Occasional Visual Disturbances: When to Seek Medical Help

Q: Occasional Visual Disturbances: When to Seek Medical Help

Hello： The discomfort in your left eye may require consideration of a retinal issue. <br>However, since you have already consulted an ophthalmologist without any specific findings, the next step would be to consider a possible neurological problem. <br>You have also seen a neurol

Occasionally experiencing flashes of light in the vision, but the ophthalmologist cannot identify the cause?

Hello Dr.
Lin, recently I've been experiencing a sensation in my left eye near the outer corner that feels like seeing stars (this seems to occur more often when sitting, standing up, or sitting cross-legged).
It happens intermittently, sometimes several times a day, and other times it may not occur at all throughout the day.
This has been bothering me for nearly four months.
During this period, I consulted a neurologist who examined my optic nerve and checked for any pressure on it, but the results were normal.
An eye examination also did not reveal any issues.
I have a history of nasal and skin allergies, and I suspect I may have migraine symptoms (pain on the left or right side of my head, with a pulsating pain at the back of my head).
I also have a history of low hemoglobin levels, diagnosed as anemia.
I'm not sure which specialist I should see to identify the potential issue...
What conditions could lead to this uncomfortable sensation? What would you recommend for my next steps in seeking medical advice? Thank you.

Niming, 20~29 year old female. Ask Date: 2023/02/05

Dr. Lin Zhebin reply Family Medicine

Hello: The discomfort in your left eye may require consideration of a retinal issue.
However, since you have already consulted an ophthalmologist without any specific findings, the next step would be to consider a possible neurological problem.
You have also seen a neurologist, and again, no particular findings were noted.
Additionally, if the issue is related to allergies, it is unlikely to affect only one eye.
If it is related to migraines, you should consider whether the discomfort in your left eye often serves as a precursor to migraine attacks.
If it is related to anemia, it also should not affect just one eye.
In summary, I recommend that you consult an ophthalmologist again for a detailed examination of the retina.
If no specific findings are identified, you should then see a neurologist to see if further blood tests and a brain MRI can be arranged.

Reply Date: 2023/02/05

More Info

It sounds like you are experiencing a range of visual disturbances that have been quite distressing for you. The symptoms you describe, particularly the sensation of "seeing stars" or flashes of light in your peripheral vision, can be associated with various underlying conditions. Given your history of migraines, allergies, and anemia, it’s important to consider how these factors might interplay with your current symptoms.

Firstly, the phenomenon of seeing flashes or spots of light, often referred to as photopsia, can occur due to several reasons. In many cases, it can be benign and related to changes in the vitreous gel of the eye, especially if you have a history of myopia (nearsightedness) or if you are experiencing age-related changes. However, it can also indicate more serious conditions such as retinal detachment or vitreous hemorrhage, which require immediate medical attention.

Since you have already consulted with both a neurologist and an ophthalmologist without any significant findings, it may be worthwhile to consider a few additional steps:
1. Comprehensive Eye Examination: If you haven’t had a dilated eye exam recently, it might be beneficial to do so. This allows the ophthalmologist to get a better view of the retina and check for any abnormalities that might not have been visible during a standard examination.

2. Neurological Evaluation: Given your history of migraines, it may be helpful to revisit a neurologist, especially if your headaches have changed in frequency or intensity. Sometimes, visual disturbances can be a precursor to a migraine aura, which can occur with or without a headache.

3. Allergy Management: Since you mentioned having allergies, it’s worth considering whether they could be contributing to your symptoms. Allergies can cause eye irritation and may lead to visual disturbances. Consulting with an allergist might provide insights into managing your symptoms better.

4. Blood Work: Since you have a history of anemia, it might be prudent to have your blood levels checked again. Anemia can lead to various symptoms, including fatigue and dizziness, which could potentially exacerbate your visual disturbances.

5. Lifestyle Modifications: Pay attention to your hydration, nutrition, and overall health. Sometimes, simple lifestyle changes can have a significant impact on how you feel. Ensure you are eating a balanced diet rich in iron and vitamins, staying hydrated, and managing stress effectively.

6. Monitor Symptoms: Keep a detailed diary of your symptoms, noting when they occur, their duration, and any potential triggers. This information can be invaluable for your healthcare providers in diagnosing the issue.

In summary, while your symptoms may not indicate a serious condition based on previous evaluations, it is essential to remain vigilant and proactive in seeking further medical advice. If your symptoms worsen or new symptoms arise, do not hesitate to seek immediate medical attention. Your health and peace of mind are paramount, and it’s important to address any concerns you may have with your healthcare providers.

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