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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
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My daughter is 11 and for years (5 maybe) she has experienced

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My daughter is 11 and for years (5 maybe) she has experienced complaints of colors bothering her. She says the colors are very intense and irritating to her eyes and the colors seem to pop out at her. We noticed that when she complains of this her pupils are usually dilated much larger than what I would deem normal. Her pupils are zooming in and out with no change in light when she complains of these episodes. Sometimes they are very dilated and sometimes they zoom in and out like they are trying to focus or adjust. We have been to Washington University in St. Louis but they were not doing it at that time (the zooming) and we were told that the colors popping was all in her head. We have seen a neurologist who did some basic coordination tests on her and said she doesn't have a neurological problem. Any ideas what we should do next?
Submitted: 4 years ago.
Category: Eye
Expert:  Dr. Dan B. replied 4 years ago.

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?

 

Customer: replied 4 years ago.
no, not fair skinned or light eyes, she does get headaches from time to time more when the eyes are bothering her.

No head trauma.

No bright colors. Strangely it is usually low light instances that bother her most - like dining at a nice resteraunt. Store with low lighting but bright spot lights.

I would not say she had trouble with bright lights - except when her pupils are large.

She does have anxiety issues though.
Expert:  Dr. Dan B. replied 4 years ago.

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?

 

I am happy to be able to help you today. I will also be happy to answer any other questions until you have the information you need.

 

If you would be so kind, please help me get credit for my efforts in answering your questions and press the ACCEPT button for this encounter; this allows part of the funds that you have deposited to the website to be released for my efforts to assist you.

 

Any positive feedback and/or bonus you may feel prompted to provide would be welcomed and is appreciated. Thanks for your inquiry!

 

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.

Customer: replied 4 years ago.
Well I do understand what you are saying but the headaches in our experience seem to be secondary. It very much appears that she has eye issues which results in a dull headache later because she is trying to focus.

The pupils are not generally fixed when she is having trouble. You can look into her eyes and they are physically zooming in and out. I would say within 10 seconds you can see them move anywhere from 3 to 8 times.

She is on Zoloft which we just started 2 weeks ago. What is so unusual about this eye issue is that it comes and goes. When she was at her worst anxiety level this year at the beginning of school she went months with out any eye issues and the worse anxiety we had witnessed. Then the eyes began their craziness just two days before we began the Zoloft.

It honestly seems like it comes in spurts. She may go for months with no complaints and then for several months she has trouble. She is an A student but is frustrated right now because everything is fuzzy and she is having difficulty reading. Tomorrow may be completely different. So some months her eyes are perfectly normal and some months they are crazy.

I just feel like there is something else going on. Something that is being missed. Her peditrician is wonderful and he said lets give the Zoloft some time to see if it helps before we persue the eye issue further. But it is only getting worse since we started. I'm not sure if 2 weeks quite enough time, but I would think there would be some improvement. Her anxiety has definately improved on the Zoloft.

In the past we have also shined a light into her eyes when the pupils seems really large and there was no change in them. Other times they will change. The large fixed pupils doesn't happen near as much as the zooming pupils.

I thank you for your help. I will be calling her pediatrition for more follow up. If there is any other insight with the additional knowledge I have provided I certainly appreciate it. Have a great day!
Expert:  Dr. Dan B. replied 4 years ago.

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?

Customer: replied 4 years ago.
I was not too impressed with the neurologist to be honest. He did not do any tests other than stand on one foot, etc... He said if she had something neurologically wrong she would fail some of these physical tests he did to her. He did not suggest further testing or any type of blood-mri-ct scan (I'm a little out of my league here as to what he might have suggested...) .

She does not wear glasses and both eye doctors did a full exam and found her vision to be perfect. She's had several eye tests in the pediatritions office - your basic eye chart type exam as well as two formal eye appts and was dialated twice with what seemed to be extensive exams both times.

However - her eyes were not doing their dance at the time of our visits. She only complained about the "colors popping" out. She was about 7 or 8 at the time of the formal visits.

I can't be positive that the problem is getting worse or that she is getting older so she does more reading of smaller print than when she was younger. Of course school work is more intense now that she in 6th grade (middle school) and so she may notice the problem more. I feel that it has worsened, but can't say 100%.

I'm stumped.

The only other thing I can mention that I do not believe to be related is that she did have a celazion removed from her eye and seems to have trouble still with styes. The celazion had to be surgically removed and there were no complications except it returned and the doctor offered to surgically remove it again - which we don't need to get into, but I thought strange! While she has recurring styes - I would not say they are really a problem anymore. The celazion was beginning to effect her eyelid and look icky for lack of a better word.

Is Ocular Migraines a possibility? She never reports vision loss or spots of loss as I have seen described online.

She called me today from the nurses office to say that the sunglasses I bought her were not helping today. They helped on a bad day she had last week, but today she said her probelms were mainly focusing on her work. She said words are blurry but her music notes in orchastra she can focus on ok. Not sure if that means anything at all but maybe the symptoms subsided for a while which happened to be orchastra class.

Thanks!
Expert:  Dr. Dan B. replied 4 years ago.

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?

Customer: replied 4 years ago.
Yes that does make sense and I appreciate so much your time and energy spent on my question. I would like to see an EEG to see if anything shows up.

I can remember there being something said about her being far or near sighted by one of the docs and I remember he said it was normal for children to have that; but can't remember he specifics now. I don't remember the eye exam being done after the dialation, but that could be my poor memory. I will look into that.

I do think that I would like to persue a different neurologist and I thank you for your help! Have a wonderful holiday season!
Expert:  Dr. Dan B. replied 4 years ago.
Good--I'm glad you have a plan about things to look into. I would be very interested in knowing what happens in the near future. Good luck to you and have a great holiday season too!
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3205
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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