Epilepsy and Your Eye Health
How Seizures Affect Your Vision
Many people with epilepsy see visual warnings before a seizure starts. These warnings are called auras. You might see flashing lights, zigzag lines, bright spots, or dark areas in your vision. Some people see colorful shapes or feel like they are looking through a tunnel. These auras usually last from a few seconds to a couple of minutes. Writing down what you see during auras helps your doctors understand your seizure pattern. This information lets you take safety steps when an aura begins.
Your eyes may move in specific patterns during different types of seizures. These movements help doctors figure out what kind of seizure you are having. During focal seizures, your eyes may turn to one side. During absence seizures, your eyes might blink rapidly or stare without blinking. Tonic-clonic seizures often cause your eyes to roll upward.
After a seizure ends, you might notice blurry vision or see double. This happens because seizures affect the parts of your brain that control your eyes and process what you see. These vision changes usually clear up within a few hours as your brain recovers. If blurry or double vision lasts more than a day after your seizure, schedule an eye exam. Long-lasting vision changes might mean your treatment needs adjustment.
Several seizure medicines can cause vision side effects. Some medications may blur your vision, cause double vision, or make your eyes move on their own. Other medicines can make it harder to focus or make your eyes more sensitive to light. Most vision side effects are temporary and improve as your body adjusts to the medicine.
Common vision side effects from seizure medicines include:
- Carbamazepine and phenytoin may cause blurred or double vision at higher doses
- Topiramate can rarely cause sudden eye pressure increases or vision changes
- Vigabatrin may lead to vision loss that requires regular monitoring
- Lamotrigine and oxcarbazepine sometimes cause blurred vision or double vision
- Levetiracetam typically causes fewer vision problems than older medicines
Most people with epilepsy keep good vision throughout their lives. Regular eye exams help catch any problems early when they are easier to treat. At our Greater Philadelphia Metropolitan Area practice, we check for medicine-related changes, look for injuries from falls during seizures, and watch for other eye conditions. Our multispecialty team uses advanced diagnostic technology to protect your vision while you manage epilepsy.
Photosensitive Epilepsy
About three to five out of every 100 people with epilepsy have photosensitive epilepsy. This type means that flashing lights or certain patterns can trigger seizures. Photosensitive epilepsy usually starts during childhood or teenage years. Lights that flash between 10 and 25 times per second are most likely to cause seizures, but some people react to slower or faster flashing.
Many things beyond simple flashing lights can trigger seizures in people with photosensitive epilepsy. Striped patterns, bold contrasts, and repeating designs may also cause problems.
Watch out for these common triggers:
- Strobe lights at concerts or from emergency vehicles
- Sunlight flickering through trees or reflecting off water
- Bold striped patterns or high-contrast images
- Fast-changing scenes in video games or movies
- Some LED displays or flickering fluorescent lights
Television, computer, phone, and tablet screens can trigger seizures in people with photosensitive epilepsy. Sit at least two feet away from screens and use larger monitors with high refresh rates. Turn down brightness, add blue light filters, and take breaks every 30 minutes. Never use screens in dark rooms because the contrast between the bright screen and dark space increases your risk.
Special glasses and screen filters can help protect you from visual triggers. Polarized sunglasses with blue light blocking features reduce the effect of flickering sunlight and certain artificial lights. Some people wear these protective glasses both outdoors and when using screens.
Helpful protective tools include:
- Blue-blocking lenses that filter specific light wavelengths
- Polarized sunglasses to cut glare and flickering reflections
- Anti-glare screen protectors for computers and phones
- Covering one eye when you face potential triggers
Many video games and movies now include warnings about flashing lights. Read these warnings carefully and avoid content with heavy strobing or fast scene changes. When you watch movies or play games, take frequent breaks and stay in a well-lit room. Use the smallest comfortable screen size and turn on seizure reduction settings when available. Having someone preview content before you watch it adds extra safety.
Warning Signs That Need Quick Attention
When you notice your visual aura starting, move to a safe place right away. Sit or lie down away from stairs, sharp objects, and hard surfaces. Tell someone nearby that you might have a seizure so they can help keep you safe. If your aura symptoms change or feel different from usual, contact your neurologist the same day. New or different auras might mean your seizure type is changing or your medicine needs adjustment.
Short-term blind spots during seizures that affect the visual parts of your brain are fairly common. These usually go away when the seizure ends. However, complete vision loss in one or both eyes or blind spots that last more than a few hours after your seizure need immediate medical care.
Get emergency care if you experience:
- Complete vision loss in one eye, which may mean a blocked blood vessel
- Blind spots that last after you recover from your seizure
- A curtain-like shadow across your vision
- Vision loss with severe headache
Some epilepsy medicines, especially topiramate, can cause sudden increases in eye pressure. This creates severe eye pain, redness, and blurred vision. This condition is called acute angle-closure glaucoma and is a medical emergency. Without treatment within hours, it can cause permanent vision loss. The pain is often intense and may come with nausea, vomiting, and seeing halos around lights. If you develop severe eye pain, especially after starting or increasing an epilepsy medicine, go to the emergency room immediately.
Most vision changes from epilepsy are temporary and harmless. However, certain symptoms need emergency evaluation to protect your vision.
Go to the emergency room for:
- Sudden severe eye pain with or without redness
- Complete vision loss in one or both eyes
- Double vision that lasts more than 24 hours
- Eye symptoms with severe headache or confusion
- Vision loss with flashing lights and new floaters
Eye Exams for People With Epilepsy
Having epilepsy makes routine eye exams more important. Your seizure medicines may affect your vision or eye health. Seizures can sometimes injure your eyes. Early detection of medicine-related problems lets your doctors make timely changes. Most people with epilepsy need comprehensive eye exams every year. If you take medicines that affect vision, you may need exams more often.
