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Q. Can acoustic noise trauma due to micro-suction procedure cause blurring of vision?

Answered by
Dr. Asha Juliet Barboza
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Mar 23, 2022

Hi doctor,

I have a situation that is causing me lots of concern, and I have seen many specialists in my country, but it did not help. Three months back, just before Christmas, I suffered an acoustic noise trauma. The doctor had performed a micro-suction ear wax removal which caused a very louder noise inside my ears. The doctor took five to ten minutes on each ear. After this, I developed tinnitus, hyperacusis, and aural fullness. It settled down around three and a half weeks, although tinnitus is at a quieter baseline and some hyperacusis. But about two and a half to three weeks, I noticed more symptoms. I had slight swaying, and my wisdom tooth gums swelled and later got settled and were also checked. I also had a blurry eye, and the lid felt heavy. It got worse, and both eyes were blurry. I also developed dry eyes and got drops. As advised, I am using the VisuXL drops, but my eyes also feel very liquid, and I can see it. I get a flash in the corner of my eye when blinking, and my eyes feel pain when I move them. It does not just feel like eye strain, and my muscles are weakened. And the lid that feels heavy sometimes when I blink causes pain to the eye and feels sharp or gritty. I went to the opticians saw three ophthalmologists, one neuro-ophthalmologist, and they said it looks fine, and I am just anxious. I also saw a neurologist who suggested a brain MRI scan without contrast in a couple of weeks. Got prescribed new glasses three weeks ago with minor astigmatism. My right eye has a spherical power of + 0.50 D, cylindrical power of - 1.00 D, and an axis of 170.0 degrees. My left eye has a spherical power of + 0.25 D, cylindrical power of - 0.75 D, and an axis of 10.0 degrees. I went to opticians again four days ago, and my prescription had already changed and gone up. I also get some static in my eyes, and even when wearing glasses seems more, and in the better eye, the static seems more. The laptop and television seem brighter, feel like I have been out in the sun and cannot adjust, and feels more liquid pressure in the eyes.

I had a pressure test done at the hospital two days back and other eye and hearing (not advanced) tests. The OTC scan of the retina looked fine. Also did a blood test for Sjogren's syndrome and waiting for the results. I get negative after images, too, and slight double vision or ghosting around edges and fuzziness, and with the glasses sometimes. On the worse eye, the eyelid feels heavy and weak. When I look around in shops or supermarkets, I feel disorientated and blurry and have light issues, and I have a lot of sensitivity to light. I had no problem before this at all. I am agitated and concerned. No specialist around me can link this to acoustic trauma, but it only happened after this. I am frightened that this trauma and blast to my ears has done some neuropathy or neurological damage, neurons misfiring, some nerve issues or cells or tissues or blood flow. Is there any other test, like VEP, other advanced tests to check tissues, vessels, brainstem, if any neuron damage or something is being blocked? I want to get to the bottom of this issue. I hope I do not lose my vision or worsen, but this situation has upset me. What do you think about this situation based on symptoms and all this information? What do you think this could be? Or suggestions for further tests etc. Kindly help.

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#

Hello,

Welcome to icliniq.com.

I understand your concern. So sorry to hear about your predicament. From the details you have given so far, I understand that all these issues began after getting your ear wax removed. You mentioned that you had dental swelling, which could have been an infection that could have spread upwards towards your eye, causing the eyelid's heaviness. We call this preseptal cellulitis. I suggest it had to be treated with antibiotics and anti-inflammatory medication prior. The sensitivity to light or photophobia can occur if your pupils are not reacting to light. If they are partially dilated, you can experience this phenomenon. I also suggest you test this by looking into a mirror and checking if both pupils are equal. Afterward, using a flashlight, swing the light into each eye and see if the pupils are reacting and, if they are, are they reacting equally. Secondly, I suggest you look for Ishihara color vision charts online and close each eye and read each chart on your laptop. Compare if the colors are similar between each eye and check if the color seems brighter or washed out between each eye. If you find any difference, I suggest you need to revisit your neurologist. Regarding the static, I cannot understand what you mean by static, is it flashes?

