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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7909
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Hi, I have two totally unrelated problems that are concerning

Customer Question

Hi,
I have two totally unrelated problems that are concerning me.

1. For several weeks I have noticed something very strange happening with my vision. When I look just a little out of the corner of my eyes, I can see strange images that appear to be of my eyes. They are about the size of a five cent piece, circular and whitish in colour. They have wriggling lines throughout that look like worms. I don't wish to sound gross, but this is exactly as I see them.
The reason I liken these images to be my eyes is because when I close my eyes, depending on which side I am looking out, I can see my eyelashes cover over the top of them.
I realise how crazy, strange this may sound but I am telling you exactly what I am seeing. I see about six of them at a time and have suffered from problems with my peripheral vision for some time. I also have cataracts.

2. I have been having a change in the taste of foods I have been eating for a while. Every time I eat I think the food is off because it tastes different to when I've eaten it usually. Sometimes, it's been hard to eat the food because it makes me feel ill.
I am on a bpap machine which is similar to cpap for Severe Obstructive Sleep Apnoea and usually when I wake up, my mouth is so dry and parched that it hurts a lot to swallow. I have to drink a lot of water to stay dehydrated and sometimes it is hard to keep this from happening because I also have a ileostomy. I lose quite a lot of effluent from this at times which could contribute to this.
I was diagnosed with GORD about ten years ago and I'm taking nexium for this. I haven't had too much trouble since I've been on this.
I've also been diagnosed with Multiple Systems Atrophy, which is a neurodegenerative disease.
I do hope you can help me find out what is going on here, especially with my eyes as this has been worrying me so much.
Thankyou for reading my questions.
Pam
Submitted: 10 months ago.
Category: Eye
Expert:  Dr. Rick replied 10 months ago.
Hi. I'm Dr. Rick and I have two decades of ophthalmology experience. I'm online and happy to answer your question today.

As far as your eyes are concerned I believe I have an idea of what is going on...

You are likely experiencing a PVD or posterior vitreous detachment, a common event that happens in many people.

You have a thick gel material in the middle of your eyes called the vitreous. Over time as it liquefies, this gel material collapses on itself, forms little clumps that you can see as dots, lines or bugs. As these clumps form the vitreous pulls away from the wall of the eye. In the process it can stimulate the retina -- causing the flashes that you may see.

It is recommended that you see your ophthalmologist to look at the retina to make sure there are no problems such as a retinal hole or tear. In most cases, there are no problems, but this exam is precautionary and allows for preventative treatment of any lesions that are found.

If you notice a sudden increase in floaters, flashes of light (like a lightning storm), a shadow/veil in the periphery of your vision, or a decrease in your vision that doesn’t improve in a few minutes this can be worrisome for a retinal detachment. You would need to contact your ophthalmologist promptly in that case.

What can you do about the floaters? Well, floaters don't go away, and they don't really get worse. Over time they tend to "sink" out of your central vision and you brain "filters" them out so you don't notice them so much anymore. They almost never cause significant visual problems except, of course, if they cause a secondary retinal detachment as discussed above. The only way to decrease or remove the floaters is with a major surgery called a vitrectomy. As a retinal specialist for almost 2 decades I've only done this procedure to remove floaters in a handful of cases.

Here is a video of the actual surgery to remove floaters:
http://www.retinavitreous.com/video%20files/intro_floaters.html


In January 2013 a new drug, called Ocriplasmin, was approved by the FDA to dissolve vitreous strands in a particular eye condition called vitreomacular traction. Perhaps someday this drug could be used to also remove floaters…. Only time will tell.


As far as the issues in part 2 of your post, I'm not really sure of what you should do, other then consult with a MD knowledgeable about MSA which, as you know, is very rare.

Does this make sense to you?

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS
Customer: replied 10 months ago.


Dear Dr. Rick,


 


Thank you so very much for this very informative answer to my question regarding my eyes. It certainly fits exactly with what I am experiencing.


 


I just wanted to say that these 'floaters' appear on both sides and there are more on the left as compared with the right and these are definitely increasing. One thing I am noticing now that where the little dots are, which I forgot to mention in my letter, there appears to be one that is more darker and quite a bit bigger than these other dots. The floaters are starting to overlap on the left and when I blink it looks like rain running down the middle with those wriggly things that can sometimes look like worms or fish hooks. There is now also a couple of dark areas, which are changing when I blink. There are also similar changes starting to happen more on the right also, though not as severe.


