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Hypertension, spot in the eye, MRI normal, no diagnosis, Second opinion?

Hello, This is sort of weird but I have been unsucessful getting any answers from my current doctors. I m a 32 year old female. I do have hypertension that is controlled with medication. I have a spot in my vision in just my right eye. The spot is above and right of center (about 2 o clock if you will). It developed (or I finally noticed it) on July 11th. I thought I was getting a migrane , I got the scotomas that are normal for me when I get a migrane but no headache developed. When the scotomas subsided I was left with this one spot, no change in location, size, or shape. My family Dr. refered me to an ophthalmologist . She ordered an MRI then referred me to a neuro-ophthalmologist. The MRI showed a 1.1cm nonspecific signal abnormality within the anterior left temporal subcortical white matter . A demyelinating process is a consideration. Normal MRI of the orbits. 8mm pineal cyst . The two ophthalmologists I ve seen have both said there is nothing in my MRI scans that indicates a problem. They also say my eyes are fine and there is no diagnosis. I m concerned that they are concentrating too much on my eye problem and not considering other possible causes for this vision issue. I tried to talk to my family Dr. and I haven t been able to get him to call me back. I feel like they think I m making it up. I have two questions. 1) What could be the cause of my spot if it s not a problem with my eye? and 2) Should I pursue a second opinion on the MRI? What type of Dr. would be most likely able to help me?
Asked On : Fri, 27 Jul 2012
Answers:  1 Views:  111
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Ophthalmologist 's  Response
There are a number of conditions that could be causing your symptom. Most likely, it appears you have something "in" the eye that is causing this spot. The "nice" answer is that you have a partial Posterior Vitreous Detachment and some of the little attachment plate material that holds the vitreous against the nerve or retina has popped off and is now floating in front of the retina casting a shadow. This could be a relatively static thing with it not moving much or it could be sort of floaty where you move your eye and it moves too, but sort of follows before it stops moving. That's the nice answer.

The not so nice answer: You have hypertension at the age of 32. Why? Have they worked this up? Is this a diet issue? lifestyle issue? but whatever it is, you have this "hypertension". The retina as certain signs in it that demonstrate to the physician that you have hypertensive vascular disease. The tiny vessels in the retina become spasmed and narrow, and tortuous, and hard, and they can slow the flow of blood in a vein while crossing that vein, kind of like the car running over the garden hose and the sprinkler doesn't go around very fast anymore, at least until you get the car off the hose. These vascular spasms can cause small "strokes" or infarcts in the nerve fiber layer of the retina. These areas are called "cotton wool" spots and they look just like that, little blotches of cotton near the retinal surface. That means those nerves are NOT sending messages along the nerve fibers, and it also means that the light passing through the retina in that spot cannot hit the photoreceptors below. That could be a cause of the 'spot'. Then you could have had a small hemorrhage. Those vessels ARE high pressure now due to the hypertension and they'll bleed within the retina causing these dot and blot hemorrhages which can block the view as well.

The more complex problems that can cause a focal scotoma go on and on and vary from STD's, diabetes, MS, and on and on. My bet, either the "floater" or the retinal bleed or cotton wool spot.
Answered: Wed, 1 Aug 2012
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