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Movement/Pressure Phosphene, normal or not?

Recently in the past 2 months I've had visual distortions in my side/peripheral vision. Initially I characterized them as blind spots since I could blot out door knobs and the like looking at a certain angle.

But after digging around I'm fairly certain that I was wrong. That they aren't blind spots, or maybe, not just the normal bind spots everyone has, but phosphenes.

A brief description - I see them based on where I position my eyes and my eye movement. Now I'm not straining my eyes or doing any rapid eye movement, this is just casually looking around.

When I look to the side(left or right, it doesn't matter, both eyes have it), a crescent shadow forms. If I move my head away, slowly or quickly, that crescent shadow becomes a circle-like distortion. This is during the day. At night, it has a pale/dull white outline, dark center. Poked around online and it looks exactly like a pressure phosphene from when you rub your eyes or press your finger on your eye.   Except, I'm not putting any external pressure on the eye.

And my side vision does flicker depending on what I'm doing/environment. During the day, next to a white or solid color wall, if I'm eating, it flickers every time I chew. At night, walking in near darkness, if I look to the side as I'm walking it's like a flickering pale moon(sometimes the white outline becomes a full on pale moon). I can also see the pale moon circles just by closing my eyes and tightening my eyelids. Though in my right eye, all the way at the top, there's 2 lines, dark during the day, dull white at night, in addition to the moon circle.  
Is this just normal enthopic phenomenon? Or something I should be concerned about? I look up, and its fine until I move my eyes and then two circles appear. Is it supposed to be so easy to see? As for the size, it's like someone stuck a quarter in front of my eyes.

Now, I recently went to both an optometrist and an ophthalmologist. The ophthalmologist  did the standard tests, dilatation, the eye mapping, visual field test and didn't find anything any damage and only ruled out that its not a, b, or c. Nothing wrong with the eye except for a high pressure in one.

Optometrist said the same thing except the pressure in both eyes was high, particularly in the eye that was fine at the ophthalmologist - went from 19 to 30. Not sure what the fluctuation means. Recommended I see a neurologist if the results from the ophthalmologist reveal nothing wrong with the eye.

So, is it normal to see phosphenes like this? So easily? Day or night, with your eyes open or closed? The nurse fed me some line about the vitreous gel clumping with age or thinning, but she was just giving me shots in the dark. She gave me the results but I've yet to talk to the ophthalmologist about them or what I should do next.

One theory that I've had is that maybe it's the muscles around my eye? Could be strained? Or is this age catching up to me? I'm 36.


Some other symptoms, both my eyes are occasionally sore, sometimes an ache around or behind the eye. Red eyes. My right eye particularly gets sore a lot faster and after a few minutes of reading my distant vision blurs out. That was the primary reason I went to the optometrist, get a new prescription and get bifocals. I also have visual snow, 24 - 7, usually worse in the morning before it settles into a more static...static. Messed with my night vision and ability to contrast, etc.

So I don't know. See a neurologist? Or am I just hyper-aware and going crazy?




2 Responses
177275 tn?1511758844
Well of course I can't be sure, but statistically with a normal exam by Eye MD and optometrist and otherwise health 36 year old you are more likely anxious/hyperaware than likely to have some dread disease.  Read the section on wikipedia on entoptic phenomena.  You of course spend all the time and money you want. If you want to plow on I would see a neuroophthalmolgist rather than neurologist.
43 Comments
Well, I have high bp that also goes to extremes. My record was 215/110 a couple years back. I have it under control now with medication but it's still goes up and down.

I was in the pre-diabetic phase last blood test but I assume it'd take years for any damage.

My paternal side of the family does have a history of blindness - both my father and grandmother went blind in 1 eye. A combination of diabetes, neglect and high bp.

It might be that I'm being hyper-aware....but I'm certain that I would have noticed this long before. I'll see what the optha says and based on it I'll figure out if I'll pursue the neuro-path.




Your time should be daily devoted to control of your weight, exercise, diet, BLOOD PRESSURE, and monitor you A1c at least yearly.  Goal is to keep below 6.0   If anxiety is a problem read about cognitive behavior therapy. It is a excellent means of non-medically dealing with anxiety and hyperawareness.
My diet's ok'ish. Slightly overweight but my blood pressure is under control, but fluctuates under certain conditions. That high reading was due to stress and pain, had a broken tooth and the nerve died, agony was intense. The result from that was a constant pain in my head for 6 months.  Felt like someone left a cold dagger in my head.

