Blurry Vision - Differential Diagnosis Framework Anatomical Approach to Eye Disease: 1. Lids/Lashes 2. Extraocular Muscles/Motility 3. Conjunctiva/Sclera 4. Cornea 5. Anterior Chamber 6. Iris 7. Lens 8. Vitreous 9. Optic Nerve/Pathway/Chiasm 10. Retina 11. Refractive Errors 12. Ocular Adverse Effects of Systemic Medications 13. Trauma Cornea/Iris: • Keratitis • Corneal abrasion • Astigmatism • Hyphema • Laceration • Ulcer • Iritis Conjunctiva/Uvea: • Conjunctivitis • Uveitis Lens: • Cataracts • Lens edema • Lens dislocation • Presbyopia • Hyperglycemia Vitreous: • Floaters Orbit: • Orbital cellulitis • Endophthalmitis • Scleritis Optic Pathway: • Inflammation • Optic neuritis • Tumor • Optic nerve swelling Retina: • Detachment • Macular degeneration • Diabetic retinopathy • Macular hole • Hypertensive retinopathy • Central retinal vein occlusion - Retinal vein occlusions are much more common than retinal arterial occlusions Optic Chiasm Lateral Geniculate Nucleus Visual Cortex: • CVA/TIA • Malignancy • Concussion Other Causes of Blurry Vision: • Migraine • Acute angle-closure glaucoma • GCA • Adie’s pupil • Glaucoma • Leber hereditary optic neuropathy (LHON) (Initial blurry vision → visual loss) • Medications (anticholinergics etc) • Alcohol intoxication • Sjögren’s syndrome • Hypervitaminosis A • Carbon monoxide poisoning • Central retinal vein occlusion (Retinal vein occlusions are much more common than retinal arterial occlusions) • Branch retinal vein occlusions Blurry Vision Red Flags: • Sudden change in vision • Eye pain (with or without eye movement) • Visual field defect (by history or examination) • Visible abnormality of the retina or optic disk • HIV/AIDS or other immunosuppressive disorder • Systemic disorder causing retinopathy (sickle cell anemia, possible hyperviscosity syndrome, diabetes, hypertension, Waldenström macroglobulinemia, multiple myeloma) #Blurry #Vision #differential #diagnosis #ophthalmology #causes
