The blurred vision is the most common symptom in ophthalmology. Usually including a gradually increasing loss of vision is understood. In a sudden, complete loss of vision in one or both eyes (blindness), acute visual loss. But small visual field defects (eg., By a mild retinal detachment) can be described by the patient as blurred vision. Etiology The most common causes of visual impairment (s. Common causes of blurred vision) include ametropia (refractive error; most common cause total) Age-related macular degeneration Cataracts Diabetic retinopathy The blurred vision is usually Einder the following four basic mechanisms: clouding of the normally transparent Okularstrukturen ( cornea, lens, vitreous), which have to pass the light beams on the way to retinal disorders of retinal diseases of the optic nerve or its compounds ametropia. Common causes of blurred Cause Typical findings diagnostics Haze for transparent structures of the eye cataract gradual onset, often risk factors (eg. As aging, Kortikosteroideinnahme), loss of contrast, glare The diagnosis can be ophthalmoscope or put through a slit-lamp examination. Clinical examination corneal opacity (z. B. post-traumatic or post-infectious scarring) corneal abnormalities in the slit lamp examination Clinical examination retinal diseases Age-related macular degeneration gradual onset, central vision affected (central scotoma) without loss of peripheral vision, macular drusen or scarring, neovascular membrane fluorescein angiography or other imaging of the retina when clinically indicated Infectious Retin itis (eg. As cytomegalovirus, Toxoplasma) Usually HIV infection or other immunosuppressive disease, often eye redness or pain, abnormal retinal findings investigations as clinically indicated (eg., Anti-Toxoplasma antibodies) retinitis pigmentosa Mainly night blindness, gradual onset, pigmented retinal lesions Diagnosis based on special investigations (z. B. dark adaptation, electroretinography). Retinopathy as part of a systemic disease (eg. As, hypertension, SLE, diabetes, Waldenstrom’s disease, multiple myeloma and other diseases that can cause hyperviscosity syndrome) risk factors, ophthalmoscopic retina abnormalities (s. Interpretation of retinal results) studies based on clinical suspicion macular pucker risk factors (eg., diabetic retinopathy, uveitis, retinal detachment or eye injury) blurred or distorted vision (z. B. straight lines appear wavy). Funduscopy, optical coherence tomography macular vision loss initially centrally Funduscopic optical coherence tomography retinal vein occlusion risk factors (eg. As high blood pressure, age, glaucoma) painless loss of vision (usually sudden) Sometimes, blurred vision Funduscopy Sometimes fluorescein angiography Sometimes optical coherence tomography diseases of the optic nerve or the Sehbahn optic neuritis Gradual onset (in multiple sclerosis rapidly inserting) often one-sided or asymmetric motion-dependent eye pain, direct pupillary response stronger attenuated than the consensual (afferent pupillary defect) sometimes blurred Papillenbegrenzung and / or sensitive eyeball Often MRI to exclude multiple sclerosis refractive error ametropia The visual acuity depends on the distance from the object; Visual acuity with refractive help correctable Clinical visual acuity by an optometrist or ophthalmologist For certain diseases, there are several mechanisms. For example, a cataract in the early stages or a reversible lens swelling under a poorly controlled diabetes can affect the refraction. For certain causes of blurred vision (z. B. acute corneal lesions or abrasions, ulcers, herpes simplex keratitis, herpes zoster ophthalmicus, acute angle-closure glaucoma) are more associated with other symptoms such as eye pain and eye redness. Rarer with blurred diseases associated hereditary optic neuropathies (e.g., as dominant optic atrophy liver) and corneal scars caused by vitamin A deficiency. Clarification history In the current history of onset, duration and course of the symptoms are recognized and the question of whether one or both eyes are affected. The symptom should be described as accurately as possible. These open question be put or requests formulated (z. B. “Please explain exactly what you mean by blurred vision.”). Thus, there is. As a difference between the loss of detail and the loss of contrast. A visual field defect may not be perceived by the patient as such, but it is described instead that steps be overlooked or words are not seen when reading. Important Accompanying symptoms include eye redness, photophobia, suspended, feelings of light flashes (photopsias) and pain at rest or during eye movement. It