I do have one more question about an additional visual illusion?

I noticed this when I wake up and open one eye. Usually sleep on the side so one eye is buried into the pillow.

Wake up and I notice a flicker of a small dark spot in the center of my vision that immediately fades. I can only see this when I open one eye, or the other. This dark spot/flicker is in the center of both eyes it seems.

Another illusion/trick of the mind? Usually my central vision or when I keep my eyes centered everything is fine except for the VS.

Just trying to find some peace of mind until I can contact my optha to go over everything and figure out what to do if anything.

That observation is posted here many times. Its due to the macula adjusting from dim light (eyes shut) to bright light   three different systems of sight in the retina: dark,  twilight, bright light
Alright, I'm back.

I followed up with the Opthamalogist's office and the results from my Visual Field Test were normal and they ruled out any damage to the eye/retina.

The nurse told me this...

It would have been nice if I could have gone over the results with the Doctor himself but after multiple weeks and phone calls this was the only person I could go over my test results with. Great service...

Anyway, that didn't help me and I explained what I was seeing again to HER, not the doctor and she said it was unusual and gave me the name of a Neuro-Opthamalogist I could go see.

Got back from the Neuro-Opthamalogist today and I'm to get an MRI a week from now.

The NO noticed that my optic nerve is compressed. She showed me something, not sure what I was supposed to look at since I don't know what a regular optic nerve looks like and said there was a compression or something seemed to be pressing on it. A ring like indentation or a bright white light in the center of it? Who knows, wish I took a picture.

However, on the sheet she gave me for reason of exam(MRI) she wrote: Optic atrophy both eyes with positive scotoma, need to rule out compressure/vascular lesion? Best I can to translate.

It's to be a High-Field MRI, Bun, Creatinine, Contrast, Non-Contrast, Brain, Orbits, path to chiasm visual pathway, path optic nerve chiasm?

Could I get a translation of that? Or what I might expect? The NO told me it could be something, could be nothing. But...how could it be nothing if its compressed?

And then there's that term, Optic atrophy. Does this mean my vision can't go back to what it was? This is all to prevent further deterioration?

And once again, failed to tell every symptom. I experience low-level back of the head, above the neck pain that's persistent. Which....is where the visual cortex is located? Dun dun dun!

A mystery is afoot and there's a culprit that needs un-masking.


Optic atrophy is wasting of the optic nerve. The optic nerve normally has a reddish orange color, in atrophy it starts to look anemic. The MRI is to determine if there is pressure from a tumor or lesion on the nerve or intrinsic disease like multiple sclerosis.   BUN and Creatinine are BLOOD TESTS.   The other tell the radiologist what she wants to be visualized.   Not much can be done till the test results are back.
Took the MRI this week but can't get the results until another week. I was told if it was something really serious they'd inform me right away...but who knows the criteria for that.

An idle mind is the devil's playground so I have another normal or not question.

I've had starbursts for as long as I can remember. The light beams/rays around lamps/headlights at night. Now I notice that they're curved.

Oncoming headlights - the starbursts bend at the ends almost forming a giant reverse C. Looking at street lamps it's the same thing in the sense that the center is straight but the ends are curved.

Normal or not? Could it be my eye-glasses? I don't have the anti-reflective etc. and my glasses seem a little thick.
That is rarely a symptom of anything serious. Can come from a variety of reasons but one is the optical aberrations of a normal eye.
Another few days before I get the results of the mri...twisting and turning in the wind....

So here's a new question. Not about the circle-like distortions but about the smudge or branch-like blotch in my upper vision(staring straight up).

Is it possible I'm seeing a vein on the sclera? When I focus on it, it looks like a dark branch coming down. On the white of my eye, underneath the top eyelid is a large red vein that bears a similar resemblance.

Honestly, this is wearing me down and I'm paranoid, or tell myself I'm paranoid, that my vision is getting slightly worse.

No you will not be able to see the veins of the sclera except with a mirror.  As an entoptic phenomena you can see arteries/veins of the retina in certain situations.
Back again.

Update - Neuro-Opthamologist ruled out(after reading mri results) lesions, compression, etc. Couldn't explain why I see what I see but definitely recommended seeing a neurologist which I'm on track for next week. Call me Odysseus.

