Doctor DanB : Hello and thanks for your question. Are you available to chat?
Customer: Yes I am
Doctor DanB : Did that grey spot "float" around in your vision? In other words, when you moved your eyes did it float just behind the movements of your eye, catching up to its original spot?
Customer: It seemed to lag a bit behind my eye movement; however, it stayed pretty close to center in my vision for the duration. Never changed size, and could see it with eye closed and open.
Doctor DanB : Did it have a sudden (instantaneous) or gradual (few seconds) onset? How long did it last? Did it go away suddenly or gradually? Was it associated with light sensitivity, headache, nausea and/or increased irritability?
Customer: The spot itself seemed to come out of nowhere. It gradually got worse/brighter -- up until the point where my eye couldn't focus properly -- but at that time the spot was gone. I felt a bit nervous, slight headache, and it lasted around 15 minutes total, excluding the blurry/out of focus episode. I've had light sensitivity for about 3 months now, with flashes and floaters in both eyes during the day.
Doctor DanB : Has this ever happened before? Do you/did you get car sick as a child?
Customer: This tiny spot happened in the same eye two days prior. It lasted for the same duration -- but no out of focus episode. Aside from that, the closest thing that I experience regularly are after images and a single case of optical migraine in the left eye in January. As far as the carsickness, never.
Doctor DanB : I think what you have described sounds like a migraine. Let me elaborate...
Doctor DanB : A typical migraine starts with abnormal visual phenomena which sometimes is described as shimmering or zig-zag lights, which can sometimes surround a blurry area of the vision. Some people describe areas or splotches of their vision that blank out and some have lights or psychedelic phenomena surrounding these areas. They often 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), a headache (and/or possibly eye pain) typically starts and the light show tends to progressively go away. For every different person with migraine there is a different pattern; some people only have one of these accompanying symptoms, but the commonality is this gradual onset and resolution of either negative (void) or positive (lighted) visual phenomena, experienced in both eyes (even though it may seem to be predominantly in one eye or one side of the visual field. 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. Does this make sense? Doctor DanB : I think the sensation of having something your eye is not necessarily connected to this migraine process. It is likely a dry eye and can likely be helped by using artificial tears 2 to 3 times per day for the next several days.
Customer: That makes sense. I just never knew a migraine could be occurring with just a tiny speck of coloration and no headache. As far as blinking and my eye going out of focus and back in for a few minutes after -- is this synonymous with migraine as well? That was the most troubling aspect of it all.
Doctor DanB : Yes, this fluctuation of the vision can be associated with the migraine. And actually, acephalgic migraines are quite common. Do you have any other questions about this?
Customer: Last one.. At what point, if any, should I be prompted to seek emergency care? Any specific timeframe that the spot doesn't go away, etc.
Doctor DanB : If you have focal weakness/numbness, complete loss of vision in one eye,double vision, difficulty walking, talking or swallowing, these are signs of stroke and not migraine and should prompt you to go into the ER. The visual symptoms generally last an hour or less on average.
Customer: Okay, that's what I needed to know. Thank you!