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Transient Unilateral blurred vision, no other symptoms - what could it be?
69 yo female / overall good health / Perfect BP (112/68) / normal sugar / high cholesterol but not medicated or serious / no other medications / osteoporosis / chronic GI issues (bloating etc.) but nothing dangerous / Overall very good and clean diet (sometimes cheat with small amounts of fast food) / CBC from April 2015 was perfect except for high-ish cholesterol which has not changed and again is not dangerous / Docs would call me very health overall for my age.
Hi all,
A couple of months ago I had a few short (30 min) episodes of unilateral blurred vision, but only things in the distance (approx. 12 ft) were blurry, and we clear close up. Then I had the same issue again this week, but it was for about 6 hours. My eye doctor does not see an eye-related cause for this, so she referred me to a GP. (I wear glasses, have astigmatism in other eye. Also have glaucoma, but again she cannot see anything in the eye which would have caused this.) The GP did a superficial exam to check for stroke/TIA and did not find a cause for concern. He did not see a need for blood work for some reason (he can be conservative about testing). When I mentioned that this has happened twice, he referred me to a neurologist "just in case." I'm quite nervous and unsure of what this may be. No other symptoms whatsoever, overall very healthy. Please help. Can this be nothing? The GP mentioned that sometimes this can be a part of aging, but eye doctor never mentioned this and said to look into other causes. Also, a friend MD asked if GP took had blood and recommended that we check sedimentation in the blood. No idea what this means. So much to look into, I'd love some guidance.
Thanks in advance and best wishes to you all.
Hi all,
A couple of months ago I had a few short (30 min) episodes of unilateral blurred vision, but only things in the distance (approx. 12 ft) were blurry, and we clear close up. Then I had the same issue again this week, but it was for about 6 hours. My eye doctor does not see an eye-related cause for this, so she referred me to a GP. (I wear glasses, have astigmatism in other eye. Also have glaucoma, but again she cannot see anything in the eye which would have caused this.) The GP did a superficial exam to check for stroke/TIA and did not find a cause for concern. He did not see a need for blood work for some reason (he can be conservative about testing). When I mentioned that this has happened twice, he referred me to a neurologist "just in case." I'm quite nervous and unsure of what this may be. No other symptoms whatsoever, overall very healthy. Please help. Can this be nothing? The GP mentioned that sometimes this can be a part of aging, but eye doctor never mentioned this and said to look into other causes. Also, a friend MD asked if GP took had blood and recommended that we check sedimentation in the blood. No idea what this means. So much to look into, I'd love some guidance.
Thanks in advance and best wishes to you all.
I think you need to see the neurologist for some reassurances. I suspect strongly this is not tumor. As I've explained twice TIA, TA, and amaurosis should blur ALL your vision not leave near clear.
I doubt the neurologist will turn up anything serious. If that is negative and you had a third episode (in which you should absolutely confirm again whether distance, near, intermediate with your glasses on if you wear them and without glasses also is clear or blurred) then I would suggest your ophthalmologist refer you to a neuroophthalmologist.
JCH MD
I doubt the neurologist will turn up anything serious. If that is negative and you had a third episode (in which you should absolutely confirm again whether distance, near, intermediate with your glasses on if you wear them and without glasses also is clear or blurred) then I would suggest your ophthalmologist refer you to a neuroophthalmologist.
JCH MD
Thank you, doctor. You are absolutely right, but my nerves got the best of me. I went to a local urgent care this evening and they confirmed that I should not suspect TA(did not do testing, claimed I should have some head pain and I "would be blind by now if this started two months ago." They advised that I follow up with a neurologist and have an MRI of my brain to rule out strokes, tumors, etc. From what I have explained in the above comments, should I be concerned about tumors? I understand sometimes the have no symptoms or few. I am also concerned that the blurriness being unilateral may suggest something is going on in the brain...the nurse mentioned this. I will be making an apt with a neurologist on Monday but would feel better with a bit more information. I am hoping this is eye-related, but since my ophthalmologist said "everything looks fine" I am trying to zero in on what else it could be. I want to believe it's nothing but am frightened. Sincere apologies for the additional question(s)!
Your understanding is flawed. I have managed quite a number of TA and suspected TA including one of the youngest biopsy proved TAs in the medical literature.
