Differential diagnosis of endogeneous visual phenomena

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Abstract

Purpose

To draw attention to either goal-targeted or misleading features of phantom images originating from the optical media of the eye, retina, visual pathways and cortex.

Methods

Retrospective analysis of cases, connecting patient reports on various patterns of endogeneous visual phenomena with pathology at different levels of the visual system, by keratotopography, refractometry, perimetry, biomicroscopy, OCT and electrophysiology.

Results

Common features of our case histories are patient reports on visual phenomena which lack clear correlates to the outside visual environment. We demonstrate how the above diagnostic tools discern optical photic phenomena from mechanical phosphenes, vitreous traction phosphenes from photopsias arising due to retinal pathology and from lightning due to optic neuropathy. Criteria are defined for discerning these alltogether from the various appearances of filling-in phenomena in visual field scotomas.

Conclusion

A thorough interpretation of a patient’s report on endogeneous visual phenomena provides a valuable starter into ophthalmologic diagnosing and into some better understanding of disease mechanisms.

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