Vision Disturbances and Migraines

[lilyofthewest]

At nearly 2 years out, my vision disturbances had decreased in severity and frequency. Then a month or so ago they ramped way up again. After reading someone here say their eye dr. said they may be related to small blood clots on the retina, I thought about that and realized that I'd been neglecting to take daily low dose aspirin. So I got back on it hoping that might help, and low and behold the vision disturbances are again on the wane. My cardiologist's still in denial despite the issue only arising post surgery.

In regard to the metropolol side effects, I took myself off it because after about 10 months, it was causing my hair to fall out in clumps. By the time I figured out the problem I'd lost about half my hair. Thankfully shortly after I quit the metropolol my hair started to come back in and is now near normal.

 

[DachsieMom]

In my case, metoprolol made my hands leathery and peeling horribly. I was only on 25 mg but once I stopped taking it, I was fine.
I have the visual aura and migraine.

 

[Suckyvalvegurl]

Since I have had my surgery I see floaters several times a day. Anyone else?

 

[Jenrc]

Hi all,

Been a long time since chiming in here, I had OHS in 2012 after a bout of endocarditis. I have a mechanical Aortic valve On-X and a collar on my mitral valve. I wholeheartedly believe there is a tie-in with cardiac issues and eyesight.

When I had the endocarditis, I had very frequent floaters for months. I was also pregnant at the time so there is always that factor. As I became more ill with endocarditis (before diagnosis), I had very severe eye issues. I would get these blackout spots--like when you look at the sun or a bright light too long and it causes temporary vision loss in the spots. I got them all the time, few times a day for weeks.

Magically, after the endocarditis treatment (7 weeks in and out of hospital on IV antibiotics) those spots dissipated and the floaters did not return. I then had a c-section with my son and a week later I had my OHS. In the hospital after that, I experienced this weird thing with my vision at night. Everything became hazy--like when I switched on the light, it was a fog.

That continued for a few weeks, but really only at night after I had been sleeping awhile and got up. In one of my follow-up visits I mentioned this (as I had while in the hospital for a week after surgery), so my Dr. set me up with an Ophthalmologist to check things out. They took pictures of my retina and sure enough there were tiny tears in them (I think this is the scenario, it's been 7 years). The Doctor mentioned that he saw this frequently in OHS patients (I did give him my full story, pregnancy included) and that he was going to monitor me to make sure they healed up. They did and I am fine now.

Occasionally I get floaters but yes those usually lead to a very minor headache and sometimes not at all. Never have gotten migraines. I see an Optometrist every year and we always discuss vision disturbances but I haven't had any so severe as when I was sick and following my OHS.

Anecdotal, but once Drs see enough of this, it might sink in a little as a possibility.

 

[Classtime Sailer]

Yes about the floaters. They happen less frequently now or maybe I don’t notice them as much.

 

[Dan Zulu]

I never had migraines or visual disturbances before my surgery. For years now, ever since the OHS, I have optical migraines, shimmering lights that make me stop working. Neurological ophthalmologist thinks the 183 minutes on bypass caused it.

 

[Suckyvalvegurl]

Hi Dan - I started having those when I turned 40. Long before my surgery. I read that it is common after age 40. Of course I am sure that long bypass time could be a cause also. I certainly have had "floaters" ever since my surgery.

 

[doclewis]

have posted my experience with optical migraines previously. I was interested in post quoting neuro-ophthalmologist said about time on bypass. I asked my surgeon post op and he said it didn't make any difference and didn't tell me time on bypass. Two theories that I have heard are increased blood flow to brain and somehow related to bypass.

 

[Dan Zulu]

I was in my early 30’s when I had my David procedure.

