Symptomatic Disturbances of Vision

Chayan Pramanik, D. Optom

Student, Pailan College of Management & Technology, Kolkata, India

Visual disturbances affect the normal sight. Several conditions and disorders may cause various types of visual disturbances which are commonly seen in inflammatory conditions of the eye such as retinal detachment, and retinal oedema etc. Some are temporary and can be relieved with treatment. However, some could be irreversible. ⁽¹⁾

Types of visual disturbances: The most common visual disturbances are –

a. Photophobia:

Photophobia is abnormal intolerance to light. ⁽²⁾ Common causes include

1. - Corneal abrasion, Keratitis and retinal damage
  - Lack of pupillary constriction
  - Uveitis
  - Albinism
  - Overstimulation of the photoreceptors
  - Migraine headaches
  - Cataracts
  - Sjogren’s syndrome
  - Mild traumatic brain injury

b. Headaches and eye problems:

Eye strain is when eyes get tired from using them intensely for a long time. Headaches and blurry vision can be symptoms of eye strain. To help, rest your eyes by taking regular breaks using the “20-20-20” rule which is to relax your eyes every 20 minutes by looking at an object at least 20 feet away for at least 20 seconds. ⁽³⁾ Some predisposing factors that can lead to headaches include:

1. - Angle closure glaucoma
  - Giant cell arteritis
  - Sinus problems
  - Arthritis
  - High blood pressure
  - Nerve diseases
  - Vascular disease
  - Migraine
  - Tumours
  - Stroke
  - Aneurysms

c. Diplopia:

Diplopia refers to simultaneous perception of two images of a single object. Diplopia may be monocular or binocular. ⁽⁴⁾

Table 1: Causes of monocular and binocular diplopia

Monocular diplopia	Binocular diplopia
Subluxated lens Double pupil Incipient cataract Keratoconus Eccentric IOL	Paralytic squint Myasthenia gravis Anisometric glasses Thyroid disorders

d. Metamorphopsia:

There is a distortion of the objects seen and this is attributed to rising of the retinal layers which alters the contour of the retina. ⁽⁵⁾

e. Photopsia:

Photopsia is the flashing of light in front of eyes. Some of the most common conditions leading to photopsia include macular degeneration, ocular migraine, optic neuritis, peripheral vitreous detachment, and retinal detachment. ⁽¹⁾

f. Floaters:

Floaters are small dark shapes that float across the vision. They can look like spots, threads, squiggly lines, or even little cobwebs. Most people have floaters that come and go, and they often don’t need treatment. ⁽⁶⁾

Image Courtesy: https://www.medanta.org/patient-education-blog/what-are-eye-floaters-and-how-can-it-affect-your-vision/

j. Halos:

Halos appear as circles of light around objects. Seeing halos around lights are a result of diffraction, an effect that occurs when the light bends while entering the eye. The causes of halos around lights include corneal oedema, cataract, dry eye syndrome, fuch’s dystrophy, astigmatism etc. ⁽⁷⁾

k. Scotoma:

The word scotoma implies blindness in a part of the vision. The scotoma is classified as central and peripheral. Scotoma is seen in optic neuritis, papilledema, anterior ischemic optic neuritis, macular degeneration, glaucoma etc. ⁽⁵⁾

I. Amaurosis fugax:

It refers to a sudden, temporary, and painless monocular visual loss occurring due to a transient failure of retinal circulation. Common causes are carotid transient ischaemic attacks, embolization of retinal circulation, papilledema, giant cell arteritis.⁽⁸⁾

Image Courtesy: https://healthjade.net/amaurosis-fugax/

Diagnosis of visual disturbances

Visual disturbances can be the first symptom of other serious conditions, such as glaucoma, brain tumour, aneurysm, and stroke. These tests are usually performed which are physical examination, eye examination, blood test and imaging test such as CT scan, MRI etc. ⁽¹⁾

Treatment plan for the visual disturbances

The first step in treating a visual disturbance is to find out the underlying problem that’s causing it. In some cases, the disturbance will go away naturally. Common treatment options are medication, glasses or contact lenses, dietary changes, and surgery. ⁽¹⁾

Conclusion

Several conditions and disorders may be the cause of visual disturbance. If someone experiences a visual disturbance that arises suddenly, it is advised to consult an eye care practitioner. Early diagnosis and treatment can prevent irreversible blindness.

References:

1. Holland, K. (2019, August 31). What’s causing disturbances in my vision? Healthline. Retrieved August 17, 2022, from https://www.healthline.com/health/visual-disturbances
2. Melissa Conrad Stöppler, M. D. (2019, September 10). Photophobia: Symptoms, signs, causes & treatment. MedicineNet. Retrieved August 17, 2022, from https://www.medicinenet.com/photophobia/symptoms.htm
3. Mayo Foundation for Medical Education and Research. (n.d.). Mayo Clinic. Retrieved August 17, 2022, from https://www.mayoclinic.org/
4. Khurana, A. K., Khurana, A. K., Khurana, B., & Khurana, A. K. (2019). Comprehensive ophthalmology. Jaypee Brothers Medical Publishers.
5. Agarwal, L. P. (1962). Eye diseases. Kitab Mahal.
6. Photopsias. (n.d.). Retrieved August 18, 2022, from https://eyerounds.org/tutorials/photopsias/index.htm
7. Ferreira, L. (2021, December 18). What causes halos around lights? Verywell Health. Retrieved August 18, 2022, from https://www.verywellhealth.com/halos-around-lights-5092835
8. Thoveson, A., Baig, I. F., Mortensen, P. W., & Lee, A. G. (2022). Hypnic Amaurosis Fugax. Journal of Neuro-Ophthalmology, 42(1), e357-e358.