Unexplained Glare: Seeking Answers for Persistent Eye Symptoms

Mysterious glare?

I have been experiencing glare for the past six months.
I have seen four doctors, but none have been able to identify the issue.
I went to a large hospital for examinations, including corneal topography, dry eye tests, and a fundus examination, all of which showed no problems.
My symptoms include halos and starbursts around lights, along with photophobia during the day.
The intensity of the glare has tripled since six months ago and is continuing to worsen.
Recently, I have also noticed that around light sources, there are lightning-like flashes and water ripple patterns.
Have you encountered similar patients, or do you have any idea where the problem might lie (such as the retina, vitreous, or lens)? Please help.
P.S.: There is no astigmatism, and the symptoms are more pronounced at night.

Jerry, 10~19 year old female. Ask Date: 2024/04/08

Dr. Cai Wenyuan reply Ophthalmology

Monitor the situation, and if symptoms persist, seek medical evaluation.

Reply Date: 2024/04/08

More Info

It sounds like you are experiencing a complex set of visual symptoms that have persisted for several months, and I understand how distressing this can be. Based on your description, you are dealing with glare, halos around lights, and other visual disturbances that have worsened over time. Despite thorough examinations by multiple eye care professionals, no definitive cause has been identified. Let's explore some potential explanations for your symptoms and discuss possible next steps.

Potential Causes of Your Symptoms
1. Corneal Issues: Although your corneal topography and dry eye tests came back normal, it’s worth noting that conditions like corneal ectasia or irregular astigmatism can sometimes be subtle and may not be easily detected in standard tests. These conditions can lead to visual distortions, including glare and halos.

2. Lens Opacities: While you mentioned that there is no astigmatism, it’s essential to consider the possibility of early cataract formation or other lens opacities. These can cause light scattering, leading to glare and halos, especially in bright light conditions. A thorough examination of the lens, including a slit-lamp examination, can help identify any opacities.

3. Vitreous Changes: The vitreous gel that fills the eye can undergo changes with age or due to high myopia, leading to symptoms like floaters and flashes of light. If the vitreous is pulling on the retina, it can cause visual disturbances. Although you have not mentioned flashes, the “lightning” effect you describe could be related to vitreous traction.

4. Retinal Issues: Although your retinal examination was normal, conditions such as retinal tears or detachment can sometimes present with similar symptoms. It’s crucial to have a comprehensive retinal evaluation, including an optical coherence tomography (OCT) scan, which can provide detailed images of the retina and help identify any subtle changes.

5. Neurological Factors: Sometimes, visual disturbances can stem from neurological issues rather than purely ocular problems. Conditions affecting the visual pathways in the brain can lead to symptoms like glare and visual distortions. A referral to a neurologist may be warranted if other causes are ruled out.

6. Photophobia: Your sensitivity to light (photophobia) could be exacerbated by various factors, including dry eye syndrome, migraine-associated visual disturbances, or even psychological factors like anxiety, which can heighten awareness of visual symptoms.

Next Steps
1. Follow-Up with an Eye Specialist: Given the persistence and worsening of your symptoms, it may be beneficial to seek a second opinion from a retinal specialist or a neuro-ophthalmologist. They can provide a more in-depth evaluation of the retina and the visual pathways.

2. Consider Comprehensive Testing: Request additional tests such as OCT, visual field testing, and possibly even a visual electrophysiological test to assess the function of the retina and optic nerve.

3. Manage Symptoms: In the meantime, consider using tinted glasses or anti-reflective coatings on your lenses to help reduce glare. Artificial tears may also help if dry eyes are contributing to your symptoms.

4. Document Changes: Keep a detailed log of your symptoms, including when they occur, their intensity, and any potential triggers. This information can be invaluable for your healthcare providers in diagnosing the issue.

5. Explore Neurological Evaluation: If ocular causes are ruled out, a consultation with a neurologist may be necessary to explore any underlying neurological conditions that could be contributing to your symptoms.

Conclusion
Your symptoms are complex and multifaceted, and while it can be frustrating not to have a clear diagnosis, continuing to seek answers is essential. Collaborating closely with your healthcare providers and possibly exploring additional specialties will be crucial in uncovering the underlying cause of your persistent glare and visual disturbances. Remember, you are not alone in this journey, and there are professionals who can help you find relief and clarity.

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