Common ocular symptoms and their causes

1. Defective vision. It is the commonest ocular
symptom. Enquiry should reveal its onset (sudden or
gradual), duration, whether it is painless or painful,
whether it is more during the day, night or constant,
and so on. Important causes of defective vision can
be grouped as under:
Sudden painless loss of vision
Central retinal artery occlusion
Massive vitreous haemorrhage
Retinal detachment involving macular area
Ischacmic central retinal vein occlusion
Sudden painless onset of defective vision
Central serous retinopathy
Optic neuritis
Methyl alcohol amblyopia
Non-ischacmic central retinal vein occlusion
Sudden painful loss of vision
Acute congestive glaucoma
Acute iridocyclitis
Chemical injuries to the eyeball
Mechanical injuries to the eyeball
Gradual painless defective vision
Progressive pterygium involving pupillary area
Corneal degenerations
Corneal dystrophies
Developmental cataract
Senile cataract
Optic atrophy
Chorioretinal degenerations
Age-related macular degeneration
Diabetic retinopathy
Refractive errors
Gradual painful defective vision
Chronic iridocyclitis
Corneal ulceration
Chronic simple glaucoma
Transient loss of vision (Amaurosis fugax)
Carotid artery disease
Papilloedema
Giant cell arteritis
Migraine
Raynaud’s disease
Severe hypertension
Prodromal symptom of CRAO
Night blindness (Nyctalopia )
Vitamin A deficiency
Retinitis pigmentosa and other tapetoretinal
degenerations
Congenital night blindness
Pathological myopia
Peripheral cortical cataract
Day blindness (Hamarlopia)
Central nuclear or polar cataracts
Central corneal opacity
Central vitreous opacity
Congenital deficiency of cones (rarely)
Diminution of vision for near only
Presbyopia
Cycloplegia
Internal or total ophthalmoplegia
Insufficiency of accommodation
2. Other visual symptoms. Visual symptoms other
than the defective vision are as follows:
Black spots or floaters in front of the eyes may appear
singly or in clusters. They move with the movement
of the eyes and become more apparent when viewed
against a clear surface e.g., the sky. Common causes
of black floaters are:
Vitreous haemorrhage
Vitreous degeneration. e.g.,
– senile vitreous degeneration
– vitreous degeneration in pathological myopia
Exudates in vitreous
Lenticular opacity
Flashes of light in front of the eyes (photopsia). Occur
due to traction on retina in following conditions:
Posterior vitreous detachment
Prodromal symptom of retinal detachment
Vitreous traction bands
Sudden appearance of flashes with floaters is a
sign of a retinal tear
Retinitis
Distorted vision. Distorted vision is a feature of
macular lesions e.g., central chorioretinitis. It may be
in the form of:
Micropsia (small size of objects),
Macropsia (large size of objects),
Metamorphopsia (distorted shape of objects).
Coloured halos. Patient may perceive coloured halos
around the light. It is a feature of:
Acute congestive glaucoma
Early stages of cataract
Mucopurulent conjunctivitis
Diplopia, i.e., perceiving double images of an object
is a very annoying symptom. It should be ascertained
whether it occurs even when the normal eye is closed
(uniocular diplopia) or only when both eyes are open
(binocular diplopia). Common causes of diplopia are:
Uniocular diplopia
Subluxated lens
Double pupil
Incipient cataract
Keratoconus
Eccentric IOL
Binocular diplopia
Paralytic squint
Myasthenia gravis
Diabetes mellitus
Thyroid disorders
Blow-out fracture of floor of the orbit
Anisometropic glasses (e.g., uniocular aphakic
glasses)
After squint correction in the presence of
abnormal retinal correspondence (paradoxical
diplopia).
3. Watering from the eyes. Watering from the eyes is
another common ocular symptom. Its causes can be
grouped as follows:
Excessive lacrimation, i.e., excessive formation of
tears occurs in multiple conditions (see page 367).
Epiphora, i.e., watering from the eyes due to blockage
in the flow of normally formed tears somewhere in the
lacrimal drainage system (see page 367).
4. Discharge from the eyes. When a patient complains
of a discharge from the eyes, it should be ascertained
whether it is mucoid, mucopurulent, purulent,
serosanguinous or ropy. Discharge from the eyes is a
feature of conjunctivitis, corneal ulcer, stye, burst
orbital abscess, and dacryocystitis.
5. Itching, burning and foreign body sensation in
the eyes. These are very common ocular symptoms.
Their causes are:
Chronic simple conjunctivitis
Dry eye
Trachoma and other conjunctival inflammations
Trichiasis and entropion
6. Redness of the eyes. It is a common presenting
symptom in many conditions such as conjunctivitis,
keratitis, iridocyclitis and acute glaucomas.
7. Ocular pain. Pain in and around the eyes should
be probed for its onset, severity, and associated
symptoms. It is a feature of ocular inflammations and
acute glaucoma. Ocular pain may also occur as
referred pain from the inflammation of surrounding
structures such as sinusitis, dental caries and
abscess.
8. Asthenopic symptoms. Asthenopia refers to mild
eyeache, headache and tiredness of the eyes which
are aggravated by near work. Asthenopia is a feature
of extraocular muscle imbalance and uncorrected mild
refractive errors especially astigmatism.
9. Other ocular symptoms are as follows:
Deviation of the eyeball (squint)
Protrusion of the eyeball (proptosis)
Drooping of the upper lid (ptosis)
Retraction of the upper lid
Sagging down of the lower lids (ectropion)
Swelling on the lids (e.g., chalazion and tumours)