV infection, blood pressure monitoring, and possibly electrocardiography if high blood pressure or a kidney disorder is suspected.

Treatment

Underlying disorders are treated. Corrective lenses or surgery may be used to improve visual acuity, sometimes even when the cause is not just refractive error (for example, for early cataracts Cataract read more ).

Essentials for Older People

Although some decrease in visual acuity normally occurs with aging, acuity normally is correctable to 20/20 with refraction, even in very old people.

Key Points

  • Refractive error is the most common cause of blurred vision.

  • If refractive error is the problem, corrective lenses or surgery (particularly if cataracts are the cause of the change in refractive error) can usually correct the blurriness.

  • Doctors check visual acuity and determine whether glasses or a pinhole device corrects the problem, and if it does not, they dilate the eye with drops and carefully examine the retina.

  • People with warning signs should see a doctor as soon as possible.

  • Because glaucoma is common, intraocular pressure is usually measured.

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