Neck and Eye Symptoms: A Neurology Perspective

Neck and eye issues?

Hello Doctor: I had a retinal tear in May of last year and underwent laser treatment twice for each eye.
After each procedure, I experienced some lingering side effects.
One perplexing symptom is that about half a month after the second laser treatment (in October of last year), I began to see a flash of light above my eyes when I turned my neck or head.
Even with my eyes closed, I can still perceive that light when moving my head or neck.
It feels like shining a flashlight in a dark room, creating a circular pattern, but the light moves from the upper left to the lower right.
This has persisted for two to three months.
I have consulted three different ophthalmologists during this time, and they all said that my retina looks fine, but they are unsure about the cause of this symptom.
Additionally, I have been experiencing tinnitus for five years.
Six months ago, I noticed that when I sleep for three to four hours, the tinnitus suddenly intensifies, and I see many bright dots flashing in front of my eyes, which significantly affects my sleep quality.
I also consulted a neurologist and underwent an MRI of the head, an EEG, and X-rays of my neck in July of last year, but no cause was found.
Please advise me on which specialist I should see.
Thank you.

mei, 40~49 year old female. Ask Date: 2004/02/17

Dr. Ye Boshou reply Neurology

The literature does not mention such symptoms; could it be an issue with blood flow in the retina? It's uncertain.
Regarding the mentioned symptoms (specifically headaches), it is recommended to first perform a cranial ultrasound to check for any blood flow issues.

Reply Date: 2004/02/17

More Info

Your symptoms, including the visual disturbances and neck discomfort, are indeed complex and warrant a thorough evaluation from a neurological perspective. Given your history of retinal issues and the recent onset of symptoms, it is essential to consider both neurological and ophthalmological factors.

Firstly, the phenomenon of seeing flashes of light, especially when moving your head or neck, can be indicative of several conditions. This symptom, known as photopsia, can arise from various causes, including retinal issues, vitreous detachment, or even neurological conditions affecting the visual pathways. Since you have a history of retinal laser treatments, it is crucial to rule out any complications related to those procedures. While your ophthalmologists have indicated that your retina appears stable, the persistence of these visual disturbances suggests that further investigation is necessary.

The fact that you experience these flashes when turning your head could also suggest a connection to your neck. Cervical spine issues, such as cervical spondylosis or nerve root compression, can sometimes lead to referred sensations in the head and visual disturbances. The neck and head are closely interconnected, and issues in one area can manifest symptoms in another. A thorough evaluation by a neurologist, who can assess both your neurological function and any potential cervical spine issues, would be beneficial.

Additionally, your experience of tinnitus (ear ringing) and the exacerbation of this symptom with sleep disturbances is noteworthy. Tinnitus can be associated with various conditions, including inner ear disorders, neurological issues, or even stress and anxiety. The fact that your tinnitus worsens during sleep could indicate a possible link to your overall stress levels or sleep quality, which can further complicate your symptoms.

Considering the multifaceted nature of your symptoms, it may be helpful to consult with a neurologist who specializes in neuro-ophthalmology. This subspecialty focuses on the relationship between the nervous system and vision, providing a comprehensive approach to diagnosing and managing conditions that affect both areas. They can perform specific tests to evaluate your visual pathways and assess whether there is any neurological involvement contributing to your symptoms.

In summary, I recommend the following steps:
1. Consult a Neuro-Ophthalmologist: This specialist can provide a focused evaluation of your visual symptoms in relation to your neurological health.

2. Cervical Spine Assessment: If you have not already done so, consider imaging studies of your cervical spine to rule out any structural issues that may be contributing to your symptoms.

3. Sleep Evaluation: Since your symptoms worsen with sleep disturbances, a sleep study may be beneficial to assess for any underlying sleep disorders that could be exacerbating your tinnitus and visual symptoms.

4. Stress Management: Given the potential link between anxiety and your symptoms, exploring stress management techniques or therapy may also be beneficial.

5. Follow-Up: Regular follow-up with your healthcare providers is essential to monitor your symptoms and adjust your treatment plan as necessary.

Your symptoms are complex, and while they may be interconnected, a thorough evaluation by the right specialists will help clarify the underlying causes and guide appropriate management.

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