First your symptoms do not suggest TA, I described the type of vision loss typical of TA and its complete amaurosis (blindness). While it can occur at your age it is unusual. Most TA patients are late 70s and especially 80's, 90's. The eye findings in TA are often dramatic. If your sed rate and CRP are normal you don't have TA. A biopsy is not used where suspicion is low, symptoms are not typical of TA and those 2 tests normal. You can still have TA and a negative temporal artery biopsy. Its called a "false negative" and due to "skip lesions" of the artery.
JCH MD
First your symptoms do not suggest TA, I described the type of vision loss typical of TA and its complete amaurosis (blindness). While it can occur at your age it is unusual. Most TA patients are late 70s and especially 80's, 90's. The eye findings in TA are often dramatic. If your sed rate and CRP are normal you don't have TA. A biopsy is not used where suspicion is low, symptoms are not typical of TA and those 2 tests normal. You can still have TA and a negative temporal artery biopsy. Its called a "false negative" and due to "skip lesions" of the artery.
JCH MD
Thanks for the prompt reply! My concern is that if the ESR test is normal, it does not rule out TA. From what I understand, the only way to rule out is biopsy and MRI. Is this correct? Is the normal result from ESR + other test mentioned enough to feel safe enough to wait until next week for further testing if doc suspects? Thanks so much. This is my last question I promise!
I also misread the time as seconds not minutes. HOWEVER all of my statements about TIA, TA (temporal arteritis), heart or carotid disease would all blur your vision distance, near and intermediate not just at distance.
Patients with TA rarely feel good. Your family doctor can rule out this unlikely problem with two tests: Sedimentation Rate and C Reactive Protein. Unless something different develops you can contact their office monday and make arrangements to have those inexpensive tests drawn. I strongly suspect they will be normal.
Pazeo (the replacement for pataday allergy drops) might cause some blurring within 30 minutes of instillation as a very unusual reaction but would not cause problems 10 days post installation.
Might check with your ENT doctor re your tinnitus.
JCH MD
Patients with TA rarely feel good. Your family doctor can rule out this unlikely problem with two tests: Sedimentation Rate and C Reactive Protein. Unless something different develops you can contact their office monday and make arrangements to have those inexpensive tests drawn. I strongly suspect they will be normal.
Pazeo (the replacement for pataday allergy drops) might cause some blurring within 30 minutes of instillation as a very unusual reaction but would not cause problems 10 days post installation.
Might check with your ENT doctor re your tinnitus.
JCH MD
Thanks very much for your comprehensive reply, doctor. Much appreciated. I do have an update and would love your feedback. Firstly, again as I wrote quickly I mistakenly wrote glaucoma instead of cataracts. I have mild cataracts, not glaucoma. I do not take anything for either. I was taking Pazeo drops around the time when the first spells of the unilateral blurred vision happened, but it was about 10 days from the last spell since I had used the drops. Could it somehow be from the drops with that length of time since use? Finally, I suspect that this may be temporal arteritis after doing a bit more research, and would love some guidance. Here are a few symptoms which may be relevant:
- transient unilateral blurred vision (distance only)
- tinnitus, one day about a week ago, lasted about 6 hours (note I have a known inner ear problem and have had ringing and equilibrium issues for years, however this was worse and my ears felt clogged, have not really had it like this before)
- chronic dry cough for about 6 months or more (along with nasal drips etc.)
- minor weight loss of 3 lbs. in the past 3 months
- no pain whatsoever on head (scalp, etc) but did notice last week that the skin above my eyebrows felt the tiniest bit swollen only on the day I happened to notice it, but again no pain or tenderness whatsoever
- Overall feel really great, no fatigue, no fever, no headaches - no malaise whatsoever
My question is, given the risk of stroke or permanent vision loss, should I run to an emergency room or can this wait until Monday? And if so, which tests are necessary to rule in/rule out? Hospitals/physicians sometimes do unnecessary testing and I want to be armed with as much information as possible.
Many, many thanks once again!
- transient unilateral blurred vision (distance only)
- tinnitus, one day about a week ago, lasted about 6 hours (note I have a known inner ear problem and have had ringing and equilibrium issues for years, however this was worse and my ears felt clogged, have not really had it like this before)
- chronic dry cough for about 6 months or more (along with nasal drips etc.)
