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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
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Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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Suddenly seeing prisms in peripheral vision

Resolved Question:

Just had sudden onset of prisms in my peripheral vision - should I be concerned?

It lasted about 5 minutes, and I am seeing fine now. No sudden headache, numbness or weakness, dizziness, or other symptoms. Have pressure in my sinuses between the eyes.

Do I need to get to the ER?

Submitted: 2 years ago.
Category: Eye
Expert:  Dr. Dan B. replied 2 years ago.

Did it go away suddenly or gradually?
Did you have any nausea or light sensitivity with it?

Customer :
It went away within 5 mins, and somewhat gradually - no nausea or light sensitivity, but I do feel pressure and swelling in my sinuses between my eyes.
Should I take a baby aspirin? my concern is that I have asthma, not sure if aspirin is OK w/ asthma

Doctor DanB :
Was this something you noticed in just one eye or was it in both eyes? Have you ever seen this before?

Customer :
This was the first time I've had it, and it was in both eyes, but seemed worse in my left eye, angular prisms of color. I have had floaters, but they've always seemed mild.

Doctor DanB :
Would you say this prism effect seemed more psychedelic or electrical in nature?

Customer :
Possibly more electrical - the colors were in a grid pattern, and kind of moved up and down, but not quickly. The colors were not flowing, amorphous - definitely had a distinct pattern and shape - and I was able to see straight ahead.

Doctor DanB :
Thanks for the additional information. I think you've had a migraine. Now bear with me as certainly your migraine is not typical.
A typical migraine headache starts with an abnormal “light show” which sometimes is described as shimmering or zig-zag lights, which can sometimes surround a blurry area of the vision. 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, but everyone's pattern is different; some people don't have any of these other symptoms. After the onset of the lights (called scintillating scotomas), the headache typically starts and the light show tends to progressively go away.
The visual phenomenon that people experience with migraines do vary from person to person but often involve blurry vision with a lighted phenomenon; many people describe them as shimmering, but most consistently is an abnormal lighted visual phenomenon which is sometimes associated with blurring or hazy vision. One of the hallmarks of a person with a typical migraine headache is their need to abandon all activity in favor of a quiet, dark room where they can sleep off the headache.
One of the less commonly known features of migraines is that many persons can have this visual migraine phenomenon without actually having headache; this is called an acephalgic migraine. The spectrum of severity of headaches among migraine sufferers runs the gamut from no headache to severe, debilitating headaches. There tend to be many varied triggers for migraines, but some of the most common are chocolate, wine and cheese, stress, overuse of the eyes, and exposure to fluorescent lighting. Many people find that over-the-counter migraine preparations such as Excedrin-migraine work well.
The common theme among these preparations is the ingredient of caffeine. There are prescription medicines that can be taken on a daily basis to help prevent them (if they become frequent enough to alter your life) and there are also medicines that can be taken on an as needed basis to help abort the headaches once they start. Most primary care doctors feel comfortable prescribing these, but if not, a neurologist would be a good place to start.
If you are having other symptoms such as loss of vision in one eye, double vision, difficulty talking or swallowing, or are experiening numbness or weakness in any specific part of the body, these are symptoms which are not normal for migraines and you should see either your primary care doctor or an emergency room doctor as soon as possible.

Customer :
So, it doesn't sound like I've had a stroke?
Is there also a possibility of a retinal tear or other retina issue? I have not had an eye exam in a few years, and now I'm terrified...I will make one this week.
Been under a great deal of anxiety and strain this past week due to my father's failing health.

Doctor DanB :
No this doesn't sound like a stroke at all. I can certainly understand being scared of this seeing as how this was your first episode. while flashing lights can signify a retinal tear, these are usually quick, flashes or arcs of light and are only seen in one eye, and not a part of the peripheral vision of both eyes. That's why I suspect this is migraine and not a retinal tear. However, I agree with you that it's still a good idea to have that exam this week.

Customer :
Just wondering if chronic sinus issues could overlap the symptoms at all. I did have one glass of wine and some cheese today, plus came off a train with fluorescent lights....

Doctor DanB :
While sinus issues can cause pressure and a slight headache, they would in no way cause you to have these prism lights (scintillating scotoma), but could serve as a trigger for a migraine perhaps. However, as you just said, you've certainly had enough recognized triggers recently already.

Customer :
Thanks Doctor - you've put my mind at ease, and have been really helpful. Have a great holiday!

Doctor DanB :
You too and Good luck.

Customer :
I will definitely get to the eye dr. this week, and again, appreciate your help!

Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3176
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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