Persistent monocular visual loss in migraine patients

The relationship between migraine and vision is complex. Besides migraine aura status and persistent visual aura without infarction, recognized by International Headaches Classification 3, cases of persistent monocular alterations have been described in migraineurs. To discuss the role of migraine as a risk factor for persistent monocular visual loss. We present five new cases of persistent monocular visual loss in migraineurs, discuss the differential diagnosis and possible relationship with migraine. Five young healthy patients are reported (three women) with a history of migraine (four with visual aura), that developed persistent monocular visual defects, four during an episode of migraine with aura. All patients were submitted to an extensive investigation. In three patients the scotoma was identified on automated perimetry; one of these patients had retinal hemorrhagic lesions, with fluorescein angiography revealing an isolated retinal vasculitis. In two patients fundoscopy revealed transient cotton wools spots. Except for the patient with retinal vasculitis, etiologic investigation was not conclusive. Monocular visual loss can occur in the setting of multiple pathologies that affect the eye and related structures. Although diseases requiring emergent intervention should always be excluded, we propose migraine should be considered as a contributing factor for unexplained monocular persistent scotoma.Monocular visual loss can occur in the setting of multiple pathologies that affect the eye and related structures. Although diseases requiring emergent intervention should always be excluded, we propose migraine should be considered as a contributing factor for unexplained monocular persistent scotoma.