Shrunken vision describes the perception that objects or the visual field appear smaller than normal, known as micropsia. It can have retinal, optical, or neurological origins.
Retinal and Optical Causes
Macular oedema, epiretinal membrane, and other macular disorders can make images appear reduced in size in the affected eye. High minus spectacle lenses and certain contact lens designs also minify images.
- Patients may feel that one eye sees a smaller image than the other (aniseikonia)
- Post‑surgical changes or retinal displacement can alter perceived size
- Migraine aura and some neurological conditions can cause transient micropsia
- Psychological or perceptual syndromes, such as Alice in Wonderland syndrome, produce dramatic size distortions
Assessment
Evaluation involves macular imaging, refraction, and sometimes neuro‑imaging. Management aims to treat retinal disease, balance image size optically, and address neurological or systemic causes.
- Persistent unequal image size may require specialist optical solutions
- Sudden onset with other neurological symptoms needs urgent review
- Rehabilitation helps patients adapt when micropsia cannot be fully corrected
- Clear history of onset, duration, and triggers is important for accurate diagnosis
