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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3343
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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My 21 year old daughter has a history of pseudotumor cerebri

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my 21 year old daughter has a history of pseudotumor cerebri and she has had 5 days of a blurred area in one eye, and now there is a black spot in that eyes vision. we were in the emergency room and seen 2 days ago and it is not a result of increased pressure from pseudotumor. what else could cause this?
Doctor DanB : Hello and thanks for your question. Are you available to chat?

yes, thanks

Doctor DanB : Do you know if that black spot and blurred area moves with the movements of the eyes, trailing behind her eye movements ever so slightly before catching up to the same place in her visual field?

she says the black spot seems to move but the blurriness stays on the left side of her eye for the most part

Doctor DanB : I think what she is experiencing is a vitreous floater, which thankfully, is a pretty benign process for the most part. Let me explain...
Doctor DanB : A floater tends to follow your eye movements, floating behind and then catching up to the same position they occupied. These floating spots or "bugs" or cobwebs (they can come in many shapes and sizes) as some people call them, are tiny pieces of the vitreous jelly that occupies a large amount of the volume of the back of the eye.  This vitreous jelly, when we're born, is the consistency of a jello jiggler (thick jello). As we age it liquifies and becomes more fibrous bands and water. Because of this liquification and the resultant fibrous bands that are left, there becomes more points of traction that the jelly exerts on the back of the eye where it is attached. As we move our eyes in different directions and as our pupils change shape, or even as we rub our eyes, some of these bands can become unattached from the back of the eye and a piece of it floats around, attached still to the rest of the jelly. It is this traction of the vitreous jelly on the retina that can sometimes produce flashes that you may see or may not see, or may see in the future.  If you have or develop them, these flashes tend to be small, like starbursts and are usually intermittent; they can also appear as an arcing light. One of the most important things to understand about floaters is that the process of a new floater happening can rarely lead to a retinal detachment, so it is important to know the 4 signs of a possible retinal detachment. These are: 1. sudden increase in or new floaters, 2. flashing or arcing lights that are persistent and not going away, 3. a shade/shadow/spot in your vision that you can't see light through, or 4. a large drop in your vision which doesn't improve after a few minutes. For any of these symptoms you must see an ophthalmologist as soon as possible. 
Doctor DanB : Does that make sense?

well, she did have a significant visual field loss as well as a change in visual acuity when we were seen Friday. She also had swelling of the optic nerve, only on the left side. She had only the blurriness at that time. Now she has the black spot, but she says it is totally black, no light in that spot.

Doctor DanB : So this partial optic nerve swelling is new?

yes,she had gotten to normal visual field and no optic nerve swelling for the past year or so. she had a procedure done in August and they discovered her right jugular is occluded and the left is compressed by two bones, so we know she has issues with that but don't know if it is related to new eye symptoms

Doctor DanB : This partial optic nerve swelling could be an optic neuropathy that could develop from altered blood flow (if there is stasis or poor blood flow, thus could cause damage to the optic nerve). It's possible that an inherent blood disorder could also cause a similar picture, which could be assessed by a laboratory workup of blood dyscrasias by her doctor or a hematologist. It's also possible that an an infiltrating process such as sarcoidosis or TB could cause this type of picture. These are entities that should also be evaluated since the obvious pseudotumor cause does nor appear to be at play. Does that make sense?

yes. is this something that can wait until Monday to see her neuro-ophthalmologist for or should we return to ER?

Doctor DanB : I think she would likely be okay to wait until Monday to see her neuro-ophthalmologist but if she were to have other strange symptoms such as difficulty talking, walking, weakness, numbness, severe headache, or double vision, then this should prompt you to return to the ER.

she has had weakness of arms and legs, but that is not new. she also has had severe headaches, but is not having one now.

Doctor DanB : If things worsen significantly I would have a low threshold to bring her back to the ER.

ok, thank you very much for your information.

Doctor DanB : You're welcome. 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. This does not end our conversation, however-we can continue to discuss any of your concerns without further charges until you are satisfied. 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.

of course, thanks.

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Customer: replied 5 years ago.
just wanted to let you know she was seen on Monday and admitted to hospital for optic neuritis. Had 5 day course of IV steroids, slight improvement in vision at this point. we appreciate your help last week.
It's a very good chance that her vision will improve significantly. I'm glad she got the help she needed. Good luck!