My vision remains mostly unchanged. The distortions have gotten slightly worse, a bit bigger, more defined but the near constant 24/7 shimmering above my eyes has once again diminished(Note: Visual Snow remains constant and always worse upon waking).

Unfortunately in the last 2 days I seem to have developed a new issue. Every time I center my eyes to look at a screen(tv/ipad/computer) a shadowy patch forms in my upper right quadrant. It seems right below that smudge in my upper right eye. It diffuses and turns into a shard of light, edged with darkness?

I believe it may be a floater but it doesn't really float. My floaters usually glide through the air like kites on an invisible string. This line/shard of light and darkness seems to have a poor frame-rate. It's either flickering or teleporting. It's like an old movie reel with a bad frame-rate.  

And I've never had a floater reflect light like this before. It's like the overall shimmer I experienced now focuses onto 1 spot.   In addition, sometimes I see a flash of light. Like a star twinkling.

Reading online it seems to be a rule of thumb to go to an opthamologist when you have new floaters and flashes of light?

I don't quite know if I meet the criteria. My last dilated exam by the optha was in November. The neuro-optha did take a look but she didn't dilate my eyes so I don't know if that counts.

Should I try to ignore this? Tough it out until I see the neurologist next Friday? Or should I call up the ophthalmologist...or the neuro-opthamologist to follow up on this?

Oh, and those two smudges in my vision seem to have started to encroach down upon my upper quadrants even with my eyes centered. Now every time I look up in front of a wall or in dim lighting I see those smudges that look like ink blots. They fade in and then out. It's like when you press down on a calculator screen, that inky blackness appears then fades.

Meh, my vision sucks.
Obviously you have a 'puzzler" of a problem.  Hope the neurologist can be helpful.  Sometimes you have to settle for "we don't know what is causing it but it doesn't appear to be anything that is serious or that requires surgery/radiation/chemo/etc.
Well, hopefully the neurologist can figure out what the big distortions are. Otherwise, I believe embracing madness is the only real choice. My most bizarre symptoms happened over the holidays where after waking the next morning after drinking a moderate amount of alcohol I had....imagine rain upon a car windshield. The windshield being your vision and the rain in the shape of 1's and reverse 3's...Along with some wiggly lines. I avoid drinking now.

Would you recommend I see the ophthalmologist again to get another dilated eye exam since I seem to have new floaters along with some flashes of light? Could this be something with the vitreous fluid in my eye? I've been straining my eyes a lot lately cursing at my distortions so...maybe they've decided to take revenge...

Look at me, talking as if my distortions already have malevolent intentions. I'm on track, yep.  




You seem to be having a very difficult time dealing with this and in all sincerity I suggest you see a psychiatrist/psychologist to help you deal with your anxiety.  Might consider waiting till your neurology consult is done before seeing another ophthalmologist but the choice is yours.
Well, I have ocd, being obsessive and  anxious are the norm  for me unfortunately. I'll call up the optha, see what they say.

As far as I can tell, it's either a spot or a line that flickers dark and light upon movement right at the top of my vision. It's incredibly annoying.
Discuss your problems with your psychiatrist/psychologist.  Ask about cognitive therapy it helps OCD.  
I'm going to wait for the neurologist. I'll go to the optha if things take a turn.

Right now these new floaters are just bugging the hell out of me. Usually my floaters look like tufts of shadow/cobweb or glass worms. I have so many I usually just block most of them out. These are a bit different.

Like tiny black rings with a light white center. And they just seem to flicker with light.

Can floaters reflect light?

It doesn't bother me much at all during the day. Then it's just an annoying black spot. But at night and most especially when my eyes settle to look at a screen, be it a tv or monitor, etc. It's like they catch the light and spark. Add that with their movement that looks like a low framerate film it's irritating.







I really can’t add any useful information
=
Back again.  Have a question over a point of confusion I'm having.

I went in to have my new floaters checked out. Result - Same old stuff, highly myopic, nothing wrong with the retina, see what the neurologist has to say.

And that's the thing. The retina.  I'll confess my ignorance in that I assumed that was the whole eye. But apparently it's just the back...

Going back to every visit I recall that's all he ever said. I can only tell you you're retina looks fine.