Eye pain: When the optometrist checked your eyes, did they apply an eye drop, dilate your pupil, and recheck your eye power? It is called cycloplegic refraction. If you have plus power, hypermetropia, it will show up only after this test is done. Undercorrection of hypermetropia, especially with astigmatism, can cause eyestrain, manifesting as eye pain.

Ghosting and fuzziness can occur due to dry eyes, excessive watering, or even astigmatism if the axis correction is wrong. If there is a retinal issue, it can also happen, but your OCT (optical coherence tomography) is standard.

Pain on movement of the eye: If a single eye was experiencing this symptom, I would suggest you rule out optic neuritis or retrobulbar neuritis more so if your color vision was affected, but in your case, it is on both eyes, am I correct? Another cause of pain in both eyes' movement and photosensitivity can occur sinusitis. Bilateral neuritis is extremely rare.

I suggest the following:

1) Get a thyroid profile done: To rule out dysthyroid ophthalmopathy.

2) Go ahead with the MRI (magnetic resonance imaging) of the brain, sinuses, and orbit with contrast.

3) Get your refractive error retested with cycloplegic refraction from another specialist.

4) Use lubricating eye drops more frequently.

5) Try steam inhalation twice daily and see if it helps until the scan is done.

Please upload a picture of your eyes and any report that you have.

Thank you.


Probable diagnosis:

Dry eyes.

Hi doctor,

Thank you for the reply. I have had no medications. And I saw a dentist and did a scan of my mouth and teeth, and no infection was found. It just got inflamed, which has usually happened before. I think the wisdom teeth have another spurt of growth. But as I said, it all happened after this situation, the eyes, etc. I had my pupils dilated did an OTC scan and pressure test with a handheld device that the doctor did multiple clicks in the eyes. They were measured two days back for pressure. The doctor did that Ishihara color number chart for one eye at a time to read the numbers. I did not notice too much difference. Sometimes when I do it myself at home, I feel there is the slightest difference in color but not many other times. Also, the dilation of pupils when I look in the mirror of my worst eye, it seems the pupil is not always even. Sometimes it is, or it takes longer to go smaller. And can you explain if the axis corrections are wrong and how they could be? My neuro-ophthalmologist feels I am overly stressed and anxious from the event and have a functional neurological disorder. I do not believe it, although I do not deny I am highly anxious. I have my concerns as this happened after that noise trauma in my ears.

I am scared this is sinister or would not get better. Yes, the pain in both has slightly subsided since using the drops, but it felt so bad before I was worried. Also, yes, I get fuzziness and static with and without glasses. It just feels like static or fuzziness in my vision all the time. I get a flash in the corner when blinking. Nobody can answer this, but this is a sudden visual change for me, and I am scared it will worsen. It was only a couple of weeks after my noise trauma. I will attach the report and photos. Kindly help.

#

Hi,

Welcome back to icliniq.com.

I understand your concern. I could not find the OCT of macula amongst the attachments (attachment removed to protect the patient’s identity). Those mainly were fundus photographs that looked normal. Flashes can indicate irritation of the retina, unlike skin which responds to the irritation by itch or burns, and the retina responds as flashes as it is a nerve. The flashes can commonly be experienced during sudden eye movements, rubbing, or even blinking hard. I do not think you should concern yourself about it. As for the axis of astigmatism, if there is a slight variation or tilt from what you require, you may experience a ghost image, especially if you are overly anxious. Wearing a new pair of spectacles always takes time to adjust for anybody. I suggest you should try using the new pair constantly. If they have increased the plus component from the previous pair, it takes time for the eye muscles to adjust. So it is paramount that you still wear them, so the accommodation muscle relaxes, thereby reducing the eyestrain.

I would suggest getting the thyroid test done, and sinusitis ruled out as it seems those are the only things you have not covered and least sinister. I know these issues began after the ear episode, but there is no connection between that area and the eye for it to be related. I also suggest adding omega-3 to your diet. It helps stabilize the tear film and take supplements or add flaxseed or fish to your diet. It also helps reduce meibomitis, aggravating photosensitivity due to premature tear break up.

Kindly revert in case of further queries.

Thank you.


The Probable causes:

Dry eyes.

Probable diagnosis:

Dry eyes.


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