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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7364
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Symptoms Two weeks ago i was doing the shopping when suddenly

Customer Question

Symptoms:

Two weeks ago i was doing the shopping when suddenly i had a vision in my left eye of two white and black arc lines opposite each other. It made me feel a little off balance and nausea's, this lasted 1 to 2 minutes long.

Two days later i suffered a severe migraine with hot and cold sweats, sensitivity to sound and light and vomiting after eating dinner. The latter symptoms lasted over night whereas the migraine lessened to a throbbing headache in the back of my head over 2 or 3 days, i took panadol on the last day which took it away.

Unsure whether it could be medication related, during this time i was on my second course of antibiotics (Dalacin-C) for a diagnosed ear canal infection, i cannot recall the name of the first course of antibiotics that were prescribed to me.

Three days ago i was at home on my laptop when the same vision from the shop night occurred. I knew that something didn't feel right in my eye so i looked in the mirror and observed my left pupil dilated and in an egg/irregular shape, this lasted again 1 to 2 minutes. Very concerned i was driven to ER. Triage assessed me first for signs of stroke, took my blood pressure which was normal but my heart rate was up a little. 3 hours into waiting to see an ER doctor a headache started in my left temple, i took 2 Neurofen for this. The doctor saw me and said my eye symptoms were migraine related, she also spoke to another doctor who also explained to me that it is from a migraine. They gave me a letter to pass on to my GP. The night prior to this i took one Endep 10 sleeping pill.

The next day i went to my GP, he said that it could be migraine related, however, he referred me to an optometrist. The optometrist tested my eyes and reported:- "Taryn came in today in regards XXXXX XXXXX pupil dilation & visual disturbance which has apparently occurred on two occasions. Activity today was fine at R & l 6/6+2 with minimal myopia. intraocular pressures were within normal range at R 18,18 L17,18 @ 5.19pm (NCT). Confrontation perimetry was full field and equal and pupil reactions normal & equal. Ophthalmoscopy was unremarkable but due to the symptoms i would recommend further review with a Ophthalmologist or neurologist. That evening i took another Endep 10 for sleeping.

Yesterday, i took this report back to my GP who then gave me a referral to see a neurologist and to have an MRI: "Thankyou for seeing Taryn who is presenting with unequal pupils with headache with pulsating feeling in occipital region. Family history of migraine." I am due to make an appointment for this on Monday 10th October.

Last night, i was sitting at the laptop again when i felt activity in my left eye, i looked in the mirror again and saw my pupil in an oval shape this time and dilated. I took a photo of it with my phone. It lasted up to 2 minutes. This caused me to be very upset, worried and constantly anxious, i had a lack of appetite and dizziness with nausea. Could this be an anxiety attack or related to my eye?

Could you please explain to me what you think is going on with my eye? I am extremely worried that because i have constant throbbing in my head that something could be putting pressure on the lobe that controls my eyes, what do you think about this?

list of symptoms i have had include:

*Throbbing/pulsating feeling sometimes with or without pain in the upper back part of the head (a couple of months)
*On and off general headaches
*sleepless nights/insomnia (a few months)
*A swaying feeling once when laying down and once sitting up. (happened 1 day, 3 times that day about 2-3 weeks ago).
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. PG replied 2 years ago.

Dr. PG :

Thanks for interacting with the experts at Just Answer

Dr. PG :

Your concern is quite understandable

Dr. PG :

Your symptoms are quite consistent with the diagnosis of Ocular Migraine

Dr. PG :

While an MRI should certainly be done to rule out the less likely possibility of a tumor / demyelinating disorders (like MS etc.)

Dr. PG :

BUT it is very likely that the results would be normal, or consistent with the diagnosis of Ocular Migraine

Dr. PG :

Do get back for any clarification

Dr. PG :

Please accept the answer by pressing the GREEN accept button too,

Expert:  Dr. PG replied 2 years ago.
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Customer: replied 2 years ago.
Relist: Other.
Chose a doctor but a different doctor answered. Chose a high level of detail for answer, however, dont think i received much detail.
Expert:  Dr. Rick replied 2 years ago.
Hi. I'm online and happy to answer your question today. I agree with Dr. PG that your symptoms are consistent with ocular migraine.


