Sudden Blurry Vision: Possible Causes and Next Steps

Sudden blurred vision, unable to see one's own hand in front of the face?

Hello, doctor! I am quite confused about what kind of examinations I should undergo for my issues.
In 1997, I experienced a sudden episode where my vision went completely black without any warning or symptoms.
This lasted for about eight minutes, occurring approximately seven times a day, with each episode lasting around thirty seconds, and it continued for an hour before resolving on its own after two weeks.

In 2003, I had a second episode where I could see light, but only the brightest ones; everything else was completely dark.
This episode was similar to the first one, and I was at the hospital at that time.
Blood tests for anemia were normal, vision tests were also normal, and an electrocardiogram showed no abnormalities.
Since no cause could be determined, I did not pursue further examinations after I returned to normal.
In 2013 or 2014, I fell down the stairs and hit the top and back of my head.
I had a bump and pain, but no nausea or vomiting.
A few days after the fall, my vision became extremely blurry again, where I could see light but not much else.
The episodes occurred every five minutes, lasting about thirty seconds, and I forgot how long this lasted, but it resolved within two weeks.
I went back to the same hospital, where only an EEG was performed, and the results were normal.
The doctor assessed my coordination and concluded that I was fine, suggesting it might be a functional disorder, but I was unsure how to proceed and just waited for the symptoms to resolve on their own.
The fourth episode occurred on July 8, 2018, around noon.
I went to the emergency room at Chang Gung Hospital that night, but the doctor said they could not address my issue and sent me home without any tests, recommending outpatient follow-up.
This time, I experienced near-total vision loss for about three minutes, seeing light but unable to discern anything else, with episodes lasting around thirty seconds.
I calculated that the episodes lasted about two hours before returning to normal, but they started again shortly after.
This episode was quicker and lasted only four days, with some variations in frequency and duration, but the duration of each episode remained around thirty seconds.
Interestingly, I felt a heaviness in the bridge of my nose, and after massaging the area below my eyebrows, I noticed an improvement in the frequency of my vision loss.
I continued to massage my nose, eyebrows, eye sockets, and temples, and felt it was effective.
However, when the heaviness returned, my vision would become blurry again.
I also occasionally experienced a feeling of pressure in my head, so I took painkillers to prevent any worsening symptoms.
By Thursday, the heaviness in my nose and forehead had disappeared.
Additionally, I observed that when watching TV, the subtitles seemed to shake, although they were not actually moving.
My vision is normal; I do not have myopia, hyperopia, or any significant diseases, and previous test results have all been normal.
During a recent visit to the hospital in early June, I underwent visual conduction tests, which also returned normal results.
I am puzzled about what this situation could be and where I should seek further examination.
Moreover, I wonder if it is possible to identify the cause while I am currently asymptomatic.

Lin Xi, 30~39 year old female. Ask Date: 2018/07/22

Dr. He Jianxian reply Ophthalmology

It is recommended that you first consult a cardiologist to rule out any issues related to atrial fibrillation and thrombosis (though the likelihood of this is low).
If those are not present, the most probable issue you are experiencing is a migraine aura (which does not necessarily involve significant headache).
This condition can cause abnormal electrical activity in the brain, leading to visual disturbances, which typically resolve on their own.
However, if the frequency of these episodes is too high, it is advisable to seek a solution from a neurologist.

Reply Date: 2018/07/22

More Info

Sudden blurry vision can be a concerning symptom, and understanding its potential causes is crucial for determining the appropriate next steps for evaluation and management. Based on your description, it appears that you have experienced multiple episodes of transient vision loss or significant visual disturbances over the years, which can be indicative of various underlying conditions.

Possible Causes of Sudden Blurry Vision
1. Transient Ischemic Attacks (TIAs): These are temporary episodes of neurological dysfunction caused by a brief interruption in blood flow to the brain. TIAs can lead to sudden vision changes, including temporary blindness or blurry vision. Given your history of episodes lasting around 30 seconds to a few minutes, this could be a possibility.

2. Retinal Issues: Conditions such as retinal detachment or retinal vein occlusion can cause sudden vision changes. These conditions often present with symptoms like flashes of light, floaters, or sudden loss of vision. Although your previous eye examinations have been normal, it may be worthwhile to have a comprehensive retinal evaluation, including imaging studies.

3. Optic Nerve Disorders: Conditions affecting the optic nerve, such as optic neuritis or ischemic optic neuropathy, could also lead to sudden vision changes. These conditions may be associated with other symptoms, such as pain or changes in color vision.

4. Neurological Issues: Given your history of head trauma and the episodes of visual disturbances, it is essential to consider neurological causes. Migraines, particularly ocular migraines, can cause transient visual disturbances. Additionally, structural issues in the brain, such as tumors or lesions, could also lead to similar symptoms.

5. Vascular Issues: Conditions affecting blood flow, such as hypertension or vascular malformations, can lead to sudden changes in vision. Your history of head trauma may also play a role in vascular changes.

6. Psychogenic Factors: In some cases, visual disturbances can be related to psychological factors, such as anxiety or stress. This is often termed functional or psychogenic visual loss, where no organic cause is found.

Next Steps for Evaluation
Given the complexity and recurrence of your symptoms, a thorough evaluation is warranted. Here are some recommended steps:
1. Comprehensive Eye Examination: Schedule an appointment with an ophthalmologist for a detailed eye examination, including visual field testing, optical coherence tomography (OCT), and possibly fluorescein angiography to assess the retina and optic nerve.

2. Neurological Evaluation: It may be beneficial to consult a neurologist for a comprehensive neurological examination. This could include imaging studies such as an MRI or CT scan of the brain to rule out any structural abnormalities.

3. Blood Tests: Consider having blood tests done to check for any underlying systemic conditions that could contribute to your symptoms, such as blood sugar levels, cholesterol, and inflammatory markers.

4. Monitoring Symptoms: Keep a detailed log of your episodes, noting the duration, frequency, associated symptoms (like headaches or dizziness), and any potential triggers. This information can be invaluable for your healthcare providers in diagnosing the issue.

5. Follow-Up: Regular follow-up with both your ophthalmologist and neurologist is essential to monitor your condition and adjust management as necessary.

Conclusion
While your previous evaluations have not revealed any significant issues, the recurrence and nature of your symptoms warrant further investigation. Sudden blurry vision can have various causes, and a multidisciplinary approach involving both ophthalmology and neurology may be necessary to arrive at a definitive diagnosis. It is essential to address these symptoms promptly to ensure that any underlying conditions are identified and managed appropriately. Always prioritize your health and seek immediate medical attention if you experience sudden changes in vision, especially if accompanied by other concerning symptoms.

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