should be noted the impact darkness (night vision), bright lights (ie, causing blurred vision, Your Stars, Halo See [rings around light see], photophobia) have, subject distance and visual aids and whether the central or peripheral vision seems to be more affected , The investigation of the organ systems includes questions about symptoms of possible causes such as increased thirst and polyuria (diabetes). A history of previous eye injury or other diagnosed eye disease should be recorded and it should by disorders that are known to be risk factors for eye diseases (eg. As asking hypertension, diabetes, HIV / AIDS, systemic lupus erythematosus, sickle cell disease, disorders can cause hyperviscosity syndrome, such as. for example, a multiple myeloma or Waldenstrom’s disease (macroglobulinemia)). The drug history should questions about the use of drugs that can impair vision (z. B. corticosteroids), and disease treatments that affect vision (eg., Diabetic retinopathy), beinhalten.Körperliche investigation Nonvisual symptoms are assessed as needed ; The eye exam is all that is needed eventually. Tests of visual acuity are essential. Many patients do not show the full power. Providing adequate time and a flattering approach to the patient may lead to more accurate results. The visual acuity is ideally so measured that the patient 6 m (20 ft) in front of a Snellen panel which hangs on a wall, is. If this test can not be performed, the visual acuity can be measured by a plaque about 36 cm is held (14 in) in front of the eye. The measurement of the near vision should be done for patients> 40 years using a reading correction. Each eye is measured separately, while the other eye is covered with an opaque object (but not by the patient’s fingers as they may come apart during the test). If the patient can not read the Snellen top row of the panel at a distance of 6 m, the visual acuity is tested with a distance of 3 m. If nothing can be read from the table even at the shortest distance, the examiner shows various amounts finger to check whether the patient can accurately count them. If this is not the case, testing the examiner whether the patient can perceive hand motions. If this is not the case, light is directed into the eye to see if the light is perceived. Visual acuity is measured with and without the own glasses of the patient. If the visual acuity is corrected with spectacles, the problem is due to a refraction. If the patients have their glasses do not turn a stenopaic panel is used. If no commercial stenopaic shutter is available, one can be made at the bedside, using holes with a 18-gauge needle can be stuck through a piece of cardboard, while the diameter of each hole is easily varied. then select the patients the hole that corrected visual acuity most. If the visual acuity is corrected by a stenopaic aperture, the problem is due to a refraction. The use of a pinhole is a fast and efficient way to diagnose refractive errors, which are the most common cause blurred vision. As a rule, however, only a visual acuity of 20/30 and not of 20/20 can be achieved with the pinhole. An eye examination is also important. Direct and consensual pupillary reaction to light are studied with the swinging-flashlight test (a torch is moved back and forth quickly from the eyes). Visual fields are checked by confrontation and the use of an Amsler grid. The opacity of the cornea is ideally examined with a slit lamp. The anterior chamber is examined for cells and positive Tyndall (flare) with a slit lamp, if this is possible, although it is unlikely that the results of this study explain blurred vision in patients without eye pain or redness. The lens is investigated with an ophthalmoscope, with a slit lamp or both on turbidity. An ophthalmoscope is via the use of a direct ophthalmoscope. More details will be visible when the eyes for the ophthalmoscopy with a drop of a sympathomimetic (e.g. phenylephrine 2.5%.), A cycloplegic, or both be extended (e.g., 1% tropicamide or 1% cyclopentolate.); dilation min almost completely after about the 20th There is so much studied the fundus as can be seen, including the retina, the macula, the fovea, the vessels and the optic disc and their margins. (To d. E. A peripheral retinal detachment see) to view the entire collection, the examiner an ophthalmologist must, as a rule, use an indirect ophthalmoscope. The intraocular pressure is gemessen.Warnzeichen The following findings are of particular importance: Sudden changes in visual acuity eye pain (with or without eye movements) visual field loss (determined by medical history or examination) visible pathological changes in the retina or the optic nerve