 


These images only appear when I have my glasses on. Does this change anything. As well as this, when I hold up my hand I can still see these on my palms.


 


I don't know whether this is of any significance, and I apologise for not mentioning this earlier, but I have a headache only on the left side above my eye. I have just noticed that this really only appears when I see these images. It seems to be betting worse as well. This is accompanied by nausea, which may or may not be associated with my eye problem.


I shall leave that question with you Dr. Rick. I am so grateful to you for enlightening me on what could be going on here and I will definitely be giving you a BIG TEN.


I will be ringing my specialist Opthalmologist's rooms on Monday. As I live in Australia, in Brisbane, I have a very good doctor. I will get an appointment as soon as I can.


 


I look forward to hearing from you if you have more to offer me.


Thanks again,


Pam.


p.s. I will talk to my GP regarding my other problem, which seems to pale in importance to the problems with my eyes.


 


 

Expert:  Dr. Rick replied 10 months ago.
Pam,

If these images lasted for 10 min to an hour or so, then they might be caused by an ocular migraine. Here is information on this condition:


What you are describing is consistent with ocular migraines, a condition that I not only treat in my office but that I have been dealing with personally for decades.
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. I almost never got the headaches after the visual effects.
There was one time, I was in the middle of a very delicate retina operation, when an attack started. After a few moments I lost most of my central vision and the inferior part of my visual field. I, calmly, removed my surgical instruments from the patients eye and we all sat around in the OR for 15 minutes until my vision returned. Other than that my ocular migraines have not really caused me any significant problems :o)

Don't forget to mash the positive feedback button for me...the one labeled "excellent" is the most fun to push by far ;)

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Dr. Rick MD FACS

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7909
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 10 months ago.

Hi Dr. Rick,


Thank you once again for this information. I am so sorry that you suffer from these ocular migraines. I'd imagine this would definitely be a big problem with delicate eye surgery. It would certainly make it hard to concentrate when you are experiencing pain like that. I suffered from migraines when I used to get my periods, when I was younger. Of course I don't any more.


 


I have had my headache on and off for two days now. It's right across the front of my head now not just in one place as before. The images are only there when I look out the corner of my eyes with my glasses on. They are perfect circles that shimmer. I can see my eyelashes on top of some of the closer circles and when I close my eyes, they completely disappear but the other circles stay there. For example, if I close down my right eyelid where I can see eyelashes they go but others remain.


 


My vision is blurry all the time and has been for a long time. However, I have other things that happen with my eyes, especially when I look into someone's face. This is also very weird because people's faces literally break up. Their eyes grow further apart, sometimes there is even a third one, which is freaky. Often if I look long enough, their face's completely disappear in front of me, leaving just a white space where their eyes, nose and mouth would be.


 


I find it hard to look at people when I talk to them for this reason. It is so upsetting to see this happen. I have a stigmatism in both eyes and have had my lenses changed so many times. I wear bifocals which is great, but lately I have had troubling focusing properly and find I have to blink several times to read the words.


 


If you can shed any light on these things other things I've mentioned, I'd be most grateful.


 


Thanks again,


Pam.


 


 

Expert:  Dr. Rick replied 10 months ago.
Pam,

It does sound like you have multiple things going on at once.

The blurry vision could be due to a number of causes and, on Monday, your ophthalmologist should be able to sort it all out.

The thing with peoples faces breaking up when you look at them and their eyes, nose and mouth disappearing leaving only a white space does not sound like an eye issues to me. Physiologically and optically it does not make any sense at all. Perhaps your regular MD can shed some light on this very interesting issue.

I wish you the very best and hope things clear up soon, mate :)

Have a good weekend.

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you can please give me a “10” rating in all areas. It has been a pleasure to assist you today.

Thanks in advance,

Dr. Rick MD FACS
Customer: replied 10 months ago.


It sounds like you are doubting me with regard to what I experienced when I look at people's faces. Okay, it may not be an opthalmological problem, but just the same, it does happen.


 


Thank you for your help. I shall not be in touch anymore. I will wait and see what my Opthalmologist says when I get to see him. I may have to wait a few days because my reference has expired. I have to wait till I get another from my GP.


 


With Thanks


Pam

Expert:  Dr. Rick replied 10 months ago.
Pam,

I am not doubting you....just saying that is not consistent with eye physiology or known pathology.

I wish you the very best.

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