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)



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