Acute-Onset Visual Snow Syndrome After LASIK

Abstract

PURPOSE: To describe a case of acute-onset visual snow syndrome occurring after bilateral myopic laser in situ keratomileusis (LASIK). METHODS: Case report. RESULTS: A 38-year-old man presented with a 7-month history of constant positive visual disturbances involving his entire binocular visual field after bilateral LASIK. The patient described his symptoms as a “moving texture” present at all times in all lighting conditions that he noticed beginning the evening of the same day he had LASIK. The phenomenon was worse in low lighting and was in fact present in complete darkness, even when his eyes were closed. The patient also endorsed large halos, nyctalopia, and enhanced entoptic phenomena in both eyes, all of which had subjectively worsened after LASIK. Topography-guided customized ablation treatment enhancement had been performed to reduce the patient's symptoms without success. On presentation, uncorrected distance visual acuity was 20/16 in both eyes. Results of slit-lamp examination and corneal imaging were unremarkable in both eyes. The patient was eventually fit with scleral contact lenses, which reduced his halos at night but did not improve his visual snow symptoms. CONCLUSIONS: Although visual snow and visual snow syndrome have been known to present suddenly in a subset of cases, this is the first published case report of acute-onset visual snow syndrome immediately after refractive surgery. Visual snow syndrome has reportedly been preceded by specific events, including migraine attacks, medications, and trauma. Because the symptoms are non-ocular in origin, further refractive surgery enhancement is not indicated. [ Journal of Refractive Surgery Case Reports. 2022;2(3):e51–e54.]