Visual Disturbances After Waking: Causes and Solutions

Q: Visual Disturbances After Waking: Causes and Solutions

Hello： Based on your situation, it is possible that there is an issue with the macula. <br>I recommend that you visit an ophthalmologist for a detailed examination as soon as possible. <br>Only after reviewing the results of the examination can we determine the appropriate treatm

Visual disturbances upon waking?

Dr.
Gao: Hello! I have some vision problems, and I would like your advice.
I am sixty-one years old.
I have had amblyopia in my left eye since childhood, and now I have hyperopia and presbyopia in my right eye.
Twenty years ago, I experienced severe hypertension that led to retinal hemorrhage, and I have been taking antihypertensive medication daily since then.
The retinal blood vessels had recovered a few months after the incident.
However, about a month ago, I noticed the following vision issues:
1.
Every time I wake up from a nap and open my eyes to look at the light yellow wall in front of me, I see a small light yellow-green rectangular frame near the center of my vision, which contains a similarly light yellow-green, sparsely arranged, irregularly shaped net-like line.
When I fully open my eyes, the frame and the net lines disappear.
Recently, upon waking, I sometimes see that my entire field of vision is filled with sparse light yellow-green net lines instead of just the small rectangular frame, and similarly, after opening my eyes several times, the net lines disappear.
2.
Every morning at five o'clock, when I wake up before dawn and the room is only illuminated by faint light from the street, I can see the room's layout, but at the same time, there is a large black shadow occupying about one-fifth of my entire field of vision.
This shadow varies in size daily, taking on a regular oval shape, and it slowly contracts from the outer edge towards the center point of the oval over two to three seconds before completely disappearing.
I later discovered that if I deliberately open my eyes slowly after waking, the shadow does not appear.
I kindly ask for your guidance on how to treat my vision problems.
Thank you very much! Sincerely, Xiao Bao.

Xiao Bao, 60~69 year old female. Ask Date: 2015/08/13

Dr. Gao Pilin reply Ophthalmology

Hello: Based on your situation, it is possible that there is an issue with the macula.
I recommend that you visit an ophthalmologist for a detailed examination as soon as possible.
Only after reviewing the results of the examination can we determine the appropriate treatment direction.
Thank you for your message.

Reply Date: 2015/08/13

More Info

Dear 小寶,
Thank you for reaching out with your concerns regarding your vision. Based on the symptoms you've described, it seems you are experiencing a range of visual disturbances, particularly upon waking. Let's break down your symptoms and explore potential causes and solutions.

Understanding Your Symptoms
1. Visual Disturbances After Waking: The phenomenon of seeing a yellow-green rectangular frame with a net-like pattern upon waking can be attributed to several factors. This could be a form of visual migraine or a phosphene, which is a sensation of seeing light without light actually entering the eye. These occurrences can be benign, especially if they resolve quickly upon blinking or moving your eyes.

2. Black Shadow in Peripheral Vision: The black shadow you see upon waking, which occupies a significant portion of your visual field, could be related to a few conditions. One possibility is vitreous detachment, which is common in older adults and can cause shadows or floaters in your vision. Another possibility is retinal issues, such as a tear or detachment, especially considering your history of hypertension and retinal bleeding.

Potential Causes
- Vitreous Changes: As we age, the vitreous gel inside the eye can shrink and pull away from the retina, leading to visual disturbances like floaters or shadows.

- Retinal Health: Given your history of hypertension and retinal bleeding, it is crucial to monitor the health of your retina. Changes in blood flow or pressure can lead to various retinal conditions.

- Ocular Migraines: These can cause temporary visual disturbances, often accompanied by headache, but can occur without pain. They typically resolve within a short period.

- Eye Fatigue: If you are experiencing visual disturbances after waking, it may also be related to eye fatigue or strain, particularly if you have been using screens or reading extensively before sleep.

Recommended Solutions
1. Comprehensive Eye Examination: It is essential to have a thorough eye examination by an ophthalmologist. They can perform tests to assess the health of your retina and vitreous, including a dilated fundus examination and possibly imaging studies like optical coherence tomography (OCT).

2. Monitor Blood Pressure: Since you have a history of hypertension, ensure that your blood pressure is well-controlled. Fluctuations in blood pressure can affect your vision and overall eye health.

3. Visual Hygiene: Practice good visual hygiene by taking regular breaks from screens, ensuring proper lighting while reading, and using appropriate eyewear for your refractive errors.

4. Stay Hydrated and Maintain a Healthy Diet: Proper hydration and a diet rich in antioxidants (like vitamins C and E, omega-3 fatty acids, and lutein) can support eye health.

5. Follow-Up: If your symptoms persist or worsen, or if you experience new symptoms such as flashes of light, sudden vision loss, or increased floaters, seek immediate medical attention.

Conclusion
While some visual disturbances can be benign, your history and the nature of your symptoms warrant a thorough evaluation. It is crucial to address these issues proactively to ensure your vision remains stable and to rule out any serious conditions. Please consult with your eye care provider as soon as possible to discuss your symptoms in detail and receive appropriate care.

Thank you for sharing your concerns, and I hope you find this information helpful. Please take care of your eye health, and do not hesitate to reach out for further assistance.

Best regards,
Doctor Q&A Teams

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