Acute Blurred Vision 26/M For Dr. Kuturyz

Dr. Kutryz,
I have had two episode in 6 months of acute blurred vision in my left eye that lasted an hour each time.  I am a 26/male.  I was also recently diagnosed with a Patent Foramen Ovale.  My mother (Ruth) works at your practice.  Could you explain to her what is wrong with me, it would be easier for me to do if I could draw it out and explain it, but I am too far away for that.
Thanks

[Michael J Kutryb, MD]

We just had a conversation about the possible causes.  My first impression is that this most likely is not an eye problem but likely a brain related issue and specifically it is most likely vascular related.  Basically blood and oxygen may not be getting to the visual areas of the brain for a period of time.  (it is also plausible that blood may not be getting to the eye - and that should be looked into - definitely - with a complete dilated exam - ASAP.)  Regarding decreased perfusion to the visual cortex, the causes include, hypotension, orthostatic hypotension, hypotension perhaps related to a patent foramen ovale if very significant, or some type of arrythmia causing brief hypotension.  Next we get into the possibililty of some type of migraine where there can be a spasm of blood vessels in the brain leading to decreased  perfusion to certain vision centers.  Finally, there could be a physical blockage (blood clot or embolus) temporarily blocking the carotic artery in neck or an intracranial vessel,  or a narrowing of a vessel due to vasculitis or athersclerosis or another vascular anomoly like aneurysm or avm.

Workup would include:
-Full eye exam including dilated retinal exam and automated visual field
-physical exam to rule out heart murmer, low or high blood pressure, arrythmia, carotid bruit
-ekg and consider 24 hour holter
-echocardiogram
-mri of brain and consider mra
-consider carotid doppler depending on age
-serum chemistry especially lipids

In the end I suspect there could perhaps be brief periods of decrease blood pressure or possible an atypical visual migraine.  Would really want to make sure that some type of blood clot was not coming from the heart.  Would look into the cardiovascular areas especially well and they can affect your longevity if you know what I mean.  This is not a perfect answer - just my ideas off the top of my head.

Michael Kutryb, MD