HIV / AIDS or other immunosuppressive disorder could cause a systemic disease, retinopathy (eg., sickle cell anemia, possible hyperviscosity syndrome, diabetes, hypertension) interpretation of results the symptoms and complaints help determine the cause (s. Common causes of blurred vision). If the visual acuity is corrected by glasses or stenopaic aperture, a simple refractive errors is probably the cause of the visual loss. but loss of contrast sensitivity and glare can be caused by a cataract, which should be considered. However, serious findings suggest a serious ophthalmic disease through (s. Interpretation of some serious findings) and to the need for a full investigation, including a slit lamp examination, a tonometry, an ophthalmoscopic examination with dilated pupils and depending on the findings possibly an immediate or urgent referral to a Ophthamologen. Specific retinal findings help determine the cause (s. Interpretation of retinal results). Interpretation of some serious findings finding Probable cause systemic disease, which could lead to retinopathy (eg., Sickle cell anemia, possible hyperviscosity syndrome, diabetes, hypertension) retinopathy Bilateral symmetrical visual field defects lesion, cortical visual pathways affects eye pain * optic neuritis HIV / AIDS or other immunosuppressive disorder * Infectious retinitis monocular visual field defect * retinal detachment, retinal other abnormality, other optic neuropathy Retinal or Papillenanomalie Infectious retinitis *, retinitis pigmentosa, worsening retinopathy * (s. Interpretation of retinal results) Sudden changes in visual acuity * optic neuritis, sudden worsening of retinopathy or other physical eye disease (acute visual loss) * Usually is an urgent or immediate referral to an ophthalmologist is necessary. Interpretation arranged retinal results findings Cause Arteriolar constriction, copper wire arteries, flame-shaped bleeding, arteriovenous crossing sign Hypertensive retinopathy Knochenbälkchenartig, darkly pigmented lesions in the mid-peripheral retina (rarely visible with direct ophthalmoscopy) Diffuse etinitis pigmentosa bleeding, venous dilation hyperviscosity syndrome Blurred Papillenränder, indicating an optic nerve swelling optic neuritis Makulahyperpigmentierung, loss of pigmentation in retinal epithelium, drusen, bleeding Age-related macular degeneration microaneurysms and neovascularization in the posterior retina Diabetic retinopathy White Netzhautinfiltrate, sometimes loss of red reflex or visible vitreous inflammation Infectious retinitis toxoplasmosis indicated by a retinal infiltrate immediately besides a scar When testing visual acuity is properly corrected by refraction, the patients are referred for routine formal refraction to an optometrist or ophthalmologist. If the vision is not corrected by refraction, but there is no serious evidence that patients are referred for a routine examination to ophthalmologists. In certain serious findings, the patients are referred to an immediate or urgent ophthalmological examination. Patients with symptoms or complaints of systemic disease should appropriate tests are subjected: Diabetes: Fingertip or random glucose measurement Poorly controlled hypertension and acute hypertensive retinopathy (bleeding, exudates, or papilledema): urinalysis, tests of kidney function, blood pressure monitoring and ECG HIV / AIDS and retinal abnormalities: HIV serology and CD4 + totalization systemic lupus erythematosus, and retinal abnormality: antinuclear antibodies, BSG or blood Waldenstrom’s macroglobulinemia, multiple myeloma or sickle cell anemia, blood count with differential blood count and other tests (. for example, serum protein electrophoresis) as clinically indicated therapy The disturbances underlying be treated causally. Corrective lenses can be used to improve visual acuity, even if the disease that causes loss of vision, not a pure refractive error (z. B. early cataracts). Basics of Geriatrics Although a slight deterioration of visual acuity can occur in low light conditions or loss of contrast sensitivity is usually associated with aging, the visual acuity is usually corrected by refraction at 20/20 (1.0), even in very old patients. SUMMARY If the visual acuity is corrected by a stenopaic aperture, a refractive error is likely the problem. When a stenopaic aperture does not correct the visual acuity and no obvious cataract or corneal no obvious abnormality is present, an ophthalmoscopy should be performed after pupil dilation. Many of the established by ophthalmoscopy abnormalities require urgent or immediate ophthalmological transfer, especially if the symptoms have recently deteriorated.