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Visual Symptomology from Optometrist Point of View



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Visual Symptomology from Optometrist Point of View

  2. 2. Visual symptoms 1. Blurred Vision 2. Double vision 3. Vision loss 4. Photopsia 5. Hallucination 6. Floater 7. Colored halos around eye 8. Photophobia 9. Dazzling or glare discomfort 10. Chromatopsia 11. Heightened color perception 12. Nyctalopia(night blindeness) 13. Hemeralopia (day blindness) 14. Oscillopsia 15. Color blindness 16. Palinopsia 17. Visual agnosia 18. Ocular lateropulsion 19. Pain in and about eye 20. Headache
  3. 3. 1.Blurred vision Loss of visual acuity with indistinct detail. Can be unilateral or bilateral. Can be blur at near, blur at distance or both Magnitude of a patient’s complaint will depend on many factors including - the degree of defect - type of visual task being undertaken May result from eye injury, refractive error, eye disease, improperly fitted contact lens or use of certain drug. Normal Vision with diabetic retinopathy
  4. 4. History taking part How long he has had the visual blurring. Does it occur only at certain times? Ask about associated signs and symptoms, such as pain or discharge. If visual blurring followed injury, obtain details of the accident Ask if vision was impaired immediately after the injury.  Obtain a medical and drug history.
  5. 5. Etiology Medical causes  Brain tumor  Cataract  Concussion  Corneal abrasion  Conjunctivitis  Corneal dystrophies  Corneal foreign bodies  Diabetic retinopathy  Dislocated lens  Eye tumour  Glaucoma  Hypertension  Hyphema  Iritis  Migraine headache  Multiple sclerosis (MS)  Optic neuritis  Retinal detachment  Retinal vein occlusion (central)  Senile macular degeneration  Serous retinopathy (central)  Stroke  Temporal arteritis  Uveitis (posterior)  Vitreous hemorrhage
  6. 6. 2.Double vision Diplopia Mostly seen in binocular anomaly Can be unilateral or bilateral General cause is from cornea, crystalline lens, muscle, nerve and brain. Double vision is not normal and should be reported promptly.
  7. 7. Etiology  Cornea Infections of the cornea(herpes zoster or shingles) Uncommon complication of LASIK surgery.  Crystalline len Cataract  Muscle Myasthenia gravis Graves’ disease  Nerve Multiple sclerosis Guillain-Barre syndrome Uncontrolled diabetes  Brain Strokes Aneuryms Brain tumour Increased pressure inside the brain from trauma, bleeding or infection
  8. 8. 3.Vision loss Inability to perceive visual stimuli Can be sudden or gradual and transient or permanent Range from slight impairment to total blindness Age-related Macular degeneration Normal Vision Glaucoma Hemiapnosia
  9. 9. Etiology of sudden vision loss  always a medical emergency Eye injury Eye artery obstruction - this cause and other causes are a medical emergency. Retinal artery obstruction Retinal vein obstruction Eye blood vessel thrombosis Temporal arteritis Retinal detachment Amaurosis fugax Stroke TIA (Transient ischemic attack) Migraine Optic neuritis Vitreous hemorrhage Acute glaucoma Methyl alcohol poisoning Hysteria Brain injury Blow to the head
  10. 10. Etiology of gradual vision loss Cataract Macular degeneration Age-related macular degeneration Diabetic retinopathy Glaucoma Hypertension Choroiditis Retinitis pigmentosa Trachoma Field of Vision Loss in Late Retinitis Pigmentosa Loss of vision associated with macular degeneration
  11. 11. 4.Photopsia Hallucinatory perceptions such as sparks, lights or colours arising in the absence of light stimuli and observed when the eyes are closed.  Etiology: posterior vitreous detachment migraine with aura migraine aura without headache retinal break or detachment occipital lobe infarction sensory deprivation
  12. 12. 5.Hallucination Definition:  Visual perception not evoked by a light stimulus.  Perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid, substantial, and located in external objective space
  13. 13. Etiology Blind person (central or peripheral visual field loss) Bilateral eye covering (after surgery) Ocular lesions as retinal haemorrhage, glaucoma, optic atrophy Psychoses Central nervous system lesion (Alzheimer disease)
  14. 14. 6.Floaters  Floaters are little "cobwebs" or specks that float about in the field of vision.  Dots or filaments that move with the movement of eye Etiology:  Vitreous opacities  Scotomatous defects (retinal lesion, myopia)  Corneal foreign body reflection  Carbon tetrachloride poisoning  Migraine
  15. 15. 7.Colored halos around lights  Blue and violet are next to the stimulating light and red outermost.  Etiology:  Glaucoma- A.acute-angle closure with streching of the corneal lamellae glaucoma-halo noted in the awakening (IOP highest in morning)  Mucus on the cornea  Corneal scar/ edema  Krunkenberg spindle  Lens opacities  Vitreous opacities  Haze of ocular media
  16. 16. 8.Photophobia Defination:  Painful intolerance of the eyes to light.  symptom of a primary ocular disorder or underlying central nervous system disorder Etiology  Aniridia  ocular (conjuctivitis,keratitis, iritis)  Albinism  Total color blindness(achromaptosia)  Systemic disease  Toxic cause  Drug induced (digitoxin)
