Do you have a problem seeing zig zag lines? This can be an alarming symptom. Sometimes, they are described as jagged or resembling a heat wave coming off of a hot asphalt road. Others describe the symptom as looking like a kaleidoscope. The zig zag lines usually come on without warning and may slowly increase in size and intensity over several minutes. They often interfere with vision by blocking out part of the vision. For example, you may only be able to see part of a person’s face or part of a printed word. After 15–20 minutes or so, they disappear without any permanent vision loss.
What causes this symptom?
There are many causes of zig zag lines in the vision. However, the most common cause is a migraine phenomenon, called a visual aura. Migraines with visual aura may occur with or without a headache. Often, they often follow stress by several weeks. Migraine is a diagnosis of exclusion. That means it is necessary to exclude or rule out other more serious causes of zig zag lines before settling with the diagnosis of migraine.
What are more serous causes of zig zag lines in the vision?
Serious causes of may include problems in the eyes, the brain, the heart, and other medical problems. Eye problems include retinal breaks, retinal detachment, and inflammation in the eyes. Brain problems include bleeding, aneurysm, seizure, and tumors. Sometimes, zigzag lines are associated with a heart problem, such as patent foramen ovale. In this case, a cardiologist assesses and provides treatment as needed. Rarely, blood clot problems and connective tissue disease are implicated.
Who should I see about this problem?
The ophthalmologist (Eye MD) is equipped with the knowledge, skill, and equipment to diagnose the cause of your zig zag lines. Sometimes, you may need to see a retinal specialist (a type of ophthalmologist with specialty education in retinal disease). In some cases, the ophthalmologist will send you for a brain scan or to a neurologist for further care.
What is the treatment for zig zag lines?
The treatment of zig zag lines depends on the cause. Once the doctor excludes serious diseases, he may diagnosis migraine. In that case, no treatment is usually necessary. However, if the symptoms are recurrent and bothersome, the ophthalmologist will usually send you to a neurologist for assessment and possible medication.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
A visual hallucination is the perception of a visual image that is not the result of seeing an object outside the eye. Normally, the eye perceives light from objects outside the eye and sends the image to the brain for interpretation. However, there are a number of circumstances that result in images being “seen” by a patient that do not originate from outside the eye. These images are referred to as hallucinations, especially if they appear as formed images of recognizable objects, like faces, trees, or other familiar things. Sometimes, hallucinations appear as dots, lines, or geometric shapes. The hallucinations may be in color or black and white.
What causes hallucinations?
A large list of problems may cause visual hallucinations. These include drug use and abuse, delirium, mental illness, and a variety of neurological conditions (including stroke, multiple sclerosis, and dementia). Sometimes, eye disease causes visual hallucinations; this is called the Charles Bonnet syndrome. It is a common condition in which the brain “makes up images” as a result of loss of vision from an eye condition (such as macular degeneration, diabetic retinopathy, or glaucoma). Charles Bonnet was an 18th century botanist and philosopher who described complex visual hallucinations in his grandfather after loss of vision.
How can a doctor find the underlying cause of visual hallucinations?
A doctor may determine the cause of visual hallucinations by careful examination and testing. If the hallucinations are interpreted by the patient as being “real,” the cause is more likely related to mental illness or may be due to drug intoxication or neurological disease. In these cases, the mental status exam is usually not normal. In the Charles Bonnet syndrome, the patient knows what he is seeing is not real, but sees the images nonetheless. An eye exam may make the diagnosis, but in some cases, further testing is needed. And these may include blood tests and imaging studies (CT scan and/or MRI brain scan). The final diagnosis of Charles Bonnet syndrome is made only after other more serious diagnoses are excluded.
What is the treatment of visual hallucinations?
