Temporary Irregular Astigmatism as a Cause of Unexplained Vision Loss

March 30, 2009

I heard a great case on my AudioDigest today from a neuroophthalmologist. He describes a 40ish woman who complains that after about 30 minutes of reading, her vision gets blurred for both distance and near. If she looks out in the distance for a little while, it goes away. He had her repeat this in his exam room, and sure enough, it happened just as she described. I figured it was accomodative spasm or dry eye, and I would have sent her home with artificial tears and advice to interrupt her close work every 5-10 minutes. The presenter, though, decided to perform corneal topography before and after reading, and there it was- significant irregular astigmatism that slowly resolved when she stopped reading. He states this is not rare and only occurs with bifocals- somehow, the lower lid rests on the cornea and causes the astigmatism! He prescribes full field reading glasses which cures the problem and he’s a hero! Something to think about…




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