Fixed Black Shadows in Vision: Causes and Concerns

Q: Fixed Black Shadows in Vision: Causes and Concerns

Hello Mr. Zion： 1. Floaters come in various forms and are not fixed. 2. A constricted visual field means you cannot see certain things, rather than seeing extra things. 3. If applying red micro ointment before bed makes you uncomfortable, it is

Eye floaters?

Thank you for taking the time to respond, Doctor.
I would like to ask about an incident that occurred last week during a retinal examination at the hospital.
The doctor noted that there were areas of thinning in my retina and performed preventive laser treatment.
A day or two later, I noticed a small black shadow that flickers when I blink, located just below my vision.
When I look up, the position of the shadow is fixed and slightly higher.
I have experienced many floaters since childhood, but this particular shadow is stationary and does not move like the other floaters, even when I deliberately move my eyes.
After a week, I returned to consult the doctor, who said that my retina appeared normal and that the location was different from the preventive laser treatment.
The doctor believed it was just a typical floater since I had experienced a sudden decline in vision in my right eye earlier this year, dropping to around 0.6.
I was diagnosed with a corneal abrasion and treated with ointment and eye drops for a month without improvement.
During a follow-up, I was unexpectedly suspected of having glaucoma and was referred to a larger hospital.
There, it was noted that my optic cup was larger, and an unscrupulous doctor directly stated that I had a 70% optic nerve atrophy.
Since then, my eyes have been sensitive to light and have repeatedly turned red.
I am unsure if this is psychological or if there is indeed optic nerve atrophy.
I later consulted two other large hospitals, and both confirmed that my optic nerve was normal and my visual field tests were also normal.
I have since heard different doctors suggest that I might have allergic conjunctivitis or dry eye syndrome.
1.
I would like to ask if this fixed black shadow could simply be a typical floater, or could there be other factors causing it? It looks quite different from the floaters I have been familiar with since childhood.

2.
The current doctor has noted that my optic cup appears enlarged and wants to schedule a follow-up for visual field testing and OCT in two months to confirm the status of my optic nerve and visual field.
However, I am very concerned that this shadow might indicate a narrowing of my visual field.
Could this shadow potentially be a sign of visual field loss due to glaucoma?
3.
The doctor has prescribed erythromycin ointment to apply before bed.
Previously, I would wake up with redness in both eyes, but now that I apply the ointment, the redness is gone upon waking.
However, I feel that my eyes are dry throughout the day, and I hear a sound when I blink.
Is this considered normal? Should I undergo testing for dry eye syndrome to check for meibomian gland obstruction and consider other treatments? Otherwise, is using artificial tears merely a temporary solution?
4.
Will waiting two months for the follow-up examination be too long? Should I seek an earlier visual field and OCT examination at another hospital? I am worried that the shadow might increase in size when I wake up one day.
Thank you for your patience in reading this, and I appreciate your thorough responses.

Zion, 30~39 year old female. Ask Date: 2023/11/26

Dr. He Jianxian reply Ophthalmology

Hello Mr.
Zion:
1.
Floaters come in various forms and are not fixed.

2.
A constricted visual field means you cannot see certain things, rather than seeing extra things.

3.
If applying red micro ointment before bed makes you uncomfortable, it is advisable to switch to another ointment.

4.
Two months is not a long time; even for standard glaucoma patients, we typically follow up clinically every three months.

Director He Jianxian, Ophthalmology, Nantou Hospital

Reply Date: 2023/11/26

More Info

Thank you for your detailed inquiry regarding the fixed black shadows in your vision. It’s understandable that you are feeling concerned, especially given your medical history and the recent treatments you have undergone. Let’s address your questions one by one, while also providing some context and information that may help clarify your situation.

1. Fixed Black Shadows vs. Floaters: The fixed black shadow you are experiencing may indeed be different from the typical floaters you have encountered throughout your life. Floaters are usually described as small spots or strands that drift in your field of vision, caused by tiny clumps of gel or cells inside the vitreous humor of the eye. In contrast, a fixed black shadow that does not move with eye movement could indicate a different issue. While it is possible that this could still be a form of floater, particularly if it is a new development, it is essential to consider other potential causes. These could include retinal issues, such as a tear or detachment, or even changes in the vitreous gel itself. Given your recent laser treatment, it is crucial to monitor any new visual symptoms closely.

2. Concerns About Glaucoma: You mentioned that your doctor noted a larger cup-to-disc ratio, which can be a sign of glaucoma. However, it is reassuring that subsequent evaluations showed normal optic nerve health and visual fields. The fixed black shadow you are experiencing is unlikely to be directly related to glaucoma unless there is a significant change in your visual field. Glaucoma typically causes peripheral vision loss rather than fixed shadows. Nevertheless, it is wise to keep your follow-up appointments and communicate any changes in your vision to your healthcare provider.

3. Eye Redness and Dryness: The redness and dryness you are experiencing could be related to several factors, including allergic conjunctivitis, dry eye syndrome, or even the medications you are using. The fact that you notice redness upon waking and that it improves with the use of erythromycin ointment suggests that there may be an underlying issue with your eyelids or tear production. It is advisable to discuss your symptoms with your doctor, who may recommend a dry eye assessment to evaluate the function of your meibomian glands (the glands that produce the oily layer of your tears). If there is a blockage, treatments such as warm compresses or specific medications may be beneficial.

4. Timing of Follow-Up Appointments: While waiting two months for your next visual field and OCT (Optical Coherence Tomography) tests may seem lengthy, it is essential to weigh the urgency of your symptoms against the availability of appointments. If your fixed black shadow worsens or if you experience any new symptoms, such as flashes of light or a sudden increase in floaters, you should seek immediate evaluation. If your anxiety about the shadow is significant, consider reaching out to another ophthalmologist for a second opinion or to expedite testing.

In summary, while the fixed black shadow you are experiencing may be benign, it is essential to remain vigilant and proactive about your eye health. Continue to monitor your symptoms, maintain open communication with your healthcare providers, and do not hesitate to seek further evaluation if your concerns persist. Your eye health is paramount, and addressing these issues early can help prevent potential complications.

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