The treatment depends on the underlying cause. In the case of the Charles Bonnet syndrome, counseling may help. Much relief comes from knowing that the symptoms are benign and do not represent a serious medical condition. Some patients find the symptoms improve if they move their eyes up-and-down, or left-and-right, or look away from the hallucinations. Others find it helps to stare at the hallucination until it fades away. It may help to talk about the hallucination with a family member or friend. Because stress and fatigue may precipitate the hallucinations, some recommend getting plenty of sleep and rest. Exercise and meditation are helpful. Thankfully, the visual hallucinations from Charles Bonnet syndrome often subside with time and may disappear over months to years. Rarely, medication may be prescribed by a neurologist. New treatments are on the horizon.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Visual snow is the name for a visual symptom that looks like static on a television not tuned to a station. It has also been likened to pixelation on a computer screen. Many tiny flickering lights are usually seen in both eyes at the same time and encompasses the entire visual field. In some instances, it is worse in bright illumination like a bright sunny day.
What is the difference between primary and secondary visual snow syndrome?
Visual snow may be seen in patients without an underlying disease. In these cases it appears to be caused by hyperexcitability of the visual cortex of the brain. This is often called primary visual snow syndrome (VSS). Primary VSS is a diagnosis of exclusion. That is, other diagnoses must be excluded before the diagnosis of primary VSS is made. Primary VSS is related to migraine; indeed, many people who report visual snow also have migraine visual symptoms with or without headache. Other related symptoms include palinopsia (visual persistence of an image after the eyes are closed or look away), floaters and spots (entopsia), difficulty seeing in dim light (nyctalopia), difficulty seeing in bright light (hemeralopia), and flashes of light (photopsia). Other associated symptoms include ringing in the ears (tinnitus) and dizziness that varies with head position (postural vertigo).
Visual snow may be a symptom of an underlying disease (secondary visual snow syndrome). In this situation, it is critical to identify the underlying cause and offer treatment where possible. Secondary visual snow may originate from the retina or the brain. A well-described retinal cause of visual snow is due to digoxin toxicity. It usually occurs in elderly people who take digoxin for heart problems. It indicates the need to stop taking digoxin or lower the dose. Failure to reduce the dose may result in severe complications, including death. Other rare causes of visual snow include eye disease, immune disease, infectious disease, psychiatric disease, prescription drugs, past use of hallucinogens, head trauma, brain tumor, seizure disorder, and brain degenerative disease.
What causes the primary visual snow syndrome?
The cause of primary VSS is not known. It is felt to be due to an error in central processing in the back of the brain (occipital lobe). Special brain scans show hypermetabolism in the lingual gyrus of the occipital lobe in the back of the brain.
How is primary visual snow syndrome diagnosed?
The diagnosis is made on the basis of typical symptoms after testing has ruled out an underlying disease of the eye or brain. MRI brain scan is often used to rule out tumor, multiple sclerosis, degeneration, and stroke. EEG may be used to rule out seizure disorder. A spinal tap may be needed to rule out idiopathic intracranial hypertension. Pattern reversal VEP usually demonstrates loss of habituation of the occipital lobe in the brain (indicative of hyperexcitability). A neurologist usually arranges for testing as needed. An ophthalmologist may be helpful in ruling out eye disease.
What can be done about these symptoms?
It is difficult to treat primary VSS. Medications such as lamotrigine and topirimate may be helpful in some patients. Tinted glasses or clip-on lenses may also be helpful to minimize the symptoms of visual snow. Placing a yellow or orange tinted cellophane sheet on top of reading material helps some. Riboflavin and magnesium supplements may be of benefit for migraine and visual snow, as well. For many patients it is helpful to know that primary VSS is a benign condition that does not progress to blindness.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
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What are these circular spots in my vision after an eye injection?
Sometimes after an eye injection, a patient may see one or more black circular spots that move in the vision with head movement. They are usually in the lower part of the visual field, though they move up toward the center of the visual field if you position your head face down.
What causes these symptoms?
These black spots are due to air bubbles in the medicine that is injected into the eye. They appear immediately after injection. They are harmless and take 1-2 days to dissolve and disappear. Less commonly, small black circular spots may float in the vision after injection due to small silicone bubbles that are used to lubricate the syringe. These silicone bubbles do not dissolve, but they may float away from the retina and become less noticeable over time.
What should be done about these symptoms?
