Temporary white-out in one eye

[pbanders]

I'm male, 49, 6' tall, 160 lbs, in good shape and generally healthy. In 2004 I had surgery to graft an ascending aortic aneurysm, I returned to full activity. I now take 50 mg of Metoprolol and 150 mg of Avapro daily. My BP is generally normal, but can dip to as low as 90/60 after endurance exercise in the summer.

Three times since my surgery (including last night), I've experienced temporary complete loss of vision in one eye, I think it was my right eye each time. My vision transitions from normal to completely whited-out, and then back to normal, over about a 10 minute period. I note no other symptoms during this period and my BP is normal. I also on more frequent occasions experience red-out of my vision in one or both eyes. This comes on slowly, from the edges of my visual field and can progress to cover most of the field. This is often associated with low post-exercise BP. In both cases, I find that getting up and walking around, and drinking a large amount of water seems to help reverse the effect. I note no other associated symptoms

My cardiologist has no explanation for what is happening. My eye doctor has Optimap photos of my entire retina that go back to 2000, before my surgery, there are no abnomalities, and my interocular pressure is normal.

My family history has my mother and grandmother both having controllable glaucoma, with onset in the late 60's, both are deceased.

Any explanation of what is going on with my vision would be appreciated. The red-outs I understand, they seem to be due to low BP due to post-exercise dehydration and a refractory drop in pressure. The white-outs I have no explanation for and I cannot find any references to similar conditions.

[rithci]

I found this post after having a vision white out in my left eye tonight. It’s the first time it’s happened and lasted about 5 minutes before subsiding. I also had an ascending aortic aneurysm repair in 2019 and taking 50MG of metoprolol daily. I’m 67 years old and in good physical shape. Twice, before the white out, I had a sudden onset of double vision lasting about 5 minutes. An ophthalmologist couldn’t find any causes.

[John C Hagan III, MD, FACS, FAAO]

TREAT THIS AS AN EMERGENCY AND IMMEDIATELY CALL YOU FAMILY PHYSICIAN OR CARDIOLOGIST !!!!!!

[Ron_AKA]

You may want to discuss switching your beta blocker from metoprolol to bisoprolol with your cardiologist. Bisoprolol provides a more uniform heart rate reduction during the 24 hour period with once daily dosing.

[rithci]

Thank you. I made an appointment for next week with my doctor.

[John C Hagan III, MD, FACS, FAAO]

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[rithci]

To follow up, a second eye exam again showed that my eyes were normal. Another possible cause was a TIA, so I had an ultrasound on my carotid arteries, an echocardiogram, and wore a heart monitor for 14 days to detect arrhythmia. All the tests results were normal. It was suggested that the episodes could have been ocular migraines, even though I didn’t experience a headache.

[John C Hagan III, MD, FACS, FAAO]

At age 67 that extensive work up is teaded, as new onset of migraine is very uncommon after 60. A test that most physicians would have recommened would be a MRI/MRA of the head. Did you have that test?

[rithci]

Thank you Dr. Hagen. I did not have any follow up tests as none were recommended by my physician.

[John C Hagan III, MD, FACS, FAAO]

I would suggest you ask your physicians about a head MRI/MRA.  It would be on most people list of needed tests especially since a definitive cause has not been determined.

[pbanders]

I am the OP of this question. It's 2020, from time to time, I still have these white-out events. Probably once or twice a year now. No longer on metoprolol, switched to Bystolic some years ago. Onset was after my aortic aneurysm grafting surgery when I was 46, I'm now 62 (16 years later). I'm retired, still very fit and active (6000 to 8000 miles of hard cycling per year, BMI 21). I've had two or three mild concussions since 2004 in cycling accidents, no impact on the white-outs. I've been under care of a cardiologist since 2004, have seen a neuro-ophthalmologist (exam inconclusive), and have reported this condition to my doctor (internist). Nobody has diagnosed it. IMO, it's annoying but fairly benign, if it were really serious, it would have made that evident years ago. Thanks to all who responded and to Dr. Hagan for his input.  

[JohnHaganMD]

Thanks for posting Pbanders. Your original post was 13 years ago.  Glad you have done well.  Be careful with the bicycling. I gave it up after several bad falls.