  17. 17. 9.Dazzling or glare discomfort Definition:  difficulty seeing in the presence of bright light such as direct or reflected sunlight or artificial light such as car headlamps at night. Patient with glare discomfort Normal patient without glare discomfort
  18. 18. Etiology 1. Altered pupillary response 2. Asymmetric placement of the IOL in relation to the pupillary aperture 3. Corneal scars or foreign bodies 4. Idiopathic 5. Drugs such as chloroquine,acetazolam ide, or trimethadione (Tridone) 6. Emotional disorders 7. Following refractive surgery 8. Lenticular changes
  19. 19. Definition: Etiology: Abnormal condition in which objects appear falsely coloured. It named depending upon the colour seen. 1. Cone monochromatism • Blue cone monochromatism - abnormal vision of blue color 1. Drugs 2. Genetic 3. Macular degeneration 4. Optic neuritis 5. Retinitis pigmentosa 10.Chromatopsia
  20. 20. Classification of chromatopsia
  21. 21. 11.Heightened Color Perception  1. Heightened color perception is due to drugs, including the following: dronabinol ethionamide hashish LSD lysergide marihuana mescaline oxygen psilocybin tetrahydrocannabinol THC Sources from: Fraunfelder FT, Fraunfelder FW. Drug-induced ocular side effects. Woburn, MA: Butterworth-Heinemann, 2001.
  22. 22. Usually happened in person with dementia
  23. 23. 12.Nyctalopia (Night Blindness) Definition:  a condition making it difficult or impossible to see in relatively low light.  It is a symptom of several eye diseases Difficulty sees in darkness
  24. 24. Etiology Vitamin A deficiency retinitis pigmentosa congenital night blindness Sorsby's fundus dystrophy pathological myopia peripheral cortical cataract Oguchi disease refractive surgery (RK, PRK, LASIK)
  25. 25. 13.Hemeralopia Definition: Day blindness  inability to see as distinctly in a bright light as in dim one  It can be described as insufficient adaptation to bright light.  The retinas of those with day blindness are unable to process the light around them.  This, in turn, intensifies the sunlight so much that they literally can't see anything around them.
  26. 26. Etiology 1. Adie’s pupil 2. Albanism 3. Aniridia 4. Cohen Syndrome 5. Cone dystrophy-genetic condition 6. Drugs:- Trimethadone 7. Cataracts 8. Trauma:- Brain injury Ocular complications are listed as optic atrophy ,microphthalmia ,pigmentary chorioretinitis , hemeralopia (decreased vision in bright light) , myopia , strabismus , nystagmus and iris/retinal coloboma.
  27. 27. 14.Oscillopsia Defination:  A visual disturbance in which objects in the visual field appear to oscillate.  The severity of the effect may range from a mild blurring to rapid and periodic jumping.
  28. 28. Etiology :  loss of the vestibulo- ocular reflex involuntary eye movements such as nystagmus impaired coordination in the visual cortex (especially due to toxins)  aminoglycoside  Illusionary movement of enviroment unilateral bilatarel
  29. 29. 15.Color blindness Definition:  A.k.a color vision deficiency  the inability to perceive differences between some of the colors that others can distinguish.
  30. 30. Color blindness Deficiency in color vision can be due to: Inherited defects - present from birth and have genetic basis - affect both eyes equally - affect the entire visual field Acquired defects -secondary to a pathological state -may affect one eye -may affect part of the visual field
  31. 31. Classification of color blindness
  32. 32. Ocular diseases which causes color vision disturbances Ocular diseases Color vision changes Age-related maculopathy Blue-yellow defect Retinal detachment Blue-yellow defect Diabetic retinopathy Blue-yellow defect Hypertensive retinopathy Blue-yellow defect Papilledema Blue-yellow defect Glaucoma Blue-yellow defect Lesions of optic nerve &pathway Red-green defect Papillitis Red-green defect Optic neuritis Red-green defect
  33. 33. 16. Palinopsia Visual disturbance that causes images to persist to some extent even after their corresponding stimulus has left These images are known as afterimages and occur in persons with normal vision.  A person with palinopsia experiences them to a significantly greater degree, to the point where they become difficult or impossible to ignore
  34. 34. Palinopsia : Symptoms
  35. 35. Causes lesion  parieto-occipital  temporal-occipital areas as a result of a cerebral infarction, epilepsy, tumour, or brain injury
  36. 36. 17.Visual agnosia Visual agnosia is a neurological disorder distinguished by the inability to recognize familiar objects. Types : 1)Appreceptive Agnosia 2)associative visual agnosia
  37. 37. Appreceptive Agnosia - Failure in high-level object recognition despite normal vision Symptoms :  Pt are unable to recognize objects  Unable to access the structure or spatial properties of a visual stimuli  Object is not seen as a whole.  Cannot draw or copy things Causes :  damage in the lateral occipital area
  38. 38. Drawing Test Result
  39. 39. Associative visual agnosia  inability to identify objects due to impaired access to stored semantic information about the objects. Causes :  lesion on the left occipital and temporal lobe, often in conjunction with damage to the posterior thalamus and limbic cortex.