If the spots are due to air bubbles, these symptoms fade without treatment. If the spots are due to silicone bubbles, they may come and go over time. It is best not to track them with your eyes as they may become more bothersome. Try to look past these floaters and ignore them if possible. If they persistently interfere with the vision, vitrectomy surgery may be considered to remove them. This is rarely necessary.
What other symptoms can mimic this problem?
These black spots are considered a type of “floater.” Floaters are any visual spot in the vision that “floats” or moves somewhat independent of eye movement. Sometimes floaters may come on suddenly and appear like dots and fibers. This is typical for bleeding inside the eye. If dots and fiber-like floaters come on more slowly (hours to days), they may be a sign of infection or inflammation. Rarely, cancer may present as many tiny floating spots in the vision.
Floaters are distinct from blind spots (scotoma) that are fixed in the visual field and move only when the eye moves. You cannot “catch up” or move away from a blind spot by moving the eye. Blind spots are usually due to problems with the retina or optic nerve. A progressive blind spot that begins in the peripheral vision and enlarges over hours to days may be due to a retinal detachment and requires a prompt examination. Retinal detachment is often described as a curtain or shadow covering the vision.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Copyright 2022 Designs Unlimited of Florida. All Rights Reserved
There are many conditions, which threaten loss of vision, that are treated by injecting various medications into the eye. The eye conditions include macular degeneration, diabetic retinopathy, retinal vein occlusion, uveitis, and others. The injections may be given into the tissues outside the eyeball (subtenon’s injections) or into the eyeball (intravitreal injections). It is very important to avoid pain as these injections may need to be given repeatedly over time.
Why do I have pain after eye injections?
Although pain during eye injections can usually be minimized with anesthetics given before the injection, sometimes there is pain for hours after the injection. There are many reasons why this may occur:
1.) The antibiotic (betadine) may irritate the eye for hours after it has been applied to the eye.
2.) The eye may become dried out after the injection due to insufficient blinking.
3.) The eye may be accidentally scratched by rubbing the eye while it is still anesthetized.
4.) The drug that is injected into the eye may cause an inflammatory reaction.
5.) Rarely, a severe infection called endophthalmitis may occur after injection into the eyeball.
What can be done to prevent pain after injections?
The key to eliminating pain after eye injections is to identify the underlying cause. This may take some detective work. Although betadine is given at the time of injection to prevent infection, only a small dose is needed. If a large amount of betadine is used or if the betadine has not been thoroughly rinsed off the eye, it may cause blurred vision, persistent burning, itching, and/or a scratchy sensation like sand in the eye (called a foreign body sensation). Therefore, it is important for the eye doctor or technician to completely rinse the betadine off the eye after an eye injection in order to avoid pain later.
Sometimes, the surface of the eye may become dry after an injection because the patient does not blink frequently enough or not completely enough. This often happens as a result of the anesthetic used in preparation for the injection. After the injection is over, the anesthetic may continue to work for 15-30 minutes. During that time, the patient does not have the normal sensation necessary to indicate that it is time to blink. If the eye does not blink often enough, the surface may dry out and cause blurred vision, pain or foreign body sensation. Therefore, the patient may need to purposefully blink frequently or simply rest the eye closed for a while after an eye injection in order to prevent drying. Similarly, if a patient does not close the eye completely with each blink, part of the eye can become dry. In some cases, it may be necessary to forcibly close the eyes with each blink in order to be sure the lids close completely.
At times a patient may unknowingly rub and scratch the eye after an injection because of persistent numbing after an injection. Therefore, it is very important to avoid touching the eye for 15-30 minutes after an injection. If the eye needs to be dried off, a clean tissue may be used with a gently damping or blotting motion in the corner of the eye where the lids come together at the bridge of the nose. It is best not to move the tissue left and right or up and down in a rubbing fashion. Once the eye becomes dry or irritated for any reason listed above, it may take 1-2 days for the pain to go away and the eye to return to normal.
Rarely, a drug that is injected into the eye can cause an inflammation that causes pain or blurred vision. The doctor makes this diagnosis by examining the eye under the biomicroscope (called a slit lamp). If a medication is determined to be the cause of inflammation, it is treated with prescription eye drops and the offending drug is not used again in that patient in the future.
