Blurred Vision and Light Sensitivity in Older Adults

Blurred vision, loss of color perception, photophobia?

Hello, doctor.
The patient is a 69-year-old male with congenital exotropia who needs to read a large volume of text daily for work.
In June 2013, he fell and hit his head in his bathroom.
Before the decline in vision, he frequently experienced unexplained fevers and headaches.
In August 2013, while looking at his garden, he noticed many small blue spots.
Two months later, his condition worsened.
He developed photophobia and was unable to distinguish colors, perceiving everything as brown or black, and experienced a sensation of a white mist when looking at objects.
When reading, he noticed that the text would continuously enlarge, shrink, and distort.
Visual field tests, brain MRI, and optic nerve examinations all yielded normal results with no signs of glaucoma, although he has mild cataracts, his vision continued to deteriorate, and the photophobia became increasingly severe.
The doctor could not find an explanation and suggested he undergo cataract surgery.
About two weeks ago, he had successful cataract surgery on his right eye, but his vision has not yet improved.
The current situation is that his photophobia has become so severe that he cannot go outside; even wearing sunglasses does not help, and he is completely unable to distinguish colors or see the computer screen, experiencing a persistent sensation of white mist.
Which specialty should he be referred to for further consultation? What possible internal medical issues could this indicate? Thank you for your response.

T, 60~69 year old female. Ask Date: 2014/01/19

Dr. Wang Zhangji reply Ophthalmology

Photophobia is usually associated with issues related to the cornea and conjunctiva, so it is advisable to consult a cornea specialist for treatment.
Color vision is more related to the function of the optic nerve, and the potential causes of poor vision are very diverse.
It is recommended to undergo a thorough examination at an ophthalmology department and a neurology department in a medical center.

Reply Date: 2014/01/19

More Info

Understanding blurred vision and light sensitivity in older adults can be quite complex, especially when there are multiple symptoms involved, as in the case of your patient. At 69 years old, this individual has a history of congenital strabismus and has experienced a series of troubling symptoms, including light sensitivity, color discrimination issues, and a persistent "foggy" vision.
The patient's history of head trauma in 2013, along with the subsequent symptoms, raises several considerations. First, it is essential to understand that head injuries can lead to various ocular and neurological complications, including changes in vision due to potential damage to the optic nerve or other visual pathways. The presence of unexplained fevers and headaches prior to the onset of visual symptoms could suggest an underlying systemic issue that may need further investigation.

The symptoms of light sensitivity (photophobia), inability to discern colors, and the perception of a "white fog" over the vision could be indicative of several conditions. While the patient has been diagnosed with mild cataracts, which can contribute to blurred vision and light sensitivity, the persistence of these symptoms post-cataract surgery suggests that there may be additional factors at play.
One possibility is that the patient may be experiencing a condition known as "post-cataract surgery syndrome," where the brain and eyes are still adjusting after the procedure. However, given the severity of the symptoms, it is crucial to rule out other potential causes. For instance, retinal issues such as macular degeneration or diabetic retinopathy could lead to similar symptoms. Additionally, conditions like uveitis or other inflammatory processes affecting the eye could also manifest as light sensitivity and blurred vision.

Given that the initial tests, including visual field tests, MRI of the brain, and optic nerve assessments, returned normal results, it may be beneficial to consider a referral to a specialist in neuro-ophthalmology. This subspecialty focuses on visual problems related to the nervous system and can provide a more comprehensive evaluation of the patient's symptoms, especially considering the history of head trauma and the complex visual complaints.

Moreover, it may be worthwhile to consult with an internist or a geriatric specialist to investigate any systemic issues that could be contributing to the patient's symptoms. Conditions such as autoimmune diseases, infections, or metabolic disorders can sometimes present with ocular symptoms and may require a multidisciplinary approach for diagnosis and management.

In summary, the patient's ongoing issues with blurred vision and light sensitivity post-cataract surgery warrant further investigation. A referral to a neuro-ophthalmologist would be a prudent next step, along with a thorough evaluation by an internist to rule out any underlying systemic conditions. It is essential to approach this case holistically, considering both ocular and systemic factors that could be contributing to the patient's visual disturbances.

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