  40. 40.  Criteria :  Difficulty recognizing variety of visually presented objects with their semantic meaning, or organize objects into semantic categories.  Normal recognition of objects from a verbal description of it or when using sense other than vision (e.g. smell, touch, taste).  Elementary visual perception that is sufficient to copy line drawings quite well but unable to identify objects being copied
  41. 41. • copy line drawings quite well • unable to identify objects being copied
  42. 42. 18.Ocular Lateropulsion A strong forced conjugate deviation of the eyes to one side. a position bias of eye movements in the direction towards the lesion Symptoms :  Unable to reach a laterally placed fixation target in a single rapid eye movement (a single saccade)  Patients overshoot towards the side of the lesion and undershoot in opposite direction. Cause :  Asymmetrical lesion of the pons and lateral medullar
  43. 43. 19.Pain In and About Eye  Symptoms  burning, throbbing, aching, or stabbing sensation in or around the eye.  feel as if there is a foreign body in the eye.  Causes  Burns  Conjunctivitis (pink eye) or any inflammation of the upper and lower lids  Contact lens complications  Eye problems (infection, irritation, or injury such as a corneal abrasion)  Eye surgery  Glaucoma  Migraine headache  Sinus problems  Stye (hordeolum)  Viral infections such as the flu
  44. 44. 20.Headache Headaches often appear centered around the eyes or behind the eyes. Symptoms :  referred area of the pain is around the eyes.  a brow ache or an ache behind the eyes.
  45. 45. Causes : • Eyestrain - overworking of the focusing muscle within the eye. • Contact lens related problems - headache may come from a poorly fitting, tight lens, corneal infection or swelling, or from a lack of oxygen in the cornea. • Corneal ulcer • Conjunctivitis • Dacryocystitis - an infected tear drainage sac (inside corner of the eye) can lead to pain and headache • Glaucoma (acute) • Optic neuritis - inflammation of the optic nerve can cause headache and pain on eye movement along with blurred vision
  46. 46. -THE END-


  • Infections of the cornea(herpes zoster or shingles)can distort the cornea.
    Uncommon complication of LASIK surgery can leave one cornea altered, creating unequal visual images.
    Myasthenia gravis is an autoimmune illness that blocks the stimulation of muscles by nerves inside the head. The earliest signs are often double vision and drooping eyelids, or ptosis.
    Graves' disease is a thyroid condition that weakens the muscles of the eyes. Graves' disease commonly causes vertical diplopia. With vertical diplopia, one image is on top of the other.
    Nerve problems. Several different conditions can damage the nerves and lead to double vision:
    Multiple sclerosis can affect nerves anywhere in the brain or spinal cord. If the nerves controlling the eyes are damaged, double vision can result.
    Guillain-Barre syndrome is a nerve condition that causes progressive weakness. Sometimes, the first symptoms occur in the eyes and cause double vision.
    Uncontrolled diabetes can lead to nerve damage in one of the eyes, causing eye weakness and double vision.
    Brain problems. The nerves controlling the eyes connect directly to the brain. Further visual processing takes place inside the brain. Many different causes for double vision originate in the brain. They include:
    Increased pressure inside the brain from trauma, bleeding, or infection
    Brain tumors
    Migraine headaches
  • the inability to perceive visual stimuli — can be sudden or gradual and temporary or permanent. The deficit can range from a slight impairment of vision to total blindness.
  • Palinopsia is thus a condition which mimics normal phenomena, but with far greater intensity
  • An example of the image, if you place your hand in a field of vision, and move it from left to right and you will see the trails
    Patients who complain of Visual Snow literally see what resembles "television snow," that is, specs or particles that blink on and off in their vision.
  • Pt with associative agnosia are able to perform basic tasks better than appreceptive agnosia patients
    Semantic the meaning
  • To read at a close distance
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