Infection is an extremely rare cause of pain after an eye injection. In about one in several thousand injections, germs may enter the eye through the needle tract after an eye injection. This rare infection is called endophthalmitis (pronounced like “end-off-thal-my-tiss”). Symptoms usually start with pain, redness, and loss of vision several days to a few weeks after an injection. There is no perfect way to prevent endophthalmitis. The doctor uses techniques like applying betadine before the injection. The patient tries to avoid contaminating the eye by avoiding exposure the unclean areas (like a barnyard) and avoid rubbing the eyes after injection. Endophthalmitis is very serious and may result in permanent loss of vision. Therefore, any patient having deep aching pain, increasing redness, and loss of vision starting several days or weeks after an eye injection should notify their eye doctor for prompt evaluation.
What can be done to make the eye feel better?
If the cause of the pain and irritation is from betadine, drying, or rubbing the eye, the best treatment is lubrication. Lubricants are available over-the-counter in the form of eye drops, eye gels, and eye ointments (see examples at the end of this article). The thicker the lubricant, the better the relief of pain and discomfort. However, gels and ointments may be difficult to place into the eye and they tend to make the vision blurry for several minutes or more. Lubricants may be used as often as needed. Resting the eyes closed may also provide relief. Cold compresses help many patients. Over-the-counter pain medications like ibuprofen and/or Tylenol may be helpful. Prescription pain medications are rarely needed and may cause undesirable side effects.
If the cause of the pain and irritation is from a drug reaction or from infection inside the eye, the doctor will prescribe special anti-inflammatory eye drops. If the eye exam shows infection, antibiotic injections must be given into the eye and surgery in the operating room may be necessary.
If pain keeps occurring after eye injections despite taking the measures listed above, sometimes prescription eye medication can help. Non-steroid (NSAID) eyes drops or steroid/antibiotic ointments may help prevent the pain. Most instances of pain after eye injections may be avoidable. Please talk with your eye doctor to help resolve the problem in order to undergo treatment without pain.
Gels are easier to apply than ointments and may be used immediately after an eye injection to prevent eye pain and they may be used later to soothe eye discomfort.
Ointments are more difficult to place in the eye. However, they provide longer duration of action. They may be used immediately after an eye injection to prevent eye pain and they may be used later to soothe eye discomfort.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
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Uveitis (pronounced, “you-vee-EYE-tis”) is a general term used to describe inflammation inside the eye. The uvea is the name given to the layer of tissue in the eye that has a brown color (melanin pigment) and blood vessels, which serve to provide blood supply and protect the eye from excessive light. The uvea can be divided into separate parts, which perform different functions in the eye: the iris, the ciliary body, the pars plana, and the choroid. The part of the uvea in the front of the eye is called the iris (the round, blue or brown part of the eye that you can see in the mirror). Behind the iris is the ciliary body, which produces the fluid that fills the eye. The pars plana serves as the boundary between the ciliary body and the choroid. The back part of the uvea that lies under the retina (the “film” in the eye that “takes the picture”) is called the choroid. Therefore, in any one patient uveitis is usually given a more specific name depending on where most of the inflammation is located in the eye. In intermediate uveitis the inflammation is primarily located in the vitreous gel that fills the eye, which is located in an intermediate position between the front and the back of the eye. It is sometimes referred to as vitritis or pars planitis.
What causes intermediate uveitis?
Uveitis may be caused by an infection, an injury from trauma, a disease in the body outside the eye, or sometimes for unknown reasons. Infection by a virus, bacteria, fungus, or other parasite may cause uveitis. Infections may be limited to the eye or may involve other organs as well. In intermediate uveitis, infection may be caused by syphilis, tuberculosis, Lyme disease, cat scratch disease, Whipple’s disease, toxocariasis, human lymphotrophic virus (HTLV-1), or toxoplasmosis.
In other situations, uveitis is caused by inflammation without infection. For example, multiple sclerosis, sarcoidosis, HLA-B27, and inflammatory bowel disease may cause intermediate uveitis. Pars planitis is a sub-type of intermediate uveitis that often starts early in life during childhood. Its cause is unknown.
