Visual snow syndrome

Visual snow syndrome (VSS) is an uncommon neurological condition in which the primary symptom is that affected individuals see persistent flickering white, black, transparent, or coloured dots across the whole visual field. Other common symptoms are palinopsia, enhanced entoptic phenomena, photophobia, and tension headaches. The condition is typically always present and has no known cure, as viable treatments are still under research. Astigmatism, although not presumed connected to these visual disturbances, is a common comorbidity. As well, migraine and tinnitus are common comorbidities which are both associated with a more severe presentation of the syndrome. TMJ may also be a common comorbidity. The cause of the syndrome is unclear. The underlying mechanism is believed to involve excessive excitability of neurons in the right lingual gyrus and left anterior lobe of cerebellum. Another hypothesis proposes that visual snow syndrome could be a type of thalamocortical dysrhythmia and may involve the thalamic reticular nucleus (TRN). A failure of inhibitory action from the TRN to the thalamus may be the underlying cause for inability to suppress excitatory sensory information. Research has been limited due to issues of case identification and diagnosis, the latter now largely addressed, and the limited size of any studied cohort. Initial functional brain imaging research suggests visual snow is a brain disorder. There is no established treatment for visual snow syndrome. Medications that may be used to treat the condition include lamotrigine, acetazolamide, or verapamil. However, in absence of a secondary pharmaceutical indication, these do not necessarily result in benefits, and the evidence for their use is limited. In addition to visual snow, many of those affected have other types of visual disturbances such as starbursts, increased afterimages, floaters, trails, and many others. Visual snow likely represents a clinical continuum, with different degrees of severity.