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Visual Snow and Tinnitus

Visual Snow and Tinnitus

Visual Snow (VS) is considered a rare condition, but it is difficult to obtain precise statistics about how common it is in society because individuals with this disorder are often unaware that their condition is abnormal. Even when these patients consult a physician, they face numerous challenges in expressing the issues they experience with VS symptoms, often for many years. Typically, their condition is not recognized as a real disorder by healthcare professionals, leading to a lack of diagnosis.

Other Visual Symptoms: Visual snow patients are often treated in ways similar to chronic pain or fibromyalgia, as these conditions are commonly thought to be related. Frequently, it is suggested that the symptoms are psychological or the result of past or present illicit drug use.

What is Visual Snow (VS)? Visual Snow can be translated as "visual tingling" or "snowy vision." The main symptom of VS is moving dots in the visual field, resembling flying insects. The patient typically complains about a parasitic image, which is similar to the static seen on a malfunctioning television channel.

VS is characterized by small white and black dots in the visual field, resembling the image on a TV screen that is not tuned to a channel. Other visual symptoms may include: photophobia, persistent image afterimages, color swirl trails, bright flashes, poor night vision, and eye floaters. The floaters may sometimes be colorful and change color rapidly.

The clinical term for VS is "aeropsia," but it can also be referred to as "visual static" or "positive persistent visual disturbance." Although most symptoms are quite similar, each patient’s experience may vary slightly. However, every patient defines their condition uniquely with some minor differences. These visual disturbances can be permanent, meaning they are always present, or they may occur intermittently or temporarily. The condition can affect the entire visual field or just a part of it.

Although VS is more pronounced under specific light conditions and darker backgrounds, it can generally be seen under all lighting conditions. It may worsen in dim light or darkness. Some patients report that it is particularly bothersome when trying to read.

While it is not associated with a visual aura (prodrome) that accompanies migraines, many patients with VS also suffer from migraines. However, this rare syndrome is not considered a variant of migraine or a condition developed from a migraine.

In 70% of patients, tinnitus (ringing in the ears), vertigo (dizziness), fatigue, anxiety disorders (such as panic attacks), depersonalization, derealization (feeling of unreality), and depression are often associated with VS. Other issues, such as a feeling of fatigue, concentration problems, pressure in the head, headaches, occasional numbness, distractibility, and an inability to focus, may also be present.

VS is identified as a unique syndrome and is considered to be very rare. However, there is no consensus on its frequency, as it is believed that many cases do not seek medical attention despite having symptoms. This may be because individuals are unaware that what they are experiencing is abnormal or the symptoms do not bother them significantly.

Types of Visual Snow There are two main types of visual snow: Pulse and Broadband (moving/static type and broad band). These refer to how the visual field is disrupted; what the patient sees.

  • Pulse Type: In this type of VS, there are dots of equal size dispersed across the visual field. The dots are uniform in size and spread equally across the visual field. It is often described as similar to raindrops on a car windshield during light rain. The dots can be either lighter or darker than the main color of the scene the patient is observing. They may also appear to rotate or flicker.
  • Broadband Type: This is a more common type of VS, which creates a static image effect on the visual field, resembling the snowy image seen on a TV channel with poor reception. There is a blurry or snowy appearance across the visual field, which can be lighter or darker than the main color, but slightly blurs the vision. The dots can vary in size.

VS has several subtypes or additional visual symptoms, and approximately one-third of patients experience them constantly. About one-third of patients report symptoms of pulse or broadband type. These symptoms, if they persist for more than three months, are considered to be VS.

Other Visual Symptoms

  • Nyctalopia (impaired night vision)
  • Palinopsia (following images after the original image)
  • Photophobia (sensitivity to light)
  • Entoptic phenomena (spontaneous light, spontaneous photopsia, blue field entoptic phenomena, floaters) Other visual symptoms include:
  • Headaches and migraines, which are often associated with visual snow, particularly when they begin or worsen. A study found that 59% of individuals with VS had migraines.
  • Tinnitus, dizziness, fatigue, anxiety disorders (e.g., panic attacks), depersonalization, derealization (feeling of unreality), and depression often accompany VS. Fatigue, concentration issues, pressure in the head, headaches, occasional numbness, distractibility, and inability to focus are also common.

What Causes Palinopsia? Palinopsia can be thought of as an afterimage, seen as the trace of a moving object. While normal negative afterimages are usually considered retinal phenomena, palinopsia is considered a brain-related issue rather than a problem with the eyes.

The pathology behind palinopsia can stem from a variety of causes. The wide range of potential causes makes it challenging to pinpoint the source of the condition. The most common causes are brain disorders, drug use, and brain injuries, among others.

Causes of Visual Snow Although there is no consensus on the exact cause of VS, it is generally believed that thalamocortical dysrhythmia plays a significant role. Thalamocortical dysrhythmia refers to the disruption of neural activity between the thalamus (a relay station deep in the brain) and other areas of the cortex, the brain's outer layer.

Some experts believe that VS arises from functional abnormalities in a brain structure called the lingual gyrus, which is involved in processing visual input and encoding visual memories. Since visual pathways converge in the occipital lobe, abnormalities in visual processing are suspected to contribute to the condition. Specifically, nerve cells in the brains of individuals with VS may be hypersensitive to visual stimuli. These sensitive nerve cells then misfire and send incorrect signals to the brain, which interprets them as real visual images.

In a review study conducted in December 2018, several factors contributing to the development of VS were identified. Cortical hyperexcitability and subcortical network malfunction were among the primary causes. The review also presented important evidence that VS and migraines are distinct conditions, and that migraine is not the cause of VS.

Medical Conditions Associated with Visual Snow There are several medical conditions in which the symptoms of VS may appear. Some of the most common include:

  • Migraines or persistent migraine aura
  • Hallucinogen persisting perception disorder (HPPD), often associated with hallucinogenic drug use
  • Optic neuritis, a symptom of multiple sclerosis (MS), where inflammation of the optic nerve can cause visual disturbances, including visual snow.

Treatment for Visual Snow There are limited treatment options for VS. Generally, treatment focuses on addressing the underlying cause. There is no single, universally effective treatment protocol for VS, and the treatments vary depending on the symptoms. After a diagnosis, patients may undergo a challenging treatment process, and if one method fails, another may be tried.

Some treatments include:

  • Sensitive Colored Glasses: These glasses, such as migraine glasses, have helped many patients. While not officially recognized as a treatment for VS, many patients claim that these glasses make a significant difference.
  • Visual Rehabilitation: This involves various strategies, including visual adaptation and visual habits, which have been found helpful for patients with visual vertigo. While it has not been proven to relieve VS specifically, some doctors believe it is worth exploring.
  • Medication: When an underlying condition is identified, medication may be prescribed to treat the cause of the visual snow. Some studies have shown that drugs like propranolol and lamotrigine may offer some relief. (Note: Never take medication without a doctor's recommendation, as it could worsen the condition or lead to other problems.)
  • Diet: Dietary changes, such as avoiding processed foods, may help as certain food sensitivities, particularly to preservatives, can trigger VS symptoms.

Some studies also suggest that excessive screen time (on devices like smartphones and computers) could trigger VS or worsen existing symptoms.

How to Help Someone with Visual Snow If you have a friend or family member suffering from VS, you are likely aware of the challenges they face daily. The best way to help is to educate yourself about the condition and offer understanding and support.