Uveitis commonly occurs following an injury to the eye. Very rarely, cancer or cancer-fighting drugs may cause intermediate uveitis. In some cases, no underlying cause can be found to be the cause of uveitis. Tobacco may be an aggravating factor and should be discontinued.
What are the symptoms of intermediate uveitis?
The most common symptoms include tiny floating spots which move or “float” in the vision. They are usually numerous and may cause a veil-like appearance in the vision. Sometimes blind spots, blurred vision, distortion, or loss of side vision occurs. The eye may be painful, red, tearing, and light sensitive if other parts of the eye are also inflamed. Symptoms may be mild or they may be severe and disabling.
How is intermediate uveitis managed?
To effectively treat intermediate uveitis, it is important to find the underlying cause whenever possible. Take some time to carefully review and report to your doctor any unusual or unexplained symptoms such as rashes, back and joint problems. Tell your doctor if you travel abroad, spend time in rural settings, or may be exposed to animals or infections. Heredity may also play a role. You should tell your doctor about any family members with inflammatory disorders anywhere in the body. Also, review and report your ancestry (for example, Asian, Mediterranean, or American Indian ancestry). When the doctor diagnoses uveitis, laboratory tests may be ordered to help determine its cause. Occasionally, a surgical biopsy is needed for diagnosis. If infection is found, antibiotics are prescribed. To limit the damage from inflammation, intermediate uveitis is treated with anti-inflammatory medication in the form of eye drops, injections, or pills. When pills are used, the eye doctor frequently coordinates medical care with the expert assistance of a rheumatologist. Rarely, surgery is required to treat uveitis. In some cases, intermediate uveitis may be long-lasting. In these cases, years of therapy are needed to preserve vision. Intermediate uveitis is a serious eye problem and may result in loss of vision or blindness. However, by seeing your eye doctor and taking the medications exactly as recommended, damage to your vision can be minimized.
In some cases, intermediate uveitis may go away, but return at a future date. Therefore, if you become aware of symptoms of uveitis in the future, do not hesitate to contact your doctor. Preliminary evidence suggests that tobacco use may be an aggravating factor in some cases of uveitis.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
anatomy of the eye (click on image to enlarge). Image courtesy of Caitlin Albritton.
What is metamorphopsia?
Metamorphopsia (“meta-more-FOP-see-ya”) is a medical term used to describe an abnormal visual perception in which images appear distorted. For example, straight lines appear curved or jagged. It is an important symptom of retinal disease. Metamorphopsia is not caused by the need for new glasses, cataract, glaucoma, or optic nerve damage. Metamorphopsia is a sign of a retinal problem. It is detected and monitored with an Amsler grid.
Distortion of lines on Amsler Grid in right eye (click on image to enlarge)
What causes metamorphopsia?
The retina is a thin layer of nerve tissue that acts like film inside a camera. The retina “takes a picture” and sends the image to the brain. The root cause of distortion in vision is a retina that is not smooth and flat against the eye wall. This distortion of the retina may be caused by many different conditions. Sometimes, problems under the retina cause fluid leakage resulting in metamorphopsia. Such conditions include macular degeneration, central serous retinopathy, histoplasmosis, high myopia, angioid streaks, and inflammation. In other situations, distortion may be caused by scar tissue under the retina from inflammation, trauma, bleeding, or chronic leakage of fluid under the retina. Distortion of the retina may also be caused by vitreomacular traction, macular hole, or macular pucker. The ophthalmologist (retinal specialist) will undertake examination and testing to determine the cause.
Is metamorphopsia an urgent situation?
Metamorphopsia may be an urgent situation if it is new in onset or has significantly increased recently. If the cause of distortion is inflammation or bleeding, prompt treatment is needed to prevent further loss of vision and worsening of symptoms. Longstanding distortion is less likely an emergency but merits an eye examination to determine the cause.
What is the treatment?
Metamorphopsia is a symptom rather than a diagnosis, so the treatment depends on the underlying cause of the distortion of vision. This is the reason why it is important to have an eye examination in order to determine the best course of action. Contact your eye doctor or retinal specialist if you have this important symptom.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida.Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
