Ocular Migraine - Vision Migraine

Ocular Migraines

A really interesting and concerning visual phenomenon that I see in my office is the manifestations of a vision migraine. Patient s typically present with a complaint of zig zag, prismatic, kaleidoscope vision lasting from 5-20 minutes. The rainbow pattern typically starts as a small zone and grows then breaks up. Usually no other symptoms occur. Patients deny head pain, nausea, and loss of memory, numbness, and speech problems. Commonly there is a bit of feeling washed out or a little bit confused right afterwards.

The cause is a migraine process that occurs in the back half of the brain where the vision center is located. In a typical (painful) migraine blood vessels that course up the neck into the front part of the brain are wrapped with nerve endings like a fish net stocking on a leg. When the blood vessels undergo a spasm, the nerve endings are stimulated and the pounding pain results. In the vision area, the blood vessels are not wrapped by nerves therefore, when they spasm, an equivalent occurs – the visual phenomenon (a pain substitute).

The cause of migraines (regular and visual type) may be stress, medications, and certain foods. There is treatment: avoiding the offending substance, and stress reduction.

Evaluation is very important. Similar symptoms could also occur in a stroke, detached retina, or aneurysm. My best advice is to seek professional help. Start at your eye doctor’s office for a good eye exam to look for any problems. If the eyes are OK then I recommend a neurology consultation for further evaluation and treatment options.

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Flashes and Floaters

Very common visual problems that people experience are flashes, floaters or a combination of each. To explain these issues in better detail, I first need to review eye anatomy. The eye is a hollow structure filled with fluids. The front part of the eye has aqueous fliuid. It reside behind the cornea and in front of the colored iris tissue in a space called the anterior chamber. The majority of the eye is filled with a thick protein fluid called vitreous. It reside behind the iris in the vitreous cavity. Vitreous is like "raw egg whites." Lining the internal vitreous cavity is the retina vision tissue, which is like wallpaper. Over time, the jello vitreous fluid begins to undergo chages - mostly shrinking and denaturaization. Small clumps of proten form. thse clumps cast a shadow obn the retina. Most apparent in bright light, agaist a plain background such as a white wall or blue sky. The floater shapes are varous: strings, strands, aomebas, bugs, nats, webs etc. These are usually benign but defintely pesky. Floaters which are big, very dark grey, or block a large portion of your vision or occur with flashes ( "arcs / sparks" ) require immediate attention! Why? Well it may indicate a tear or detachment to the retinal tissue. The floaters here may be from a bleed or loose retinal tissue. A dilated exam with a good search of the retina by a qualified eye doctor is the best course of action. If there is a small tear, a outpatient laser procedure can "spot weld" the loose retina back into place. A large tear or detachment may require major surgery. For more information please visit www.myneweyes.com