- minor weight loss of 3 lbs. in the past 3 months
- no pain whatsoever on head (scalp, etc) but did notice last week that the skin above my eyebrows felt the tiniest bit swollen only on the day I happened to notice it, but again no pain or tenderness whatsoever
- Overall feel really great, no fatigue, no fever, no headaches - no malaise whatsoever
My question is, given the risk of stroke or permanent vision loss, should I run to an emergency room or can this wait until Monday? And if so, which tests are necessary to rule in/rule out? Hospitals/physicians sometimes do unnecessary testing and I want to be armed with as much information as possible.
Many, many thanks once again!
If all your vision (Distance, near and mid-range) was blurry it would be much more of a concern. If the eye vision goes black and all vision goes out that is called amaurosis and its a serious symptom that requires a full cardio-vascular-neurologic work up especially if it lasted several minutes or longer. Also a transient ischemic attack (TIA) will blur the vision in ALL THREE AREAS not just at distance but not near. The MD friend is concerned about a disease called giant cell arteritis also called temporal arteritis. It would cause loss of vision at all distances, maybe complete amaurosis and is often associated with other symptoms such as fever, chills, tenderness of scalp/temple areas, unexplained weight loss and malaise. You obviously don't have these symptoms.
You mention glaucoma and I'm assuming you are not on a very old glaucoma medicine called pilocarpine. Its rarely used but it can blur distance vision and make near vision clearer due to stimulation of accommodation (Focusing). I'm also assuming you use eye drops in both eyes. Modern glaucoma medication: beta blockers, prostaglandin analogs, carbonic anhydrase inhibitors rarely blur the vision. Alphagan and its generic analog bromonidine can dilate the pupil which might blur the vision some. Why it would bother you only twice no explanation. In younger people a problem called "spasm of accommodation" might cause it but it occurs in both eyes, may have pain, may have some double vision, and has bilateral small pupils. I'm also assuming that you did not accidentally get something in your eye or use in the eye having symptoms some kind over over the counter eye drop.
If you do follow through with the neurologist I would emphasize that 1. It only lasted 30 seconds and you had no other neurological symptoms (slurred speech, trouble moving arms/legs, no mentation problems) and 2. that your NEAR vision was clear.
Its hard to see how an extensive work up such as MRI/MRA, Echocardiogram, carotid dopplers etc. are indicated with your very healthy lifestyle, low risk factors and your description which does not fit TIA or amaurosis. Watchful waiting for other symptoms or increased frequency or intensity might be the order of the day and you might want to run that by your MD friend, GP and "eye doctor".
That's the long answer. The short answer would be "Yes it could be nothing serous"
JCH MD
You mention glaucoma and I'm assuming you are not on a very old glaucoma medicine called pilocarpine. Its rarely used but it can blur distance vision and make near vision clearer due to stimulation of accommodation (Focusing). I'm also assuming you use eye drops in both eyes. Modern glaucoma medication: beta blockers, prostaglandin analogs, carbonic anhydrase inhibitors rarely blur the vision. Alphagan and its generic analog bromonidine can dilate the pupil which might blur the vision some. Why it would bother you only twice no explanation. In younger people a problem called "spasm of accommodation" might cause it but it occurs in both eyes, may have pain, may have some double vision, and has bilateral small pupils. I'm also assuming that you did not accidentally get something in your eye or use in the eye having symptoms some kind over over the counter eye drop.
If you do follow through with the neurologist I would emphasize that 1. It only lasted 30 seconds and you had no other neurological symptoms (slurred speech, trouble moving arms/legs, no mentation problems) and 2. that your NEAR vision was clear.
Its hard to see how an extensive work up such as MRI/MRA, Echocardiogram, carotid dopplers etc. are indicated with your very healthy lifestyle, low risk factors and your description which does not fit TIA or amaurosis. Watchful waiting for other symptoms or increased frequency or intensity might be the order of the day and you might want to run that by your MD friend, GP and "eye doctor".
That's the long answer. The short answer would be "Yes it could be nothing serous"
JCH MD
1 Comments
Hi there, Thank you for your reply. Firstly, again as it was written quickly I listed glaucoma in error when I meant to type cataracts. I take no medication of any kind for any ailment. I was using Pazeo drops which may have been the reason a couple of months ago, but I had not used it in 10 days when I had the second spell. Also, please note the first spell a couple of months ago was about 30 minutes (not seconds) long, and this time it was about 6 hours. Many, many thanks for your help. Much appreciated!!
Apologies for the typos...written very quickly! Also, 68* years old. Thanks again.
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