[DarylRe]

I too have experienced a white out in the right eye. I have been under watch for my field vison going in for check ups about every 3-4 months for about a year or more. I had my last two visits canceled due to the Coronavirus 19 outbreak. The other day I was outside checking something on the side of my house. I started walking back toward the backyard when my vision started to blur in the center which then turned into this white circle in the center of my vision. Then the area around the white disk quickly blurred and the circle grew. This repeated very rapidly until I lost vision and had white out blindness in the right eye. I became somewhat faint at the time. I am also on Metoprolol Tartrate for b p (have been for more than 2 years).  I have had several episodes of irregular distortions that happened prior to this. The distortions happened while on a computer or looking at TV. Each time they happened I would get jagged like comic book balloons within the view. They were somewhat blurring or irregular misalignments within the view. Think of a puzzle with some pieces that fit but the print for the piece wasn't in alignment with the surrounding ones. While annoying and concerning, like floaters they were not frightening.  The white out was quite scary until my vision was restored shortly after the episode began.  I am by no means a doctor nor have scientific medical training but, I wonder if this has a connection to blood pressure or blood clot. In a couple other cases here folks reported physical activity prior. I was riding my bike not long before this happened. I am over 70 if it helps.  

[JohnHaganMD]

In a person younger than 40 by far the most common would be a migraine syndrome. Over 70 if these are new and have never happened when you were young, and you were never diagnosed with migraine it is not likely migraine.  Also your metoprolol reduces the risk of migraine.  New onset of these symptoms over 70 is worrisome.  It could be transient ischemic attack (TIA) due to disease of the heart/blood vessels or disease of the brain itself.   Generally if the eye exam was normal I would suggest the family MD refer the patient to a neurologist.  A number of blood and other tests such as carotid doppler ultrasound need to be done.  TIA have increased incident of strokes.  Do not ignore these symptoms as they are very concerning.

[DarylRe]

Thank you doctor for your quick response. I will call for an appointment tomorrow.  

[JohnHaganMD]

Best of luck. If you find something definitive please come back and repost as a learning/information for the millions of viewers of this forum.

[Kev626]

Hello , I am experiencing the same , it would reoccurre every 1-2 months . It would last for 2 min , starting slowly with whites spots as if I was having discharge in my eye .my doctor have no reason why this is happening

[JohnHaganMD]

See above

[JohnHaganMD]

If you have seen "a doctor" and no reason found see an eye MD ophthalmologist as soon as you can

[JohnHaganMD]

NOTE: there is a big difference from a "white out" that lasts a few seconds and one that lasts 10-15 minutes or longer.  The former likely does not represent anything serious but the latter can represent lack of blood flow to the eye due to disease of the eye, brain, heart and blood vessels. It requires an exam by a general MD such as a family doctor or internal medicine doctor and an ophthalmologist or optometrist.  In healthy young people this can represent a form of migraine called "eye migraines" or "ophthalmic migraine".

For Ben4wins. retinitis pigmentosa can cause that symptom and I have a patient that described them.  Lack of blood flow to the retina (ischemia) is a postulated cause

JCH MD

[Haze005]

Hi ,,pls i woke up in the mid night today and i cant see clearly with my right eye showing white but now it's getting clearer..what can i do sir?

[JohnHaganMD]

This is still relevant:  NOTE:  there is a big difference from a "white out" that lasts a few seconds and one that lasts 10-15 minutes or longer.  The former likely does not represent anything serious but the latter can represent lack of blood flow to the eye due to disease of the eye, brain, heart and blood vessels. It requires an exam by a general MD such as a family doctor or internal medicine doctor and an ophthalmologist or optometrist.  In healthy young people this can represent a form of migraine called "eye migraines" or "ophthalmic migraine".

[ben4wins]

Thank you all for posting.  They have been a comfort to read.  I just noticed my whiteout the past couple of months.  I only knew what was happening as of last night.  I closed my left eye while reading and saw only white...yikes.  I'm 5'7" 180 lbs and not on any medications.  I'm 62.  I do have RP which has been causing a vision loss and will cause blindness if I live long enough but white outs aren't a sympton.    It doesn't seem as though anyone is getting any answers through the doctors.  Has anyone had this happen for a while and it just goes away on it's own??

[mc1email]

I am reading this because I have the same periodic white out in left eye. Anything discovered as a result of the previous posts?

[Johnnysupermedic7122]

This sounds exactly like what is happening to me I am 30 years old 5'11'' and 200 lbs. it comes on very suddenly lasts about 10 min or so then goes away no pain no previous medical history at all very healthy other than maybe the occasional bag of candy or some fast food... I do run somewhat a little low on bp generally about 98/70... Not sure whether to be worried or not....

