Hello and thanks for your question.
A typical migraine headache starts with shimmering lights, often times they surround a blurry area or have dots or jaggedly lines associated with them. They tend to progressively increase in intensity and sometimes march across the visual field. Many times this is then accompanied by nausea, irritability, sensitivity to bright lights and/or loud noises. After the onset of the lights (called scintillating scotomas), the headache typically starts and the light show tends to progressively go away. Many people can have this migraine phenomenon without the headache; it is called an acephalgic migraine. Some people even start having these late in life, or may have had a few much earlier in life that behaved differently and haven't had any for decades and then begin to have them; this is not uncommon. A family history of migraines is often present as well.
Flashing lights can also be due to traction on the retina from the vitreous jelly (occupies most of the volume of the back of the eye and is connected to the retina).
If have floating dots or spots that are new and that tend to follow your eye movements, floating behind and then catching up to the same position they occupied before then your symptoms sound consistent with what are called vitreous floaters. These floating spots or "bugs" as some people call them, are tiny pieces of the vitreous jelly that occupies a large amount of the volume of the back of the eye. This vitreous jelly, when we're born, is the consistency of a jello jiggler (thick jello). As we age it liquifies and becomes more fibrous bands and water.
Because of this liquification and the resultant fibrous bands that are left, there becomes more points of traction that the jelly exerts on the back of the eye where it is attached. As we move our eyes in different directions and as our pupils change shape, or even as we rub our eyes, some of these bands can become unattached from the back of the eye and a piece of it floats around, attached still to the rest of the jelly. It is this traction of the vitreous jelly on the retina that can produce these flashes. These flashes tend to be small, like starbursts and are usually intermittent; they can also appear as an arcing light.
One of the most important things to understand about floaters is that the process of a new floater happening can rarely lead to a retinal detachment, so it is important to know the 4 signs of a possible retinal detachment. These are: 1. sudden increase in or new floaters, 2. flashing or arcing lights that are persistent and not going away, 3. a shade/shadow/spot in your vision that you can't see light through, or 4. a large drop in your vision which doesn't improve after a few minutes. For any of these symptoms you must see an ophthalmologist as soon as possible.
Which phenomenon sounds more consistent with your symptoms? If it is the flashing associated with a possible migraine or is it the flashing from traction on the retina from the vitreous jelly? If it is the latter, Your eye doctor should've examined your retinas with your eyes dilated; if he/she did that and says everything looks okay, then that is as good as you can do right now and you should know these tend to subside over time and improve. If it does sound more like the migraine phenomenon, you could consider seeing your primary care doctor or just wait and see how it goes.
Does that help to answer your question?
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My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor.
I've had both kind of symptoms, more headaches associated with menopausal symptoms which could trigger flashes, but flashes can occur without headaches. Mine may be more related to traction on the retina. My eye dr. has done thorough examinations with pupils dialated and checking for glaucoma. He said he saw a tiny bit of scar tissue, but that everything was fine. S that does mean that my retina will separate eventually? You said that these flashes should subside over time, but they have not and it's 6+ years now.
The flashes sometimes start as a dark spot that move when blinking and this eventually turns to a white sparkle type light. Sometimes it's a white type spot when looking at the sky that turns to this jagged small speck. I"ve read where people have flashes continually, so how do I know when it's serious? Since I started having these problems, when I rub my right eye, at times it feels like there is glass in there and my eye burns like crazy and waters a lot - what could that be? Sometimes I wake up and the same thing happens when I open my eye. It's not ever happened on my left eye though. I have floaters so do know the difference with those. When I get headaches, I also have pressure and pain in my right eye only.
The fact that you've had this for 6 years speaks to the fact that this is much more likely a migrainous phenomenon. Also, these flashing lights also tend to be more shimmery than flashing in migraines. In addition, they tend to build slowly in intensity and also gradually decrease in intensity until they resolve. Lastly, they sometimes tend to march across your visual field. Most people who have headaches associated with these migraine phenomena have the headaches after the onset of the visual symptoms. But many people can have these visual symptoms without a headache at all and that is called an acephalgic migraine. A family history of migraines and/or a history of getting car sick as a child are associations with migraines as well.
The feeling of glass in the eye when you rub it is not related to these other symptoms and is a sign of a surface of the eye type of problem, such as dry eye.
Thank you for taking the time to help me with all my questions!
And hank you for being the first one to finally have a possible answer to my eye pain when rubbing it. But can a person have dry eye in just one eye? That's amazing that dry eyes can cause that much pain. My eyes get red too at times. What kind of drops are safe to use for that?
You said that these symptoms associated with headaches can come later in life. I had severe headaches when I was a child, around 10-11 years old. I did notice that after my attack on Sat, I got a headache after the white jagged flash subsided. By the way, It's just one jagged, kind of 3 sided but not a triangle flash that occurs when I get these attacks.
So what type of flash occurence would warrant calling the dr.? I hear of some people having them all the time.
My Dad had glaucoma and detached retina so I am very concerned about staying alert to symptoms myself. At the same time, I'm anxiety prone, so this ends up consuming me a lot of times - very frustrating.
You're welcome. It's very important that my patients are as informed as possible about their eyes; that enables them to help treat themselves better when possible.