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 causing difficulty with reading. 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.
This is nothing to worry about. It is not a sign of a more serious underlying condition, brain tumor or anything like that. If the episodes become so frequent that they are bothersome there are medicines that can be used to decrease their frequency or stop an episode once it has started.
I, personally, have been suffering from this condition for almost 30 years and I almost never get the headaches after the visual effects.


Here is an excellent article on this topic:

http://en.wikipedia.org/wiki/Ocular_migraine

I do not believe that an MRI is indicated in your case nor is any extensive workup by a neurologist.

Does this make sense to you?


And, now, the obligatory word from our sponsors: :o)
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Customer: replied 2 years ago.

Thankyou both doctors for your replies, however......How do you explain the left pupil dilation, assymetry and constant throbbing in my head with no pain? Information i have received from other sources say that these symptoms could be of greater concern. I have gone back to another doctor today who has disagreed about the migraine diagnosis that everyone seems to be giving me and insists on me having either a CT or MRI scan tomorrow? How common is single pupil dilation? Why am i so dizzy? I have been dizzy all day with no headache now. I am also hearing a high pitch piercing sound constantly in my ears, what is this?

Expert:  Dr. Rick replied 2 years ago.
I can assure your from both from 30 years of personal experience and two decades of professional practice that monocular pupil dilation (anisocoria) occurs with migraines. Dizziness also happens in this condition, even without the migraine present.

As to the high pitch piercing sounds that I'm not sure about.....

Could all your symptoms be a sign of something more sinister? Sure. However, migraine is much higher on my differential diagnosis list then any of these worrisome diseases or conditions.

Since your doctors seem to be set on doing the billion dollar workup on you, I'd love to hear how things turn out if you have the time. As a physician I learn something new every day :o)

It has been a pleasure to help you with your question today. 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. I would also be happy to continue to answer any more questions you have until we have resolved your concern.
Customer: replied 2 years ago.
I had the MRI today and the results came back ---- "No significant focal abnormality is identified. Congenital anomaly in that the left transverse sinus, sigmoid sinus and internal jugular vein are very small. I am unable to define any clear evidence of abnormal normal signal on the appropriate sequences in these structures which indicate the presence of a thrombus."----

Is it normal for this anisocoria to occur every couple days?
Expert:  Dr. Rick replied 2 years ago.
Well, at least now you know that there is nothing terrible growing inside your head :o) They sure did a good job of getting the results out quickly....

Yes, anisocoria can occur frequently with migraine events, even without the headache.

Believe me, there is a very high probability, which is even higher now in light of the normal MRI, that you have nothing to worry about.

It is now safe to press the Yes/Accept button.......

Have a good day.
Customer: replied 2 years ago.
Hold your horses! :).....the accept button will have to wait until tomorrow sometime after my appointment with the neurologist. You would probably be interested in what he has to say now anyway.
Expert:  Dr. Rick replied 2 years ago.
Ok. I'll rein back the beasts :o)

But, you know, we can still continue our conversation after you accept my answer...I don't go up in a puff of smoke when you hit that pretty button. lol!

I'm looking forward to hearing what the neurologist has to say....talk to you soon.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7364
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 2 years ago.
Well i saw the neurologist today, he confirmed the MRI was ok and tested my reflexes. He even made me march on the spot with my eyes closed! Anyway, he referred me to a junior ophthalmologist who did some more tests on my eyes.

Basically, they couldn't give me an answer and told me to come back in February to see another neuro-ophthalmologist.

Maybe you are right after all although no one mentioned anything about an "ocular migraine". U were pretty sure of yourself saying there was no need for specialist consultation or MRI etc?
Customer: replied 2 years ago.
sorry, forgot the precious "ACCEPT"
Expert:  Dr. Rick replied 2 years ago.
Thanks for the accept :o)

I am pretty sure that all of this workup is not necessary....but, on the positive side, they have not found anything wrong, you are getting a great examination and you now know that there is nothing terrible going on....even if you don't, exactly, know what is causing your symptoms.

Thanks for the update. In February drop me a note and let me know what the Neuro-ophthalmologist finds. And I won't even ask you to press the accept button..... ;o)


Have a good day.

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