So what about the front? The lens, the cornea, etc.  Now I have this wriggling doubt. I tried to get some clarification but failed. Nurse just asks me what the doctor said...getting basic questions answered is such a pain.

Would a retinal specialist notice or examine the front of my eyes? Lens, cornea? Refraction? Shape?

This is annoying. I was just finising my visit when I heard the secretary loudly tell someone on the phone to see an opthamologist and that they're retinal specialists...

Somewhat bemused. I assumed the tests they made me take covered the whole shebang but now I don't know.





11 posts,  I'm not contributing anymore to your OCD. No further comments.
No offense. I didn't ask for your advice regarding my OCD or anything related to therapy. I'm only interested in your knowledge of the eye.

But hey, whatever.
=
A retina specialist only deals with the retina, the photosensitive layer at the back of the eye. They do not deal with the anterior part of the eye - cornea, lens etc - nor do they deal with the optic nerve.
=
Just an update. Saw the neurologist a couple of weeks back. He speculated IIH, Idiopathic Intracranial Hypertension.

He prescribed me Diamox which eliminated my neck stiffness, eye pain and back of the head-ache.
Had some slight effect on certain visual problems. Not the big distortions however.

Bad news is that since my last post I developed a grey spot that's permanently fixed in my upper peripheral vision.

I guess this is progress...







Read about this disease.  Typical patient is a young, overweight female.  There are drugs that can cause this.  Work-up is extensive and lumbar puncture does some time. Diamox is a miserable medication. It causes tingling of the toes and figures, cold feet, bad taste to food, carbonated beverages taste flat and weight loss and poor appetite is common.  Need to be followed by an ophthalmologist on regular basis checking for papilledema, regual visual fields and OCTs.
Not sure if I should make a new thread.
All of the above remains the same. Next appointment's in a few weeks.


Now to the issue/question. I finally got a new pair of glasses, had the regular optha. perform a refraction test
My prescription changed and he added a prism to both lenses, but primarily for my right eye due to blurriness and ghosting/afterimages.

That was about a week ago. For distance reading/accuracy, my vision is better than before. No issue there. But for some reason, I have trouble reading up close, like I can't quite focus. It seems like it's primarily my left eye that blurs/ghosts in and out.  

It's as if the issue reversed from before. Then, I had trouble with far distance reading with my right eye, and now I have trouble with my left eye with close distance reading.

Is this just part of the adjustment period? It's strange since my right eye has the stronger prescription/prism and it's fine...

Beyond that, everything seems to tilt to the right in my field of view.  

Should I wait another week or so? The issue with reading is quite bothersome for me since I usually read/write 4 to 5 hours a day minimum...kind of my job...




Sorry can't answer that question.
I'll wait another week or so.

I am curious however.  Would a 'too strong' prescription for distance cause difficulty with close distance reading?
In a myope (nearsighted) person YES.   In a person younger than 40 that is myopic it is easy to 'over-minus' the glasses RX if it is done without dilating the eye.  Young myopes should have the glasses test AFTER dilation (post-cycloplegic refraction).  Common problem we see in the office for all the people that get their eyes checked at commercial opticals like Lenscrafters, EyeMasters where they don't dilate eye.
It was a little too strong. Weakened slightly and it's better now.
That said, been doing better and worse, so that's fun.


The neuro upped my dose of Diamox and it seems to have an actual substantive effect this time besides head pain/neck stiffness removal.

It diminished the dark smudges I'd been seeing in the morning upon waking. They're still there if I strain or stress my eyes upwards but now my default level of vision is almost normal.


Except for the side peripherals. They remain warped and the flashing/flickering lights remain. The lights actually grew worse before he upped the dosage; they had started to appear at the bottom of my eyes as lines of light.

And in that same area the bottom 20% of my vision ghosts. There's an invisible line between where it stops ghosting.

And for some reason in the last few months halos have changed from auras of light/glow to concentric circles. Strange to look at.

I'll eventually go for that LP in the summer unless things take a turn. And maybe dream of a world where I can replace my eyes with ocular implants. Or transfer my mind into a clone body. Keeping my fingers crossed for the Chinese. O_o



What is your dose of Diamox.   There is a surgical treatment for pseudotumor cerebri called optic nerve fenestration. It requires special surgical team with considerable experience.  
Right now it's 250mg twice a day. Those dark smudges are virtually gone from that upper part of vision. And even tensing my eyes, they're about 1/5th of what they were before.

