There are few references in the literature to visual and/or ocular disturbances in chronic fatigue syndrome (CFS), even though visual symptoms are common. Ocular symptoms have been quantified, and are significantly more common than in control groups.

The ocular signs and symptoms of CFS have not been considered to be a major part of this condition in the past, yet it becomes very obvious when working with these patients that the ocular system is very much affected by, and in turn affects, this systemic condition.

Symptom histories of 141 CFS patients referred to my practice are summarized in the accompanying table. The majority had complained to the referring doctor of bothersome visual complaints, but some had not considered their visual problems to be significantly affecting their day-to-day function, or may not have mentioned any visual problems at all.

Visual symptoms

The visual symptoms typically encountered with CFS patients include:

* Blurred or foggy distance and/or near vision. Blur tends to fluctuate according to the state of the fatigue at the time;

* Difficulty focusing from distance to near and/or near to distance;

* Slowness or inability to focus on objects, particularly at near;

* Difficulty tracking lines of print. Patients seem confused and distracted by the lines of print above and below where they are reading; Poor short-term memory and concentration (generally) with reading being markedly affected;

* Diplopia or ghosting of images; Problems with peripheral vision; patients complain of not seeing objects in their side vision and of continually bumping into things and veering. Some say they feel like they have tunnel vision;

* Misjudging distances, clumsiness, poor balance and coordination. Difficulty driving due to problems judging distances;

* Dizziness and inability to tolerate looking at moving objects;

* Spots, flashes of light, floaters and halos;

* Intolerance to light (glare);

* Grittiness, burning, dryness or itchiness. Patients complain of sore eyes usually becoming worse as the day progresses;

* Headaches often increasing when reading, concentrating visually and driving.

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