 

[vitdoc]

I am a retinal surgeon with a long history of three open hearts for aortic stenosis and ultimately aortic aneurysm repair. I am very familiar with migraine and floaters. First migraine. Let’s start with the facts. Migraine phenomena whether you are speaking of just the visual aura or the aura pius headache is very common possible noted in a third of the population at some time in a person’s lifetime. The complete understanding of the cause of migraine is still not understood. Many different things have been associated with causing migraine. Foods,exercise,stress,reduction of stress (post test migraine)and many other things. So it is not surprising that surgery might also have an association . Microemboli might also have a part to play. Certain drugs might also be associated. Warfarin probably is not likely however. Loss of vision in one eye may be transient or permanent and usually would be associated with a blockage of a retinal blood vessel and is NOT migraine.

Migraine visual disturbances are BILATERAL they are neurological and cause temporarily visual issues in both visual fields from both eyes.

Floaters generally are small opacities in the Vitreous jelly that fills our eyes. As we age the jelly gets more liquified and my suddenly loosen up in the eye. When this occurs there is often a sudden increase in floaters and the eye should be checked to make sure there is no retinal tear that sometime occurs when the jelly loosens. If there is an unusual inflammatory process within the eye that can markedly increase floaters this is fairly rare. Valve surgery would not likely increase floaters.

 

[Southrnshooter]

I am a retinal surgeon with a long history of three open hearts for aortic stenosis and ultimately aortic aneurysm repair. I am very familiar with migraine and floaters. First migraine. Let’s start with the facts. Migraine phenomena whether you are speaking of just the visual aura or the aura pius headache is very common possible noted in a third of the population at some time in a person’s lifetime. The complete understanding of the cause of migraine is still not understood. Many different things have been associated with causing migraine. Foods,exercise,stress,reduction of stress (post test migraine)and many other things. So it is not surprising that surgery might also have an association . Microemboli might also have a part to play. Certain drugs might also be associated. Warfarin probably is not likely however. Loss of vision in one eye may be transient or permanent and usually would be associated with a blockage of a retinal blood vessel and is NOT migraine.

Migraine visual disturbances are BILATERAL they are neurological and cause temporarily visual issues in both visual fields from both eyes.

Floaters generally are small opacities in the Vitreous jelly that fills our eyes. As we age the jelly gets more liquified and my suddenly loosen up in the eye. When this occurs there is often a sudden increase in floaters and the eye should be checked to make sure there is no retinal tear that sometime occurs when the jelly loosens. If there is an unusual inflammatory process within the eye that can markedly increase floaters this is fairly rare. Valve surgery would not likely increase floaters.

Ok what causes the double vision? I had AVR and Dacron graft in Oct 2014. I had previously experienced migraines since I was 7 years old but never had double vision. After my surgery I experienced 2 separate occurrences of amnesia (scary) plus debilitating double vision that lasts up to 15 min. My frequency of migraines tripled. I talked to my surgeon, cardiologist and GP and they all claim to have never heard of this before. Thankfully I haven’t had any issues with amnesia since Dec 2014 but everything else continues. I take a Magnesium supplement, Metoprolol, and topamax for the migraines. I can deal with the migraines, I just need the double vision to stop, if figure out what is causing it.

 

[Paleowoman]

I get episodes of double vision too since AVR. I didn't get them or the "migraine auras without headache" which I also get, until the day after surgery. It was over five years ago that I had AVR and they have continued. On the cardiac ward one of the doctors told me that these are quite common following OHS, though he never gave an explanation of why. I don't mind the migraine auras and I don't mind the sparkles/flashes of light which also dance across my vison (which are not floaters at all), but I too don't like the double vision as it is very disorientating.

 

[Paul1972]

I get episodes of double vision too since AVR. I didn't get them or the "migraine auras without headache" which I also get, until the day after surgery. It was over five years ago that I had AVR and they have continued. On the cardiac ward one of the doctors told me that these are quite common following OHS, though he never gave an explanation of why. I don't mind the migraine auras and I don't mind the sparkles/flashes of light which also dance across my vison (which are not floaters at all), but I too don't like the double vision as it is very disorientating.

Same here I don’t mind the auras with migraine and flashes of lights across my vision, it’s the sudden spells of double vision I have had which I don’t like as its very disorientating and quite unnerving.

 

[DRG.]

