Dr Virender Sachdeva, Consultant, Pediatric Ophthalmology, Strabismus and Neuro-Ophthalmology, LVPEI GMRV Campus, Visakhapatnam.
Ocular migraines are temporary, painless visual disturbances that may affect one or both eyes. These visual disturbances may take the form of a transient blurring/ distortion of vision or rarely double vision and may sometimes be followed by a moderate to severe throbbing headache.
The significance of these visual disturbances may be two-fold:
1) These may be preceding sign of the classical migraine called ‘migraine with aura’ where the visual disturbance precedes the development of an attack of migraine.
Visual disturbance in most of these patients is like an inability to see from a small area (blind spot) that usually may enlarge in the form of a cracked window glass and moves across our field of vision. In some of these patients, it may take the form of flashes or flickering light around these blind spots (known as scintillating scotoma).
2) Sometimes these may present without typical headache episode and cause a blurring of vision/ double vision lasting for a short time, i.e. transient blurring of vision.
- These patients usually complain of a complete blackout or loss of vision which is transient, lasting for few second to a few minutes.
- Sometimes these patients might complain of a double vision (diplopia) which may sometimes persist for few hours.
Although not clearly understood, it is believed that these episodes have an origin very similar to migraine headaches. Development of certain sudden changes (called triggers) usually leads to increased activity around the nerves and blood vessels in the brain. Usual events that trigger an episode of ocular migraine include: eating old cheese/ excess chocolates/ coffee, fasting for a long time (skipping meals), acute stress/ emotional disturbances.
Treatment and Prevention:
Majority of these patients have spontaneous recovery. However the major concern is the fear that is associated with episode of sudden blurring of vision. Most of these patients do well with appropriate reassurance and don’t require active treatment.
Need for specific treatment may be indicated in case of:
- Persistent Visual disturbances. If these disturbances last > 24 hours and are accompanied by migraine headaches: use of oral medications (Non steroidal anti-inflammatory drugs, NASIDs) may be useful.
- High frequency of migraine with aura (considered as > 2 episodes per month): Such patients suffer from significant discomfort and hence are better treated with regular course of medications to prevent such episodes.
- Migraines associated with persistent double vision: These patients may sometime present as a diagnostic challenge to the neurologists and ophthalmologists. Such patients may have to undergo a sequence of tests to rule out other causes of acute onset of double vision before a final diagnosis can be achieved. Such patients may benefit from use of oral corticosteroids and vitamins while awaiting recovery. However, such vitamins should be taken under care of a neurologist/ ophthalmologist only. These patients may sometime present as a diagnostic challenge to the neurologists and ophthalmologists. Such patients may have to undergo a sequence of tests to rule out other causes of acute onset of double vision before a final diagnosis can be achieved. Such patients may benefit from use of oral corticosteroids and vitamins while awaiting recovery. However, such vitamins should be taken under care of a neurologist/ ophthalmologist only.
These episodes can be prevented to an extent by maintaining a good dietary habit avoiding episodes of hypoglycaemia and avoiding foods if any that trigger such episodes.