Blurred Vision and Headache

An Overview

Occasionally, blurred vision can cause headaches and eye strain. Most of the conditions that cause headaches are benign (harmless). Benign headaches are certainly an aggravation but are not considered medical emergencies.

Benign conditions that cause headaches include:

• Tension or stress headaches
• Migraine headaches
• Sinus-related headaches
• Cluster Headaches
• Eye strain and/or blurred vision
• Poor quality or incorrectly configured computer screens

Eye strain and blurred vision can cause headaches when a person is forced to strain the focusing muscles in their eyes to keep the vision clear. The focusing muscles get tired after a long day of forced focusing and this fatigue can lead to a tension headache or even a migraine headache.

To determine if this type of eye strain is causing a headache, a sophisticated computer called an Auto Refractor is used to read a person's "TRUE REFRACTION." With this computer, very accurate information can be obtained in just about any child or adult, even if they can't or won't talk. Occasionally, we use an eye drop called Atropine to assist in determining a patient's true refraction. This drop relaxes the focusing muscles in the eye that are normally used to keep the vision clear and allows us to measure the TRUE REFRACTION. In some people, the strong contraction of these muscles is the cause of their headache. The medical term for measuring the TRUE REFRACTION using Atropine is called a Cycloplegic (Sy'-Cloe-Plee'-Jick) Refraction.

Some or all of the steps below will be used to determine if a patient's blurred vision is causing their headaches. The process utilizes advanced computers and may involve the use of Atropine, as explained above.

The steps we use to determine the cause of headaches:

• Check baseline vision
• Determine if any other neurological changes are present.
• Determine the baseline refraction (Manifest Refraction)
• Give Atropine 2 times daily, 2 days just before the next appointment. At the next appointment, determine the person's TRUE REFRACTION.
• Determine the TRUE REFRACTION (Cycloplegic Refraction using Atropine) using the auto-refractor.
• Return to clinic to see if the patient sees better with the True Refraction. Some patients cannot tolerate their true refraction as it makes the vision "too clear."
• Prescribe glasses or contact lenses if necessary
• Follow up to assure improvement of the headaches and/or blurred vision.
• If condition does not improve or if the condition worsens, perform diagnostic testing:
• Visual Field Testing
• Computed tomography scan (CaT Scan)
• Magnetic Resonance Imaging (MRI)
• Lab tests if indicated
• Consult Neurology or Neurosurgery

In almost all cases, we discover that blurred vision and or headaches are NOT SERIOUS. Typically the patient will have a benign headache that does not require treatment. In very rare cases, however, headache can be a symptom of an underlying neurological problem. These headaches are almost always accompanied by other signs and symptoms as discussed below.

Because we never want to miss the diagnosis of a brain tumor, we work up all headaches in both adults and children using guidelines from the American Academy of Ophthalmology. Using this protocol (outlined above), we have had a 100% success rate in diagnosing brain tumors related to headaches. In other words, rest assured that if you or a member of your family has a headache related to a serious brain problem, we will probably catch it.

In children, it is tricky to assess a neurological problem because children will often answer yes to just about any question that you ask them. For example, if you ask a child "are you having any dizziness," some will say yes.

In this case, we must be more specific and ask the question, "Have you fallen down recently from being dizzy?" If a child or an adult has fallen during normal activity, there will usually be a witness.

Warning signs that a headache and/or blurred vision may be associated with a neurological problem:

• Double vision
• Dizziness
• Loss of vision (part or all of the vision in one or both eyes)
• Loss of sensation in a part of the body
• Loss of strength in a part of the body
• Generalized weakness
• Changes in personality
• Excessive weight gain or weight loss
• Children may be being much bigger or smaller than other children of the same age.
• Children may show poor performance in school.
• Loss of coordination
• Head tilting
• Localized or severe pain in the head area

If a child or an adult has any of the above symptoms along with a headache and blurred vision, the situation warrants further investigation.

In 99.99% of headaches and blurred vision, there is NO SERIOUS PROBLEM FOUND.

Headache treatment (in most cases):

• Tylenol or Advil for the headache discomfort
• Occasionally glasses or contact lenses to reduce eye strain
• Re-assurance that everything is OK.

As you can see from the discussion above, headaches are typically harmless, but proving this can be complex. Do not get frustrated if this seems confusing; headaches are complicated. We ask for your patience in the process of working up the problem. Take confidence in knowing that we specialize in diagnosing and treating headaches and please allow us to handle all the details. Feel free to ask any questions you may have on the issue. We feel that the more you know, the more you can help us manage the condition.

Although most headaches turn out to be harmless, we take complaints of headaches and blurred vision seriously. We thank you for your trust and we will do our best to provide you with the best care possible. Our goal is to keep you healthy with good vision for life.