I have a June appointment with my neuro-opthamologist. Have yet to discuss with her about what the neuroligust is doing and his theory.
Hope you do better on diamox than I did. I took it for prevention of mountain sickness when I climbed Mt. Kilimanjaro in Africa.  That is about 50% of full dose.  
I was initially on 500 but the side effects were too distracting while working.
The neurologist cut the dose in half to 250 once a day. Which really only mitigated the neck/head issues.

I think that was my mistake. I should have stuck with the 500. But now that I'm on 250 twice a day, maybe I'm acclimated enough for a higher dose. I'm curious to see if that could help with my peripheral side distortions.



This reminds me, I have a question for you.

Is it normal for the bottom half of your peripheral vision to ghost/streak? I noticed this before he upped the dose...but it's still there now even while other parts of my vision have gotten better.

There's almost an invisible line where I have normal vision and then the bottom 15 to 20% streaks. It actually looks worse than the starbursts and halos I see at night in my upper peripheral vision.

But it's much more easier to ignore since it's so far down in my field of view.

I did notice back in January when I was obsessing with my side distortions that there was a strange wavy effect around my nose, like water rippling, stirred by an invisible paddle.

I talked to a few others who had defects in their vision due to IIH. They've noticed something similar but have no idea either if its normal or not.

















I have not had enough idiopathic intracranial hypertension (IIH) patients to generalize. Of those I have taken care of this was not a complaint mainly the eye blacking out when they changed position.
There-in lies the rub. The neurologist looks baffled whenever I describe my vision. It's like he's seen a ghost, but really, that's just me.

He's just the medicine man and I'm the villager with the mystery condition.  I'm happy it's finally having a real effect but still frustrated about the lack of answers.

The meds  seemed to have decreased the pressure and mitigated some of the issues with my vision. But the sides are still the worst...from looking like crescents/circles to amorphous blobs.

They let themselves go and gained some weight.

Like a gooey spiderweb  or a melted puddle of glass thats still malleable and burnt dark in some areas. And it's those areas that flash like a camera. Like a dull flick that suddenly became movie star famous.

Hopefully nature follows suit and drugs and time will dim these stars.


This was fun to write but I must go. My diamox senses are tingling.


Been there done that with diamox
Yeah, sometime's it's not fun.

I have a question regarding starbursts/halos/double images/ghosting.

I notice if I force my eyes wide and hold them, that diminishes/mitigates all of the above.
They're still there, but not as bad.

And if I squint, they grow more grotesque. Is this due to the shape of the eyeball in nearsighted people?
Trying to figure this out.

Driving at night is not something I enjoy now.

Squeezing on the eye with eyelids or pressing with finger alters the shape of the cornea and can make astigmatism and the things you described (collectively called dysphotopsia) better or worse.
Meh, I'm back.

Perception of light at night has grown worse. As has the ghosting.

The invisible line between my regular vision and my bottom peripheral vision where ghosts dwell is now visible. A clearly defined border.  I see reflections of the living and unliving in that underworld.

Woke up yesterday, yawned, opened my eyes wide and it was like I had a line of glass running all along the bottom of my vision. Every time I widen my eyes, it's there now.

At this point I don't know what to do.

I had my follow up with the neuro-optha a few weeks back. 1st time I saw her since I began seeing the neurologist, Just nodded her head, said "that's interesting, see you in 6 months..." The Visual Field Test this time did show some spots of weakness...  

I honestly don't understand this.

At this point the only eye doctor I haven't been to is a cornea specialist. And to me, my perspective is, that it's like someone scratched up, smudged, warped parts of my glasses. But it's not my glasses, it's the vision from my eyes.

It'd hard for me to understand how this could be due to some pressure buildup from fluid in my spine.

I am literally seeing sunbeams reflecting from my eyes when I wake up.

And the ghosting in my bottom peripheral has progressed to the point that I have a constant overlay in that area of vision, slightly dimming everything in that area.

Should I get my eyes checked out again? Up my dosage of craptastic medication?
Or dance the black spiral into madness...and try to embrace apathy...

Honestly, every time I seem to get used to it, a few weeks later, a new defect appears.





I'm not commenting further.  Contributed all i can.
Avatar universal
I just posted about something similar I have
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