I have not had Migraines but I do get episodes of double vision from time to time that I did not experience before I had OHS. They are more than a bit disturbing when they happen while driving but I have found simply closing one eye allows me to function and they don't normally last more than a minute or two

 

[vitdoc]

True double vision occurs when the two eyes are not aligned. There are many reasons that can happen. Some people gradually have a breakdown in the mechanism that locks the eyes together. For example when people are tired sometimes an eye will drift and double vision occurs and often this is enough to get the eyes to realign .Sometimes a nerve to one of the six eye muscles gets damaged and double vision ensues. Sometimes there is a neurological issue affected the areas of the brain that control eye movement that can lead to diplopia (double vision). So a careful evaluation is needed to isolate what is going on. Generally if the process is transient it tends to be the intermittent brake down type. Unless emboli were forming from the valve and they went to the exact same location I would think that valve surgery would be unlikely in causing recurrent double vision. Perhaps some subtle neurological event happened with surgery that brought on the weakening of the locking mechanism. Or just a change in lifestyle such as more reading.
If the problem is frequent and disabling it should be evaluated.

 

[ottagal]

True double vision occurs when the two eyes are not aligned. There are many reasons that can happen. Some people gradually have a breakdown in the mechanism that locks the eyes together. For example when people are tired sometimes an eye will drift and double vision occurs and often this is enough to get the eyes to realign .Sometimes a nerve to one of the six eye muscles gets damaged and double vision ensues. Sometimes there is a neurological issue affected the areas of the brain that control eye movement that can lead to diplopia (double vision). So a careful evaluation is needed to isolate what is going on. Generally if the process is transient it tends to be the intermittent brake down type. Unless emboli were forming from the valve and they went to the exact same location I would think that valve surgery would be unlikely in causing recurrent double vision. Perhaps some subtle neurological event happened with surgery that brought on the weakening of the locking mechanism. Or just a change in lifestyle such as more reading.
If the problem is frequent and disabling it should be evaluated.

Thank you for the excellent explanations and medical expertise, Vitdoc. I, too have experienced both double vision and migraine auras over the years which subsequently led to a visit to the ophthalmologist and neurologist.
We are fortunate to have you on this forum with your valuable input as both an MD and seasoned heart patient. You certainly can speak from both perspectives. One of my concerns was that with BAV, a subset of us have a higher incidence of aortic aneurysms. My understanding is that this may also mean a slightly higher incidence of intracranial as well. Sorry everyone, I not trying to give you anything else to worry about, just wondering if this is something we need to keep in mind? Here is one article that I found related to this. https://heart.bmj.com/content/103/19/1477

 

[Paleowoman]

Hi @vitdoc - You've written that migraine visual disturbances and double vision can be neurological. In my efforts to find out why I have been getting these from immediately post AVR - many discussion threads about these problems in the past on the 'old' forum - I came across this article in Science Daily News about the neurological effects of heart surgery in which they say that visual problems are one of the possible effects: https://www.sciencedaily.com/releases/2009/08/090813142455.htm However, it would seem that the medics we deal with are not aware of this. In your opinion, would you agree with the conclusions of that article that in view of the fact that many of us developed these visual issues immediately post OHS that they are in fact a direct neurological effect of the surgery ?

Migraine visual disturbances are BILATERAL they are neurological and cause temporarily visual issues in both visual fields from both eyes.

Sometimes there is a neurological issue affected the areas of the brain that control eye movement that can lead to diplopia (double vision).

 

[vitdoc]

Given that people are put on bypass machines, have surgical manipulation, have air in their systems (hopefully purged) have the potential for clot formation and emboli and in the case of aortic aneurysm surgery have their brains cooled to 60 degrees Fahrenheit it would actually be a surprise if their were not some sort of neurological complications and actually to me surprising that there seem to be relatively rare. So I would not be shocked that migraine might change in it's frequency especially since we really don't understand why there are so many triggers to it. However to have a clear explanation of the detailed cause of the change in migraine after surgery probably still is for the most part unknown. I could not get access to the article referenced since one needs to have a subscription to the website to access it. But it more likely catalogs various findings after heart surgery rather than explains all the causes for them. Certainly things like strokes can be understood more readily but a cause for a change in migraine frequency still is not known .

