Hello and thanks for your question. Please allow me to ask you a few questions.
Is your daughter fair-skinned or have light-colored eyes?
Does she get headaches?
Any history of head trauma?
Does this only happen with colors that are bright or certain colors?
Does she have a problem with bright lights?
Your daughter's condition, as you've probably been told already, is quite unusual. There are a few things which may help explain some of this, however.
First of all, when a person has an anxiety attack, or even is displaying signs of anxiety even if it is not a full blown anxiety attack, that process causes the pupils to dilate--it is a very basic part of the "flight-or-fight" sympathetic nervous system reaction. Secondly, when a person is in a low-lighting environment, the pupils are automatically going to dilate more just because their job is to let more light in when the ambient lighting is low (to allow for more clear vision) and to constrict, allowing less light in when the ambient lighting condition is bright. So when she is in a dimly-lit environment with her pupils already wider and she sees bright spot lights, this high contrast naturally causes an irritation or to those who are more sensitive to it, like your daughter, can cause symptoms of eye strain and also headache, which may even further exacerbate anxiety issues.
Secondly, those people who get headaches not uncommonly tend to have issues with their eyes, just because the eyes are connected to the brain and are many times an unwilling participant in whatever the brain is experiencing. In other words, it maybe that her headaches are the cause and her eye symptoms are a secondary symptom from the headaches. This is not uncommon at all.
Knowing that she has these issues, I would recommend a few things. First, there may need to be an investigation into headaches and possible treatment trial of different medicines to see if these can help her and to find any possible causes of headaches. Secondly, I don't know if she is on any anti-anxiety medications, but appropriately treating this may also provide her some overall benefit. Lastly, she may be someone who just naturally has larger pupils than others, and it sounds very possible that she is. In that case, you may consider having her use tinted glasses, or sunglasses, or even using a low concentration of a drop called pilocarpine, on a daily basis, that helps to constrict the pupil--this may give her some relief as well.
Does all this make sense? Do you have further questions about what I've said or anything else?
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Okay, those are great details. Thanks for the clarification.
Having seen a pediatric neurologist, did your daughter get a workup to assess for seizures? Sometimes having a milder form of seizures can be associated with these sporadic, intermittent neurological issues.
Does she wear glasses for reading or at other times and if not, has she been tested for them recently?
Those are all helpful details. Given the up and down nature of her symptoms it is not surprising that the sunglasses helped previous and are not helping at other times (like today).
Usually migraines include a positive visual phenomenon like seeing shimmering or pulsating lights that gradually build in intensity and then gradually resolve, many times followed by a headache, although having a headache is not strictly necessary to make the diagnosis of migraines. Colors "popping out" at her are not usual descriptors of migraines, although this is certainly in the differential diagnosis of her symptoms. Migraines also are often accompanied by one or more of the following symptoms: nausea and/or vomiting, sensitivity to bright-lights or loud noises (at the time of the visual symptoms and/or headaches), or excessive irritability. One thing that she may be noticing is that certain colors in the visible light spectrum do actually seem to "stand out" from others; for example, red colors often look as though they are popping out of a page or background versus blue colors which look the opposite. This is a normal phenomenon, but she may be noticing this as well.
That's good to know about the chalazia, but thankfully I don't think those really play a role with your daughter's symptoms.
I think that two things that should be checked out include:
1. Whether she has latent hyperopia or not. Many children are far-sighted when younger and then tend to lose a fair amount of it as they get close to their teenage years. Some children tend to "hide" it unknowingly and spend so much of their time focusing through some far-sightedness that almost as a baseline, even when measured on refraction tests at the eye doctor, then don't show any far-sightedness in their glasses prescription. This latent hyperopia can cause eye strain and difficulty with near vision tasks and can go undetected unless the glasses prescription is measured after she's had her eyes dilated. If she does have some latent hyperopia, this may be responsible for her blurring and difficulty focusing up close.
2. Given the fact that the neurologist didn't seem to do much or entertain many possibilities for her, I would recommend that she go to either a pediatric neurologist or maybe even a neuro-ophthalmologist (a specialist in neurological diseases of the eyes). These two specialists are likely to be more attuned to your daughters symptoms and possible subtle exam findings and you may find more success with them. Certainly these milder forms of seizures are something that needs to be considered and possibly worked-up and she may need an EEG (electroencephalogram) to see any seizure activity happening in the brain.
Does all that make sense?