Frequent headache with progressively growing eye floaters and glare? What to do?

[rob841]

I'm a 30 y.o. male, otherwise healthy and fit, experiencing a disconcerting panoply of symptoms, the chief being frequent headaches, eye pain, and growing floaters with glare/aura. I'd like informed advice about what help to seek, and how to think about my current predicament.

=== Details ===
Headaches/eye pain are nearly daily, sometimes mild sometimes enough to curtail my activities. The aura happens around lights, which seem to diffuse in conjunction with other parts of my vision becoming cloudy/blurry, kind of like a white-out. It lasts for a fraction of a second. This is complemented by a light refraction (think mirage or "fish bowl") that happens when my right-eye blob of floaters pass over anything. It's very disorienting, and when combined with my pain makes it difficult to carry on life as normal. I'm worried about these symptoms – particularly floaters – becoming disabling.

=== Progression ===
The floaters did not exist four months ago. They started with a very small opacity in my upper right vision of my right eye. The aura/whiteout followed within a week. Frequent headaches several days after that, becoming near constant. Eye pain followed and fatigue. Then 1.5 months after the first small opacity showed up it expanded into "crystal worms" and dark flecks in my right eye vision.

These worms have continued to steadily grow, parts becoming darker. It's now like a dirty spider web that takes up 1/3 of my right visual field at times (they swirl around my eye). There is considerable light refraction (like a shimmering mirage or looking through a fishbowl) when the floaters pass over anything. Needless to say, with this taking up 1/3 of my right eye vision it's disorienting in addition to being disheartening. I don't drive at night anymore and try to stay away from big windows.

Fatigue was responsive to b12 supplementation. Since I started taking a combination of b12, fish oil, magnesium, and b2, my headaches and eye pain are maybe reduced by 25%. My headaches and eye pain are less frequent, with good days only having a few hours of pain.

=== What to do? ==
I've seen many eye doctors and two neurologists. Most couldn't find anything wrong, though one retina specialist (my 6th or 7th) said she thought I had dry eye. I've since started eye drops and cleaning my eye lashes. My retina looks totally healthy. No visible eye floaters during retinal photography.

My family doctor had identified low B12 levels two months ago, which I've been treating. The neurologist put me on b2 and magnesium to help with headaches.

No one seems to think the eye floaters are related to the pain, though symptoms of each started within two weeks of each other, and progressed in conjunction. The aura/whiteout and floater refraction seem to be different phenomena, though I'm not 100% certain.

Should I go see a neuro-opthalmologist? A headache specialist? Could something identifiable be speeding up the formation of floaters?

I'm chiefly concerned about my vision become totally clouded with light-defracting eye floaters. If it gets appreciably worse in the coming months (and based on past progressed it will steadily do so) I will have no choice but to seek vitrectomy, and I know how risky that is. Based on the current formation rate, the level or light refraction caused by the floaters will make using my vision difficult within 3 - 6 months.

I appreciate all thoughtful suggestions!

[JohnHaganMD]

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[JohnHaganMD]

See a neurolophthalmologist

[rob841]

Will do! Thank you.