[dirtbagclimber]

The exact same thing has been happening to me once every 6 months or so. My left eye just starts spotting and eventually goes completely white after a period of 5 mins then all vision slowly comes back after the next 5 mins. I can see just fine out of my right eye but everything is white with my left. I am currently not taking any medication. I am 28 years old, 6ft, and 160 lbs. I am very active and it great shape.  I drink alcohol but not very frequently and I have never smoked. I had a history of seizures when I was 8 to about 12 years old but I have not had any since. The episodes happen regardless if I am sitting or standing. Should I just keep track of the episodes and see a neurologist if they start getting closer together?

[jryoung2004]

Just had a white out at work.  Sitting down on computer.  This is the second time I had this.  Lasted about 15 minutes in left eye.  I am also on Metroprolol 50 mg.  I relate this to a migraine.  White out is similair to turning the white balance up on a tv until you can't make out the image, except that a small part (10% ) of my left eye field of vision is still available.

[pbanders]

FYI, it's some 3+ years later, and I still have these symptoms from time to time, though the white-outs are very rare (1 per year or so). My visit to the neuro-opthamologist was inconclusive. He saw some very subtle bilateral vision field weakness at the very edge of my low quadrants, and said it could be indicative of some damage in my vision center of my brain, but that it wasn't a sure diagnosis. As there seemed to be no clear course of what to do next, I'm just waiting to see if anything changes. So far, if anything, it's better than it was.

[mommypat]

Ok, so I am only 38 and female, but I had a white-out recently in my left eye, while standing at work (I am a hair stylist).  It started as a slow blur, like I was looking through extremely hot air, then became a complete white-out, which made finishing my customer very difficult.  The white-out itself lasted for only a minute or so once it was fully white.  But the whole experience lasted for about 10 minutes.  I felt slightly light headed, but not overly dizzy.  I've been having headaches lately, waking up with dull headaches in the morning.  I'm not an excessive coffee drinker, only 1-2 cups in the morning and that's it for the day.  I have never had a blood pressure problem.  Diabetes runs in my family, but I'm not finding any info to support any particular reason for this white-out.  Should I be making some doctor appointments?

[John C Hagan III, MD, FACS, FAAO]

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[Valetude]

I have just experienced the exact event. For the first time. Complete whiteout in right eye after waking in seated position, having exercised for an hour in a gym a few hours earlier. I am also on Metoprolol 50mgm daily, CAB graft ten years ago. I am male, 78, 73.5 kg, BP controlled by Simvastatin. Newly diagnosed type 2 diabetic not requiring medication.
Since I occasionally suffer syncope due to either (or both) orthostatic hypertension and hypo(I think)glycaemia, whiteouts are not uncommon to me, but always bilateral till today. I assume this is a TIA of the left optic nerve? No glaucome or headaches, but over the past few years have experienced some peculiar ocular things such as a massive scotoma, scintillation, and transient hypnopompic xanthopsia (for a few minutes after waking, everything seen in bright yellow). I'm myopic, but don't normally wear my glasses. I suppose, strictly, a whiteout can't be termed a loss of vision, even though I could only see a bright white light with apparently (according to my wife) no pupillary dilatation and only a vague outline of close objects in bright sunlight for the few minutes before normal vision was restored.

[John C Hagan III, MD, FACS, FAAO]

You're welcome. Hope it turns out well. If you find out something definite let us know. This can be a learning experience for all of us.
Merry Christmas
JCH III MD

[pbanders]

FYI, I just set up an appointment with a local neuro-opthamologist, thank you very much for the web reference, it made it simple to find a specialist.

[John C Hagan III, MD, FACS, FAAO]

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[pbanders]

Thanks for the reply, I'll see a neuro-opthamologist about this. I've had multiple echocardiograms, multiple MRA follow-up's for my aortic surgery, two stress echo's, and a carotid doppler. All have been normal and show that the repair is fine and I have no blockages or other issues. I also should note that I have severe myopia, about -10.0 diopters in both eyes with no significant astigmatism, and I wear both glasses (95% of the time) and contacts with no problems. I'm also don't have Marfan's or Ehler-Danlos, and have had a normal slit-lamp exam with no lens displacement.

[John C Hagan III, MD, FACS, FAAO]

That is a worrisome story. I would see a neuro-ophthalmologist. You can find one near you by going to www.aao.org.

I'm surprised your cardiologist is not more unsettled by these symptoms.  My feeling is that you will need an echo cardiogram, carotid doppler and and MRI/MRA of the head and blood work to include a sedimentation rate and C-reactive protein to at least tell you its nothing to worry about now.

Loss of vision in the eye is a big time symptom that necessitates a full court press to find the cause. One time the eye could go out and the vision not come back.

Find a neuro-ophthalmologist and have him/her and your cardiologist work through the testing. If they don't find anything and the episodes continue see a neurologist.

JCH III MD