Tag Archives: spot

Black Spots After Eye Injection

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globe anatomy
anatomy of the eye (click on image to enlarge)

What are these circular spots in my vision after an eye injection?

Sometimes after an eye injection, a patient may see one or more black circular spots that move in the vision with head movement.  They are usually in the lower part of the visual field, though they move up toward the center of the visual field if you position your head face down.

What causes these symptoms?

These black spots are due to air bubbles in the medicine that is injected into the eye.  They appear immediately after injection.  They are harmless and take 1-2 days to dissolve and disappear.  Less commonly, small black circular spots may float in the vision after injection due to small silicone bubbles that are used to lubricate the syringe.  These silicone bubbles do not dissolve, but they may float away from the retina and become less noticeable over time.

What should be done about these symptoms?

If the spots are due to air bubbles, these symptoms fade without treatment.  If the spots are due to silicone bubbles, they may come and go over time.  It is best not to track them with your eyes as they may become more bothersome.  Try to look past these floaters and ignore them if possible.  If they persistently interfere with the vision, vitrectomy surgery may be considered to remove them.  This is rarely necessary.

What other symptoms can mimic this problem?

These black spots are considered a type of “floater.”  Floaters are any visual spot in the vision that “floats” or moves somewhat independent of eye movement.  Sometimes floaters may come on suddenly and appear like dots and fibers.  This is typical for bleeding inside the eye.  If dots and fiber-like floaters come on more slowly (hours to days), they may be a sign of infection or inflammation.  Rarely, cancer may present as many tiny floating spots in the vision.   

Floaters are distinct from blind spots (scotoma) that are fixed in the visual field and move only when the eye moves.  You cannot “catch up” or move away from a blind spot by moving the eye.  Blind spots are usually due to problems with the retina or optic nerve.  A progressive blind spot that begins in the peripheral vision and enlarges over hours to days may be due to a retinal detachment and requires a prompt examination.  Retinal detachment is often described as a curtain or shadow covering the vision.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright 2022 Designs Unlimited of Florida. All Rights Reserved

Central Serous Retinopathy

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central serous retinopathy
anatomy of the eye (click on image to enlarge)

 

What is central serous retinopathy (CSR)?

Central serous retinopathy (also known as central serous chorioretinopathy) is an abnormal leakage of clear fluid under the retina, which causes symptoms of blurred vision often associated with a round or oval dark spot in the central vision. The retina is a thin layer of delicate tissue in the back of your eye, which lines the inside wall like the film in a camera. The retina “takes a picture” of objects you look at and sends the message to the brain.

What causes central serous retinopathy (CSR)?

The exact cause of CSR has not been well-defined. Classically, it occurs in middle-aged people with type-A personality and who are often under stress at home or work.  However, anyone may be affected regardless of age, personality type, and level of stress. Individuals with type-A personality are perfectionists who often feel pressured by time constraints. Research suggests that hormones released under stress can affect the blood vessels beneath the retina (in the choroid). These vessels may leak an abnormal amount of fluid, which then works its way under the center of the retina. Far-sighted eyes are more commonly affected than near-sighted eyes.  

What other things can aggravate central serous retinopathy (CSR)?

A host of factors may aggravate CSR. Sometimes, medical conditions (Cushing’s Syndrome, systemic lupus erythematosus, polycystic ovary disease, sleep apnea), medications (pseudephedrine, prednisone/cortisone/steroid by mouth/cream/injection/spray, OTC medication for the common “cold”, OTC nasal sprays, diet pills, muscle relaxants, and medications for erectile dysfunction), and other agents (testosterone, cocaine, caffeine, niacin, amphetamines, estrogen blockers, etc.) may contribute to the development of CSC. Rarely, CSC may be triggered by pregnancy, or by a viral infection or bacterial infection. Intense exercise has been implicated, as well. Indeed, anything that causes emotional or physiological stress in the body, including intense fasting, may contribute to the development of CSC.

What are non-medical treatments of CSC?

In many cases, the symptoms will disappear with time. Over a period of weeks to months, the abnormal leakage may stop with normal healing. Importantly, avoiding known triggers (listed above) may help. Other helpful measures include stress management, getting 8 hours of sleep per night, and treatment of sleep apnea.  

What are medical treatments of CSC?

The doctor can recommend the best course of action by taking special pictures of the eye called a fluorescein angiogram. The fluorescein angiogram shows where the leak is coming from and how active the leak is. Prescription medication may be helpful if fluid leakage does not go away with time alone. Patients with high blood pressure may benefit from beta-blocker medications. Thermal laser photocoagulation may be helpful if the site of leakage is not close to the center of vision. Side-effects are rare, but may include the appearance of a small, permanent blind spot in the vision. Another laser called Visudyne photodynamic therapy (PDT) may successfully avoid blind spots in the vision in eyes with areas of leakage close to the center of vision. Medicine injections may also be used to treat this condition.

What will happen to the vision?

Usually the vision returns to normal or near normal. Rarely, central serous chorioretinopathy will cause permanently limited central vision with distortion. In about a third of cases, CSC will return at a later date in the same or other eye. Repeated episodes of leakage may result in a build-up of permanent damage to the retina. Therefore, any future decrease in vision should be promptly reported to the doctor. The vision may be monitored with the Amsler grid test.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2013-2023 Designs Unlimited of Florida.  All Rights Reserved.