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Diagnosed With Visual Snow. See Flashing Lights. Pupils Differ In Size. Having Idiopathic Neurolocic Issues. Suggestions?

Posted on Sat, 19 Oct 2013

Question: I have been diagnosed with visual snow. I constantly see flashing lights. I have had to opthamalogic exams without finding. If this were due to uveitis or some inflammation would this have already been found. Sometimes my pupils are different sizes but eventually come back to the same size and are both reactive to light. THey also oscillate changing in size larger and smaller continually all in the same lighting conditions. I have had this occuring for 8 months along with other systemic to this point known as idiopathic neurolocic issues. Do you have any suggestions. My visual acuity is 20/20. I have strange things occuring in my pupils in terms of there changing in size and sometimes they are not centered in the iris as well. Could this all be idiopathich as it doesn't seem to have worsened over 8 months.

Answered by Dr. Dadapeer K (5 hours later)

Brief Answer:
Chronic infalmmatory condition- posterior uveitis

Detailed Answer:
Hello,
Welcome to Health Care Magic

The symptoms which you have mentioned here like visual snow or haziness of vision, flashing of lights basically indicate diseases involving the posterior part of the eye. Diseases like retinal tear, retinitis, posterior uveitis or intermediate uveitis present with these symptoms.

You have also mentioned about changes in the pupil size with vision being normal. The change in the pupil size is a normal condition seen in all the individuals and it is called as hippus.

However pupils tend to be decentered as you have mentioned in the history in chronic inflammatory conditions like uveitis.

Since you are a young individual with symptoms of visual snow, flashing of lights, decentered pupil, I would like to consider chronic inflammatory conditions like intermediate uveitis or posterior uveitis as first differential diagnosis.

I advice you to undergo examination by ophthalmologist or preferably by a retina/uvea specialist, with particular attention towards indirect ophthalmoscopy to look for posterior segment of the eye.

Hope I have answered your query
Thank you

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dadapeer K (9 hours later)

My follow up question is it possible for two separate opthamalogic examinations not finding uveitis?

Answered by Dr. Dadapeer K (1 hour later)

Brief Answer:
It is possible to miss intermediate uveitis.

Detailed Answer:
Hello,
Welcome to Health Care Magic,

Thank you for the follow up query.

Uveitis of the anterior segment is easy to find out and it can be diagnosed by simple Slit lamp examination. Posterior uveitis and more commonly intermediate uveitis can be diagnosed only by indirect ophthalmic examination after a special technique called as scleral depression to look for the extreme periphery of the retina. Hence it is possible to miss intermediate uveitis unless indirect ophthalmoscopy with scleral depression is performed.
Hence I recommend you to undergo indirect ophthalmoscpy by scleral depression if not undergone previously.

If you already undergone the test, then nothing to worry, it can be a normal thing as I mentioned in the earlier answer which is called as hippus.

Hope I have answered your query.

Thank you

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar