Sparks or flashes

Introduction Sparking in front of the eyes or flashing in front of the eyes is a clinical diagnosis of iliac arteritis. Temporal arteritis, also known as cranial arteritis, is named after the anatomy. It is a kind of inflammation of the large and middle arteries, which can involve arteries in multiple sites, but all have radial artery damage. Clinically it is characterized by headache, fever, eye pain, generalized pain and progressive visual impairment or even blindness. The disease is closely related to rheumatic polymyalgia.

Cause

The cause of sparks or flashes in front of your eyes:

(1) Causes of the disease:

The cause is still unclear. It is currently believed that bacterial and viral infections have a certain relationship with the disease, but no exact evidence has been found. Smoking and sun exposure can cause or aggravate the disease.

(2) Pathogenesis:

The autoimmune response is involved in the onset. The immunofluorescence technique was used to observe the deposition of immunoglobulin in the vascular wall. The immunoglobulin is an anti-vascular wall component such as elastin antibody, and also has the presence of immune complexes and complement, indicating that the disease is autoantibody or autoantigen. The antibody complex activates the classical pathway of complement and causes a series of inflammatory responses. There is also a large body of evidence that T cell-mediated cytotoxicity plays an important role in the pathogenesis of this disease. It has been reported that lymphocytes can convert to skeletal muscle and arterial antigens, accompanied by lymphoapoptin release, indicating that cellular immune-mediated inflammatory responses also play an important role in the pathogenesis of this disease. In addition, it was found that the familial incidence of this disease is obvious, and the enhanced expression of HLA-DR4 and HLA-138 may be the susceptibility gene of this disease. Other vasculitis such as polyarteritis, classic nodular polyarteritis, and thromboangiitis obliterans have been found to coexist with this disease, which fully demonstrates that the immune mechanism is directly related to the pathogenesis of this disease. According to reports, the disease can still be combined with hypertension, arteriosclerosis, diabetes and liver disease, which means that humoral factors, metabolic abnormalities may be involved in the disease.

an examination

Related inspection

Fundus examination

Check for diagnosis of sparks or flashes in front of your eyes:

Temporal arteritis is a common disease with a prevalence of about 24/100,000. The disease is a senile disease. The age of onset is most common in the age of 50 years. The ratio of male to female is 1:3. The onset is significantly related to the upper respiratory tract infection that occurs during seasonal changes.

In addition to the radial artery involvement, the disease often has systemic or systemic, multiple middle and large arteritis, such as carotid artery, aorta, subclavian artery, coronary artery, mesenteric artery, radial artery, femoral artery, artery and Various branches of the carotid artery, such as the facial artery, the occipital artery, and the ophthalmic artery, can be involved.

Early symptoms are mild, recessive onset, systemic symptoms include fever, discomfort, fatigue, weight loss, hyperhidrosis, anemia, headache and joint pain, accompanied by rheumatoid polymyalgia (polymyalgia rheumatica), manifested as double Lateral symmetry muscle stiffness, pain, pain in the neck, shoulders, lower back, hips, thighs, etc., obvious when active. Some patients have rheumatic polymyalgia as the first symptom. Myalgia can cause muscle weakness, but it is not the main manifestation. Weight loss can be similar to malignant wasting disease, polymyositis or hyperthyroidism. Musculoskeletal symptoms can be located in the tendon or tendon attachment of the shoulder joint, similar to shoulder joint tendonitis or bursitis, or similar to cervical arthritis.

The most commonly affected joints are the sternocleidal joint, the shoulder joint, the knee joint, the spine and the pelvic joint. Occasionally, the pain of the surrounding joint can be severe to the level of rheumatoid arthritis. Painful arteritis can occur weeks or months after systemic symptoms occur. Clinically, arteritis and rheumatic polymyalgia are often seen as different manifestations of a disease process. In addition, there are many patients with typical multiple rheumatic myalgia without sputum arteritis symptoms, but only when the radial artery biopsy is found. When iliac arteritis and rheumatic polymyalgia are accompanied, the first symptom of myalgia is followed by a history of iliac arteritis within a few months. The disease often overlaps with organ-specific autoimmune diseases such as thyroiditis and hyperthyroidism.

When carotid arteritis occurs, the affected blood vessels are segmental local swelling, which lasts for several days and has local pain. This period of angiography showed segmental stenosis of different lengths, and the stenosis appeared in the normal part. Vascular murmurs can be heard during auscultation at larger vascular involvement sites. The most common symptoms of iliac arteritis are unbearable pain, sometimes painful to comb and rest in bed. Headaches can be bilateral or unilateral, with scalp pain, paresthesia, numbness or burning. The burning sensation is aggravated when the wind blows. Most of the headaches caused by occipital arteritis are located in the back of the head. Upper iliac arteritis can cause toothache and oral pain during chewing. Tongual arteritis can cause numbness of the tongue, abnormal taste, and recurrent paleness.

Eye pain can be the first symptom of the disease, which means that the posterior tibial artery has been affected. May occur on one or both sides. Sudden blindness caused by ischemic optic neuritis, the most serious complication of this disease, sparks in front of the eyes or flashing in front of the eyes, is a prodromal symptom of blindness. In addition, blurred vision and quadrant vision defects may occur. Sometimes visual symptoms can change with changes in body position, which may be due to changes in the blood flowing through the diseased blood vessels when the carotid arteries change in position. Ischemic retrobulbar optic neuritis or central retinal artery occlusion can also cause vision loss. The fundus showed pale, edema, streaky hemorrhage at the edge of the nipple, and the arteries became thinner. After a few days, the retina could have hemorrhagic and flocculent exudative spots, which were absorbed after exudation. Nerve atrophy can occur after 4 months, and this change is the most common terminal consequence of the disease.

Various visual field defects can occur. A small branch of the ciliary artery can cause partial defects in the visual field. The anterior pituitary arteritis and the involvement of small arteries at the intersection of the blood supply and the blood often cause bilateral complication. Vertebral artery embolization can cause bilateral occipital blindness (cortical blindness).

Eye movement disorders are also common symptoms of the eye, with drooping eyelids being common, followed by diplopia. It occurs mostly in the early stages of eye involvement and is a prodromal symptom of blindness that lasts for several weeks. This is due to the third, fourth, and sixth insufficiency of cranial nerve insufficiency.

Sometimes it can be manifested as deafness or ear pain, which is caused by damage to the blood vessels of the blood supply to the cochlea.

For patients over 50 years of age, when there is fever, anemia, increased erythrocyte sedimentation rate, headache, eye pain or sudden change in vision, with or without myalgia, the disease should be highly suspected. Along the radial artery, there is obvious local tenderness and hardening and thickening of the blood vessels, which can be basically diagnosed as the disease. Patients with atypical clinical manifestations may present with ocular symptoms in the front and symptoms of iliac arteritis in the posterior, and should be vigilant at this time. Long-term unexplained fever in elderly patients, accompanied by increased erythrocyte sedimentation rate, should be considered as the disease, because early fever is particularly common in this disease. Older people with any type of headache or facial pain accompanied by increased ESR should be considered as arteritis. Radial artery biopsy confirmed a typical histopathological change, which can be diagnosed as the disease. In a few cases, the brachial artery is not involved, and the carotid artery and aortic branch are involved. At this time, combined with clinical, ophthalmic examination and X-ray angiography, the disease can be diagnosed.

Differential diagnosis

Identification of symptoms that are confusing in front of the eyes or flashing in front of the eyes:

1. Abnormal flash in front of eyes, increased black spots: Pathological floaters are generally caused by serious diseases, which are caused by changes in the structure of the omentum, optic nerve, ciliary body and other structures near the vitreous.

2, sensation of sensation: the main symptoms of solar retinal choroidal burns are initially radiant.

Temporal arteritis is a common disease with a prevalence of about 24/100,000. The disease is a senile disease. The age of onset is most common in the age of 50 years. The ratio of male to female is 1:3. The onset is significantly related to the upper respiratory tract infection that occurs during seasonal changes.

In addition to the radial artery involvement, the disease often has systemic or systemic, multiple middle and large arteritis, such as carotid artery, aorta, subclavian artery, coronary artery, mesenteric artery, radial artery, femoral artery, artery and Various branches of the carotid artery, such as the facial artery, the occipital artery, and the ophthalmic artery, can be involved.

Early symptoms are mild, recessive onset, systemic symptoms include fever, discomfort, fatigue, weight loss, hyperhidrosis, anemia, headache and joint pain, accompanied by rheumatoid polymyalgia (polymyalgia rheumatica), manifested as double Lateral symmetry muscle stiffness, pain, pain in the neck, shoulders, lower back, hips, thighs, etc., obvious when active. Some patients have rheumatic polymyalgia as the first symptom. Myalgia can cause muscle weakness, but it is not the main manifestation. Weight loss can be similar to malignant wasting disease, polymyositis or hyperthyroidism. Musculoskeletal symptoms can be located in the tendon or tendon attachment of the shoulder joint, similar to shoulder joint tendonitis or bursitis, or similar to cervical arthritis.

The most commonly affected joints are the sternocleidal joint, the shoulder joint, the knee joint, the spine and the pelvic joint. Occasionally, the pain of the surrounding joint can be severe to the level of rheumatoid arthritis. Painful arteritis can occur weeks or months after systemic symptoms occur. Clinically, arteritis and rheumatic polymyalgia are often seen as different manifestations of a disease process. In addition, there are many patients with typical multiple rheumatic myalgia without sputum arteritis symptoms, but only when the radial artery biopsy is found. When iliac arteritis and rheumatic polymyalgia are accompanied, the first symptom of myalgia is followed by a history of iliac arteritis within a few months. The disease often overlaps with organ-specific autoimmune diseases such as thyroiditis and hyperthyroidism.

When carotid arteritis occurs, the affected blood vessels are segmental local swelling, which lasts for several days and has local pain. This period of angiography showed segmental stenosis of different lengths, and the stenosis appeared in the normal part. Vascular murmurs can be heard during auscultation at larger vascular involvement sites. The most common symptoms of iliac arteritis are unbearable pain, sometimes painful to comb and rest in bed. Headaches can be bilateral or unilateral, with scalp pain, paresthesia, numbness or burning. The burning sensation is aggravated when the wind blows. Most of the headaches caused by occipital arteritis are located in the back of the head. Upper iliac arteritis can cause toothache and oral pain during chewing. Tongual arteritis can cause numbness of the tongue, abnormal taste, and recurrent paleness.

Eye pain can be the first symptom of the disease, which means that the posterior tibial artery has been affected. May occur on one or both sides. Sudden blindness caused by ischemic optic neuritis, the most serious complication of this disease, sparks in front of the eyes or flashing in front of the eyes, is a prodromal symptom of blindness. In addition, blurred vision and quadrant vision defects may occur. Sometimes visual symptoms can change with changes in body position, which may be due to changes in the blood flowing through the diseased blood vessels when the carotid arteries change in position. Ischemic retrobulbar optic neuritis or central retinal artery occlusion can also cause vision loss. The fundus showed pale, edema, streaky hemorrhage at the edge of the nipple, and the arteries became thinner. After a few days, the retina could have hemorrhagic and flocculent exudative spots, which were absorbed after exudation. Nerve atrophy can occur after 4 months, and this change is the most common terminal consequence of the disease.

Various visual field defects can occur. A small branch of the ciliary artery can cause partial defects in the visual field. The anterior pituitary arteritis and the involvement of small arteries at the intersection of the blood supply and the blood often cause bilateral complication. Vertebral artery embolization can cause bilateral occipital blindness (cortical blindness).

Eye movement disorders are also common symptoms of the eye, with drooping eyelids being common, followed by diplopia. It occurs mostly in the early stages of eye involvement and is a prodromal symptom of blindness that lasts for several weeks. This is due to the third, fourth, and sixth insufficiency of cranial nerve insufficiency.

Sometimes it can be manifested as deafness or ear pain, which is caused by damage to the blood vessels of the blood supply to the cochlea.

For patients over 50 years of age, when there is fever, anemia, increased erythrocyte sedimentation rate, headache, eye pain or sudden change in vision, with or without myalgia, the disease should be highly suspected. Along the radial artery, there is obvious local tenderness and hardening and thickening of the blood vessels, which can be basically diagnosed as the disease. Patients with atypical clinical manifestations may present with ocular symptoms in the front and symptoms of iliac arteritis in the posterior, and should be vigilant at this time. Long-term unexplained fever in elderly patients, accompanied by increased erythrocyte sedimentation rate, should be considered as the disease, because early fever is particularly common in this disease. Older people with any type of headache or facial pain accompanied by increased ESR should be considered as arteritis. Radial artery biopsy confirmed a typical histopathological change, which can be diagnosed as the disease. In a few cases, the brachial artery is not involved, and the carotid artery and aortic branch are involved. At this time, combined with clinical, ophthalmic examination and X-ray angiography, the disease can be diagnosed.

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