It is possible and in fact common to have symptoms in just one eye or symptoms that predominate in one eye, but the process of dry eyes is usually happening in both eyes.
I would suggest starting with some artificial tears which you can buy over-the-counter. Any kind that doesn't say get-the-red-out or redness-reliever is okay to use. Start 4x/day and be consistent with them for at least 3-4 weeks to have them help your symptoms.
The more you tell me the more I suspect migraines as the cause. If you start having isolated flashes (not shimmering or jaggedy lights) or multiple flashes or arcing lights (that pass by your vision like seeing a lightsource pass by you in your car when you are driving fast), then these are the types of flashing lights that represent traction on the retina and you should see your eye doctor for these. Because you have a family history of retinal detachment, that puts you at greater risk for them and it's good to know how to distinguish between these two.
I think this information should give you some comfort that you can distinguish between the two, but I'm always available to help you in the future if you need it.
Wow Dr., you have eased my anxiety a great deal and thank you again for being patient with me in answering these long sought after questions.
I had forgotten about my severe headaches as a child until we started talking about headaches/migraines.
My right eye is the one with the extreme pain when rubbing it sometimes, pain associated with headache behind the eye, pressure and the flash problem. Only on occasion have I seen a flash in my left eye, but nothing else.
So what do you mean by having isolated flashes? I only get one flash when it happens.
I just realized a perfect description of the flash - is as if someone just took my picture with a camera and see that flash when blinking. I hate getting pictures taken with flash because it takes a while for the image to go away.
Blood pressure can also be a cause, or are the symptoms different? My husband said he saw spots prior to getting on bp meds. Mine is usually kind of high when going to the doctors (nerves), but seems to be ok when testing at home. I've wondered if it's related to that as well.
You would think that now, after 6 years, I would not still freak out when it happens, but vision is one thing that I would hate to lose because of lack of information.
It sounds as though you are having this one, isolated "camera flash" when you rub your eye, is that correct? If so, then it is the act of rubbing which causes momentary traction on the retina and hence the flash. What you are describing is what I mean by an isolated flash.
As far as blood pressure, extremely high blood pressure can put pressure on the optic nerve and can result in similar flashing, but your eye doctor would be able to see signs of swelling of the optic nerve if this were the case. This is quite uncommon, however.
No, the flash does not happen when I rub my eye, only sometimes burns and waters.
The flash comes at random times mainly in the right eye, sometimes once a month, sometimes once or twice a week, lasting from a few seconds to several minutes.
My dr. used to tell me that it was ok if it lasted a few seconds, but from the onset in 2004, it lasted several minutes. Only in the last year has it decreased more in duration.
Your situation does sound atypical in the fact that these flashes (eye doctors call them photopsias) seem more chronic. In your case, if you do have them for several minutes at a time, I would be very aware of whether they are associated with new floaters, a definite decrease in the vision, or an area of your visual field that you do not see light through. If they are associated with any of those three symptoms, then a trip to the ophthalmologists office is warranted ASAP.
As you have had this pattern since 2004 and have been okay from a vision standpoint and your ophthalmologist continues to tell you all is well, I think you have reason to believe that.
Does that make sense?
Yes, I think so too. What I've experienced all these years is always the same pattern, same symptoms. Now I have to stay alert since I've had it so long? Like I said, the duration of the attacks have decreased so hopefully that's a good sign.
But the fact that I get these headaches with pain behind the right eye and pressure may also contribute to it.
What's weird is that floaters are mainly in my left eye, and my right eye gets the majority of the flash episodes and pressure/pain from headache.
The only thing I notice is that I'm having more difficulty reading up close as I"m slightly nearsighted (-.75). But that's due to aging and don't need reading glasses yet.
I don't necessarily think you have to be more vigilant about observing these symptoms, just that you have to know what to look for now in relation to the symptoms you have. I agree, the fact that these attacks have decreased is likely a good sign.
Headaches with eye pain may be playing a role here, you are correct. There can be this disparity between floaters and photopsias, but many times the disparity is just because the floaters can be small enough that we don't notice them. This tractional process is likely happening in both eyes, it's just that one eye is symptomatic from it (the eyes tend to be have like that: one will be more symptomatic than the other with many eye problems).
As far as having more difficulty reading, usually the mild myopia (nearsightedness) is a help in that department. But given the fact that you're fifty, your mild myopia is no longer sufficient to overcome the level of presbyopia (need for reading glasses after age 45) and you likely would benefit from using low powered over-the-counter reading glasses such as a +1.00, +1.25, or +1.50.
Actually, being near-sighted does not preclude you from using over-the-counter reading glasses. It just means that you would use a little less power than someone of your same age who wasn't nearsighted (assuming that your -0.75 prescription is correct). Also, another reason OTC reading glasses may not help as much as prescription glasses is if you have astigmatism. These OTC glasses do not correct for astigmatism and you would have a baseline blur from the astigmatism unless you have prescription glasses.
It may be that you need prescription glasses, but I can tell you with relative certainty that if your distance prescription is only 0.75 in both eyes (don't know if it's just one eye or both like that) that you would require at least some magnification for near vision by your age.
I hope this has been helpful.