Vision problems

Causes

Vision changes and problems can be caused by many different conditions. Some include:

• Presbyopia -- difficulty focusing on objects that are close. This problem often becomes noticeable in your early to mid 40s.
• Cataracts -- cloudiness over the eye lens, causing poor nighttime vision, halos around lights, and sensitivity to glare. Cataracts are common in the elderly.
• Glaucoma -- increased pressure in the eye, which is most often painless. Vision will be normal at first, but over time you can develop poor night vision, blind spots, and loss of vision to either side. Glaucoma can also happen suddenly, which is a medical emergency.
• Diabetic eye disease
• Macular degeneration -- loss of central vision, blurred vision (especially while reading), distorted vision (straight lines will appear to be wavy), and colors that look faded. The most common cause of blindness in people over age 60.
• Eye infection, inflammation, or injury
• Floaters -- tiny particles drifting inside the eye, which may be confused with retinal detachment.
• Night blindness
• Retinal detachment -- symptoms include floaters, sparks or flashes of light in your vision, or a sensation of a shade or curtain hanging across part of your visual field.
• Optic neuritis -- inflammation of the optic nerve from infection or multiple sclerosis. You may have pain when you move your eye or touch it through the eyelid.
• Stroke or TIA
• Brain tumor
• Bleeding into the eye
• Temporal arteritis -- inflammation of an artery in the brain that supplies blood to the optic nerve
• Migraine headaches -- spots of light, halos, or zigzag patterns that appear before the start of the headache

Medications can also affect vision.

Home Care

See your health care provider if you have any problems with your eyesight.

When to Contact a Medical Professional

Seek emergency care from a health care provider who is experienced in dealing with eye emergencies if:

• You experience partial or complete blindness in one or both eyes, even if it is only temporary.
• You experience double vision, even if it is temporary.
• You have a sensation of a shade being pulled over your eyes or a curtain being drawn from the side, above, or below.
• Blind spots, halos around lights, or areas of distorted vision appear suddenly.
• You have sudden blurred vision with eye pain, especially if the eye is also red. A red, painful eye with blurred vision is a medical emergency.

Make an appointment for a complete eye exam if you have:

• Trouble seeing objects on either side
• Difficulty seeing at night or when reading
• Gradual loss of the sharpness of your vision
• Difficulty telling colors apart
• Blurred vision when trying to view objects near or far
• Diabetes or a family history of diabetes
• Eye itching or discharge
• Vision changes that seem related to medication (Do NOT stop or change a medication without talking to your doctor.)

What to Expect at Your Office Visit

Your health care provider will check your vision, eye movements, pupils, the back of your eye (called the retina), and eye pressure. An overall medical evaluation will be done if needed.

It will be helpful to your health care provider if you can describe your symptoms accurately. Think about the following ahead of time:

• Has the problem affected your vision?
• Is there blurring, halos around lights, flashing lights, or blind spots?
• Do colors seem faded?
• Do you have pain?
• Are you sensitive to light?
• Do you have tearing or discharge?
• Do you have dizziness, or does it seem like the room is spinning?
• Do you have double vision?
• Is the problem in one or both eyes?
• When did this begin? Did it occur suddenly or gradually?
• Is it constant or does it come and go?
• How often does it occur? How long does it last?
• When does it occur? Evening? Morning?
• Is there anything that makes it better? Worse?

The health care provider will also ask you about any eye problems you've had in the past:

• Has this ever happened before?
• Have you been given eye medications?
• Have you had eye surgery or injuries?
• Have you recently traveled out of the country?
• Are there new things you could be allergic to, such as soaps, sprays, lotions, creams, cosmetics, laundry products, curtains, sheets, carpets, paint, or pets?

The health care provider will also ask about your general health and family history:

• Do you have any known allergies?
• When did you last have a general check-up?
• Are you taking any medications?
• Have you been diagnosed with any medical conditions, such as diabetes or high blood pressure?
• What kinds of eye problems do your family members have?

The following tests may be performed:

• Dilated eye exam
• Slit-lamp examination
• Refraction (test for glasses)
• Tonometry (eye pressure test)

Treatments depend on the cause. Surgery will be recommended for some conditions.

Prevention

Regular eye checkups from an ophthalmologist or optometrist are important. They should be done once a year if you are over age 65. Some experts recommend annual eye exams starting at an earlier age.

How long you go between exams is based on how long you can wait before detecting an eye problem that has no symptoms. Your health care provider will recommend earlier and more frequent exams if you have known eye problems or conditions that are known to cause eye problems, such as diabetes or high blood pressure.

These important steps can prevent eye and vision problems:

• Wear sunglasses to protect your eyes.
• Wear safety glasses when hammering, grinding, or using power tools.
• If you need glasses or contact lenses, keep the prescription up to date.
• Don't smoke.
• Limit how much alcohol you drink.
• Stay at a healthy weight.
• Keep your blood pressure and cholesterol under control.
• Keep your blood sugar under control if you have diabetes.
• Eat foods rich in antioxidants, like green leafy vegetables.

Alternative Names

Vision impairment; Impaired vision; Blurred vision

References

U.S. Preventive Services Task Force. Screening for Impaired Visual Acuity in Older Adults. U.S. Preventive Services: Task Force recommendation statement. Ann Intern Med. 2009;151:37-43.

Yanoff M, Cameron d. Diseases of the visual system. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 431.

Thurtell MJ, Tomsak RL. Vision loss. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 14.

Olitsky SE, Hug D, Smith LP. Disorders of vision. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 613.

Update Date: 9/3/2012

Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.