Your comprehensive eye exam includes standard tests plus extra checks based on your medicines and seizure history. Our ophthalmologists review your current medicines, recent seizures, and any vision concerns. We test your vision clarity, check how your eyes work together, and look at your eye movements.
Your exam includes:
- Visual acuity testing to measure how clearly you see
- Eye movement checks to look for medicine-related problems
- Eye pressure measurement to screen for glaucoma
- Dilated exam of your retina and optic nerve
- Visual field testing if you take certain medicines
Some epilepsy medicines need specific vision tests to watch for known side effects. If you take vigabatrin, we do detailed visual field testing every three to six months to check for peripheral vision loss. For patients on topiramate, we measure eye pressure and check the drainage angles of your eyes, especially when starting the medicine or raising the dose. These tests help catch medicine-related problems early when treatment changes can prevent permanent damage.
Communication between our ophthalmologists and your neurologist helps both doctors make better decisions about your treatment. We share information about vision changes that might relate to your seizures or medicines. Your neurologist tells us about your treatment plan. You can help by bringing contact information for all your doctors to each visit. Sign forms that let us share your records and keep a current list of your medicines with doses.
Treating Vision Problems From Epilepsy
If you notice new vision problems after starting or changing a seizure medicine, contact our ophthalmologists and your neurologist right away. Never stop your seizure medicine without medical guidance because sudden stopping can cause severe seizures. We will examine your eyes to find out what is causing your vision changes. Many vision side effects improve as your body gets used to the medicine or when your doctor lowers the dose.
Wearing glasses or contacts with epilepsy is generally safe with a few extra precautions. If you have frequent seizures, we often recommend glasses over contacts to lower the risk of eye injury during a seizure. Glasses with shatter-resistant lenses protect your eyes if you fall.
Safe eyewear options include:
- Polycarbonate or Trivex lenses that resist breaking
- Sports straps to keep glasses on during seizures
- Daily disposable contacts instead of extended wear types
- Avoiding contacts if your seizures happen often
Treatment for vision problems from epilepsy medicines depends on what symptoms you have. For blurred vision or trouble focusing, new glasses often help while you stay on your medicine. If medicine causes dry eyes, we may recommend artificial tears or other treatments. Some medicine-related eye problems need more intensive care. Acute angle-closure glaucoma from topiramate requires immediate treatment to lower eye pressure and stopping the medicine. Vision loss from vigabatrin may improve if caught early and the medicine is stopped, though some changes can be permanent.
When vision problems come from your seizure medicines, your neurologist has several options. Switching to a different medicine may stop vision side effects. Lowering the dose of the problem medicine or adding a second medicine at lower doses can sometimes reduce side effects while keeping seizures controlled. These changes require careful watching to make sure your seizures do not get worse. At ReFocus Eye Health Marlton, we work closely with your neurologist during changes and may schedule more frequent eye exams to track your progress.
Long-term vision monitoring is important when you have epilepsy. We schedule follow-up appointments based on your specific medicines, seizure control, and any vision problems. Most patients do well with yearly comprehensive exams. People taking medicines like vigabatrin need testing every few months. Between visits, pay attention to vision changes and report new symptoms quickly. Keeping a log of when vision changes happen helps us figure out the cause.
Frequently Asked Questions
Most vision changes during or right after seizures are temporary and go away completely. In rare cases, seizures can lead to lasting vision problems if they cause trauma to the eye or head during a fall, or if long seizure activity damages the visual parts of the brain. Good seizure management and safety steps greatly lower these risks.
How often you need eye exams depends on which medicines you take and your overall eye health. Some patients with well-controlled epilepsy on stable medicines can follow the standard schedule of exams every one to two years. Others need more frequent checks. People taking vigabatrin typically need visual field testing every three to six months. Any new vision symptoms need prompt evaluation no matter when your last exam happened.
Photosensitivity often changes as you age. Many people have less sensitivity after their teenage years and into adulthood. Some patients outgrow photosensitive epilepsy completely, while others have light-triggered seizures throughout life. Working with your neurologist to find effective medicines and always avoiding known triggers gives you the best seizure control.
LASIK and other eye surgeries do not directly trigger seizures in most patients with epilepsy. The bright lights used during these procedures could possibly trigger seizures in someone with severe photosensitive epilepsy. When eye surgery is needed, your surgical team can take steps to avoid flashing lights and make sure your epilepsy medicines are at stable levels.
Different epilepsy medicines carry different risks for eye-related side effects. Newer medicines tend to have better vision safety profiles. Levetiracetam and lamotrigine generally cause fewer vision problems than older medicines, though responses vary by person. Your neurologist chooses medicines based on your seizure type, overall health, and possible side effects.
If you have a visual aura while driving, pull over right away to a safe spot, turn off the engine, and wait until the aura passes and you feel completely normal. Many states have laws about driving with epilepsy. Talk to your neurologist thoroughly about driving safety. Never drive if you have auras or seizures that could make it unsafe to control your vehicle.
Eye Care for Epilepsy Patients in Marlton
Managing the connection between epilepsy and eye health takes teamwork between you, our ophthalmologists, and your neurologist. At ReFocus Eye Health Marlton, our multispecialty team uses advanced diagnostic technology to monitor your vision and catch problems early. We encourage you to stay current with eye exams, report new vision symptoms quickly, and keep open communication with your healthcare team. Together, we protect your vision while keeping your seizures well controlled.
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