Blurred Vision

Blurred vision covers a wide range, from a gradual need for stronger glasses to a sight-threatening emergency. The single most useful distinction is how quickly it came on.

Sudden visual change — over minutes to hours — is an emergency until proven otherwise. The eye and the brain do not have much reserve, and several causes of sudden visual loss are treatable only if treated quickly.

Gradual blurring over months is usually refractive error, cataract or dry eye, and is best assessed by an optometrist — who can measure your vision properly and look inside your eye, neither of which we can do.

This is one of the areas where a remote GP is genuinely poorly placed, and it is more useful to say so than to attempt it.

Gradual — common

• Refractive error — needing glasses, or a change of prescription. The commonest cause by a wide margin
• Presbyopia — the normal loss of near focus from the forties
• Cataract — gradual clouding, with glare and haloes around lights, worse at night
• Dry eye — blurring that clears on blinking. Very common with screen use and with age
• Diabetic retinopathy — and note that blood sugar changing quickly can itself blur vision temporarily, which is a common source of alarm when starting treatment
• Medication — anticholinergics such as amitriptyline and solifenacin, steroids, and PDE5 inhibitors. See the list on this page

Gradual — needing specialist care

• Glaucoma — usually painless with no early symptoms, which is why routine eye tests matter
• Macular degeneration — central vision distortion. Straight lines appearing wavy is the symptom to act on, and the wet form is treatable if caught early

Sudden — emergencies

• Retinal detachment — floaters, flashes, then a curtain across the vision
• Retinal artery or vein occlusion — sudden painless loss
• Giant cell arteritis — over 50, with scalp tenderness and jaw claudication
• Acute angle-closure glaucoma — painful red eye, haloes, nausea, vomiting
• Stroke or TIA — including loss of half the visual field
• Optic neuritis — pain on moving the eye with reduced vision and colour desaturation

What a consultation covers

• How suddenly it came on — the question that decides everything
• One eye or both — cover each eye in turn and check, because one-sided loss frequently goes unnoticed
• Whether it is blurring, distortion, double vision, or loss of part of the field
• Any pain, redness, floaters or flashing lights
• Whether it clears on blinking, which suggests dry eye
• Headache, temple tenderness, jaw pain on chewing
• Diabetes, blood pressure, and recent changes in either
• Your medicines
• When you last had an eye test

What we may arrange

HbA1c, blood pressure, lipids, and inflammatory markers where giant cell arteritis is a consideration. We can also refer to ophthalmology.

The limits of a video consultation — significant here

We cannot measure your visual acuity properly, examine the back of your eye, check your eye pressure, or assess your visual fields. Those four things are most of an eye examination.

For gradual blurring, an optometrist is a better first appointment than we are. High street eye tests are thorough, they include examination of the retina and pressure measurement, and they are free on the NHS for a considerable number of people — including over 60s, those with diabetes or glaucoma, and anyone on qualifying benefits.

For anything sudden, go to an eye casualty or A&E rather than booking any GP appointment. Speed determines the outcome.

Is blurred vision an emergency?

If it came on suddenly, yes. Sudden visual loss, sudden double vision, a curtain across the vision, or a painful red eye with reduced sight all need to be seen today.

Should I see an optician or a doctor?

For gradual blurring, an optician. They can measure your vision, examine the retina and check eye pressure — none of which we can do remotely. And it is free on the NHS for many people.

Why is my vision blurry since starting diabetes treatment?

A rapid improvement in blood sugar temporarily changes the lens, and blurring for a few weeks is common and expected. It usually settles. Mention it, but it is generally not a sign of damage.

Could my tablets be causing it?

Yes. Amitriptyline, bladder medicines such as solifenacin, steroids and PDE5 inhibitors all affect vision. Anticholinergic medicines in particular blur near vision.

What does it mean if straight lines look wavy?

That needs same-day assessment — it suggests macular involvement, and the wet form of macular degeneration is treatable when caught early.

I am over 50 with new headache and blurred vision.

Seek assessment today, particularly with scalp tenderness or jaw pain on chewing. Giant cell arteritis causes permanent blindness if not treated urgently with steroids.

How often should I have an eye test?

Every two years for most adults, annually over 70 or with diabetes or glaucoma. Glaucoma has no early symptoms, so the test is the only way it gets found.