Blurry vision and visual field loss may be caused by these diseases!

Author: Yang Diya, glaucoma and cataract specialist at Beijing Tongren Hospital, Capital Medical University

Reviewer: Tian Bei, Chief Physician, Beijing Tongren Hospital, Capital Medical University

Blurred vision can be caused by a variety of diseases, such as corneal problems, lens problems, fundus problems, optic nerve problems, etc. If blurred vision occurs, you must go to the hospital for examination in time. The doctor will identify and diagnose based on the symptoms and examination results.

Things are becoming increasingly blurry and there are double images:

If the elderly have increasingly blurred vision and double vision, it may be due to cataracts. Blurred vision caused by corneal disease, fundus disease, and optic neuropathy will generally not cause double vision if there is no related eye muscle problem. Cataracts are a painless progressive vision loss that makes vision increasingly blurred, which is equivalent to the lens in a camera becoming opaque. Double vision caused by cataracts occurs when one eye is looking at something, while double vision caused by eye muscle paralysis occurs when both eyes are looking at something.

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If the elderly have blurred vision and suspected cataracts, the first thing to do is to check the vision and correct the vision. If the patient has myopia, hyperopia or astigmatism, the corrected vision shall prevail. At the same time, the intraocular pressure needs to be measured, because high intraocular pressure may cause optic nerve atrophy, which in turn affects vision. In addition, a slit lamp examination is required to observe whether there is inflammation and opacity of the cornea, and whether the corneal endothelium is abnormal; check whether there is inflammation in the anterior chamber; and observe the condition of the pupil and lens.

For further diagnosis, fundus photography is required to visually check whether there are vascular lesions, hemorrhages, and optic nerve atrophy. At the same time, OCT (optical coherence tomography) examination is also required to observe the retinal structure, evaluate the thickness of the nerve fiber layer, and help determine whether there are lesions in the macula or optic nerve. Depending on the examination results, further visual field examination can be performed if necessary to observe whether the visual field has changed accordingly.

My eyes are swollen and I can't see clearly, as if covered by a layer of fog:

Normal intraocular pressure is 10-21mmHg. Acute increase in intraocular pressure can cause corneal epithelial edema. Corneal epithelial edema is a kind of edema like breath, which can cause blurred vision. At the same time, increased intraocular pressure can also cause eye swelling and headache. In this case, you should be alert to whether it is glaucoma. You must go to the hospital in time to measure the intraocular pressure.

Glaucoma is the leading irreversible blinding eye disease in the world and in my country. It is an eye disease that seriously endangers visual function and is divided into primary, secondary and congenital. Primary angle-closure glaucoma is more common in the elderly and often causes acute increase in intraocular pressure, headache, nausea, vomiting and other symptoms. Primary open-angle glaucoma generally does not cause acute increase in intraocular pressure. It is a chronic symptom. There may be no symptoms in the early stage, but in the late stage, the vision is obviously blurred.

With the development of science and technology, mobile phones are becoming more and more powerful. Many people cannot live without mobile phones. Playing with mobile phones for a long time can cause dry eyes, visual fatigue, eye swelling, and blurred vision. Do not ignore these conditions and go to the ophthalmology department for examination. Some young people may have glaucoma. The symptoms of this type of open-angle glaucoma in young people are not as severe as those of acute angle-closure glaucoma. Headaches, nausea, and vomiting may not be so severe. However, if the increased intraocular pressure is not intervened and treated in time in the early stage, it will cause the optic nerve to gradually atrophy and eventually lead to blindness, and this blindness is irreversible.

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Clinically, we often see young patients who come to the hospital for treatment due to advanced glaucoma. These patients often have optic atrophy, tubular vision, and intraocular pressure as high as 30mmHg or even 40mmHg. These symptoms often last for many years, and patients often mistakenly believe that it is visual fatigue caused by long-term use of mobile phones and do not pay enough attention to it.

We would like to remind young people to be vigilant to such symptoms. Especially for those with myopia, especially those with high myopia, if they find that their vision is gradually blurring and accompanied by symptoms such as eye pain, they should go to the hospital for examination immediately to rule out the possibility of glaucoma.

In addition to visual acuity, intraocular pressure, and slit lamp examinations, ophthalmologists will also ask patients to undergo corneal thickness examinations, which have a greater impact on intraocular pressure. At the same time, color fundus photography is also required, especially binocular stereo photography. In addition, the thickness of the nerve fiber layer must be tested, and OCT (optical coherence tomography) is often used for examination. Visual field examinations are also required, and patients are advised to undergo 24-hour intraocular pressure monitoring, because a large number of glaucoma patients do not have high intraocular pressure during working hours, that is, during the day, but their intraocular pressure increases during non-working hours, especially at night.

In addition to the peak increase, large fluctuations in 24-hour intraocular pressure are also abnormal, such as a 24-hour intraocular pressure fluctuation of more than 5 mmHg. In addition, some people's intraocular pressure is higher than 21 mmHg all year round, but through long-term observation, no optic nerve damage has occurred. This type is called ocular hypertension. There is another type of patient whose intraocular pressure has always been lower than 21 mmHg, but optic nerve atrophy and visual field changes have occurred, which is called normal-tension glaucoma. Therefore, even if the intraocular pressure is lower than 21 mmHg, it cannot be determined that it is not glaucoma. Intraocular pressure is only a high-risk factor for glaucoma.

Therefore, comprehensive examination and evaluation are necessary to rule out the possibility of glaucoma.

Seeing things only half way:

If you can only see half of something, there may be a problem with your visual field. In this case, you should go to an ophthalmologist in time for a detailed examination to rule out glaucoma, because optic nerve atrophy caused by glaucoma can lead to visual field defects and incomplete vision. In addition, vitreous hemorrhage and inflammatory reactions can also cause a sense of blocked vision; fundus vascular lesions, fundus hemorrhage, retinal detachment, ischemic optic neuropathy, etc. can also cause you to see only half of something.

In addition to checking for eye lesions, it is also necessary to rule out any neurological or surgical lesions. Intracranial hemorrhage, intracranial space-occupying lesions, tumors, and trauma may all lead to visual field defects and a sense of obstructed vision.

If there is a visual field defect, in addition to routine ophthalmological examinations, an eye ultrasound examination, dilated pupil examination of the fundus, and visual field examination should be performed. If there are neurological or surgical related diseases, you should go to the neurology or surgery department for treatment and have a head MRI or CT scan.