Eye Health: Symptoms and When to Seek Treatment

Assessment of Eye Health

Hello, doctor.
I would like to address some long-standing eye issues through the following questions.
I hope you can help me determine the causes of my symptoms and whether treatment is necessary.
Thank you very much for your assistance.
1.
Since I was ten years old, I have noticed floaters in my vision.
Recently, I feel that there are times when the floaters are absent, but they appear when I look at a white sheet of paper or the sky.
When I look at particularly bright areas, I see numerous bright spots, and with each heartbeat, I notice black lines resembling blood vessels in my field of vision, along with shadows at the edges of my eye sockets.
2.
About once a week, I experience small black dots in the center of my vision, but they are not entirely black; instead, they appear as a semi-transparent area surrounded by a black frame.
Each time I notice this, it lasts for about ten minutes before disappearing.
3.
When I strain my eyes to look up, down, or sideways, I see a black circular area.
4.
After focusing on a single point for a while, I feel that the image distorts or certain lines disappear, leaving a purple-black afterimage.
5.
After turning off the lights at night and moving my eyes, I see white lightning-like flashes.
6.
Occasionally, when I sneeze and turn my head forcefully, I experience curved, colorful light patterns in my vision, resembling very thin caterpillars moving from the periphery toward the center.
There are about a dozen curved lines in total, and this lasts for about ten seconds.
7.
Over the past three years, I have experienced severe dizziness about twice a year, accompanied by a region in my vision that resembles television static, obstructing my view.
Anything obscured by this area seems to disappear, and I can still perceive this area when I close my eyes.
Typically, it takes about an hour of rest to alleviate the symptoms.
I haven't encountered this situation in the past year, but when it occurs, it feels very frightening.
I have undergone a dilated fundus examination, which showed no issues, but I have not yet discussed the above symptoms with my doctor.
Please advise me on how to proceed.

Sheng Zhe, 10~19 year old female. Ask Date: 2023/04/15

Dr. Cai Wenyuan reply Ophthalmology

Observe the symptoms, and if they persist, seek medical evaluation.

Reply Date: 2023/04/15

More Info

Hello! Thank you for sharing your concerns about your eye health. Based on the symptoms you've described, it seems that you are experiencing a range of visual disturbances that could be related to various underlying conditions. Let's break down your symptoms and discuss potential causes, as well as when you should seek treatment.

1. Floaters and Visual Disturbances: The presence of floaters, especially since you were ten years old, is quite common and often benign. However, the recent changes in their appearance, such as the black lines that pulse with your heartbeat and the transient black spots, could indicate changes in the vitreous gel of the eye or even retinal issues. The fact that you see these floaters more prominently against bright backgrounds is typical, but if they are increasing in number or changing in nature, it warrants further investigation.

2. Transient Visual Phenomena: The small black dots and the semi-transparent areas you notice could be related to visual migraines or other forms of visual disturbances. These can occur without a headache and may be linked to changes in blood flow or nerve activity in the brain. The description of seeing a purple-black residual image after focusing on something for a while could also suggest a form of afterimage, which is generally harmless but can be disconcerting.

3. Flashes of Light: The white flashes you see when moving your eyes, especially in low light, could be a sign of retinal irritation or a posterior vitreous detachment. This is when the vitreous gel pulls away from the retina, which can cause flashes of light. While this is often benign, it can sometimes lead to more serious conditions if the retina is affected.

4. Visual Distortion and Migraines: The episodes of severe dizziness accompanied by visual disturbances resembling television static could indicate a migraine aura. Migraines can cause a variety of visual symptoms, including scintillating scotomas (flashing lights) and temporary vision loss.

5. When to Seek Treatment: Given the complexity and variety of your symptoms, it is crucial to communicate all of these details to your eye care professional. While you have had a dilated eye exam that showed no immediate issues, your current symptoms may require further evaluation. Specifically, you should seek treatment if:
- You notice a sudden increase in floaters or flashes of light.

- You experience any sudden loss of vision or significant changes in your vision.

- Your symptoms are accompanied by severe headaches or neurological symptoms (like weakness or numbness).

6. Potential Next Steps: It may be beneficial to schedule a follow-up appointment with your eye doctor and provide them with a comprehensive list of your symptoms. They may recommend additional tests, such as optical coherence tomography (OCT) or a visual field test, to assess the health of your retina and optic nerve. If necessary, they might refer you to a specialist, such as a neuro-ophthalmologist, for further evaluation of your visual symptoms.

7. Lifestyle Considerations: In the meantime, consider reducing eye strain by taking regular breaks from screens, ensuring proper lighting while reading or working, and maintaining a healthy lifestyle that includes hydration and a balanced diet rich in antioxidants.

In conclusion, while many of your symptoms could be benign, the combination and changes in your visual experiences suggest that further evaluation is warranted. Open communication with your healthcare provider is key to addressing your concerns and ensuring your eye health is monitored appropriately. Thank you for reaching out, and I hope this information helps guide you in managing your eye health!

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