 

[doclewis]

I have found some info but not alot on migraines and vision loss post-op.

Seems to not be very uncommon for frequencies to increase after surgery. Before surgery I used to get a vision disturbances followed by a migraine headache about 30 min later that would last about 2 hours around every other month. Fast forward to the present, and post-op I expect to have 1-2 a week. Post-op vision in my left eye just seems to be blurry most of the time unless i concentrate on it... no idea what that might mean but i do wear contacts. February 15, 2018 at 23 years old I had open heart surgery, replaced my bicuspid aortic valve with a St. Jude Mechanical valve and had the aortic root and ascending aorta replaced with a Dacron graft. I take 81mg aspirin (once a day), metropolol (twice a day) and coumadin (once a day but dose changes depending on the day).

Since im on coumadin I am limited on migraine meds I can take when I first get the vision disturbances. Most migraine meds (at least that I have read) are made up of aspirin, acetaminophen and caffeine. Since I am not supposed to take more aspirin than I already do, I usually just take Tylenol immediately if I get vision disturbances and try to follow the Tylenol with something with caffeine (coffee, redbull, etc.) depends on what is faster to go buy. Typically if I get caffeine and tylenol in my system fast enough before the vision disturbances go away then I will have a minor headache.

Although I have found a way that I can exist with these migraines, I am still looking to see if anyone has any insight or recommendations. General doc recommended some sort of anti-depressant that "might have the possibility of preventing migraines" or increasing my dose of metropolol which would drop my heart rate below 60. The doc did state that its probably not the smartest idea on the low heart rate thing, and I agree. Anti-depressants just seem like a cop-out to me from doctors when they dont want to dig deeper, and I wont take them. A friend mentioned CBD oil but idk on that or how it reacts with coumadin.

Any recommendations or insights on what other people have discovered?

Anyone else have similar experiences with vision loss and migraines after surgery?

I am always interested in posts on this subject. Have posted on other threads related to this. AVR with bovine valve 4 years ago. Life long history of ocular migraines every two to four months. Post op almost every day. This has been the only problem related to my surgery and recovery. Everything else went very uneventfully. Cardiologist, PCP, Surgeon and neurologist all said they had never heard of this. The neurologist did say that she had seen this in patients who had surgery for severe carotid stenosis, but not with AVR. She suspected related to sudden increased blood flow. I was started on low dose asa about a year after surgery. Actually was supposed to begin immediately after surgery but didn't. Neurologist said she puts all migraine patients on asa. The frequency of migraines did improve somewhat after starting on asa. However they have continued to be a problem. Now occur every 8 to ten days on average. Most occur while I am exercising or immediately after. Do get them other times but well over half occur related to exercise. I have kept a log for 18 months. I have cut way back on my exercise. Still note that most occur when I am outside and doing something at least semi-strenuous. I cant stay inside the rest of my life.

 

[Hollyn]

I am always interested in posts on this subject. Have posted on other threads related to this. AVR with bovine valve 4 years ago. Life long history of ocular migraines every two to four months. Post op almost every day. This has been the only problem related to my surgery and recovery. Everything else went very uneventfully. Cardiologist, PCP, Surgeon and neurologist all said they had never heard of this. The neurologist did say that she had seen this in patients who had surgery for severe carotid stenosis, but not with AVR. She suspected related to sudden increased blood flow. I was started on low dose asa about a year after surgery. Actually was supposed to begin immediately after surgery but didn't. Neurologist said she puts all migraine patients on asa. The frequency of migraines did improve somewhat after starting on asa. However they have continued to be a problem. Now occur every 8 to ten days on average. Most occur while I am exercising or immediately after. Do get them other times but well over half occur related to exercise. I have kept a log for 18 months. I have cut way back on my exercise. Still note that most occur when I am outside and doing something at least semi-strenuous. I cant stay inside the rest of my life.