Diagnostic and Management Strategies of Visual Snow Syndrome: Current Perspectives

Abstract

Introduction: Visual Snow Syndrome (VSS) is characterized by the presence of dynamic, continuous, tiny dots in the entire visual field persisting for more than three months, with at least two associated symptoms- palinopsia, photopsia, photophobia, or nyctalopia. VSS was introduced as perpetual visual disturbance representing TV static, based on early case reports from 1995. Despite its recognition, VSS management remains vague as many cases are refractory to treatment. This literature review aims to provide a summary of all attempted treatments and efficacies to help physicians manage VSS.

Methods: The authors performed a search of articles, literature reviews, and case reports using PubMed and Google Scholar with the key words "visual snow" and "treatment". Forty-one publications were identified; however, 14 were excluded as they did not discuss treatment options or focused on medical conditions associated with visual snow, such as migraine with aura. 27 articles were found to be relevant (from 1999-2024) with treatments in patients officially diagnosed with VSS. Treatments included pharmacotherapy, tinted lenses, neuromodulation, and behavioral therapy.

Results: Based on this review of 27 publications, benzodiazepines and lamotrigine had the best effect (71.4% and 61.5% of patients had an improvement of VS symptoms on each medication, respectively). Antidepressants and AV nodal blocking agents were frequently prescribed but were less effective. VS symptoms improved with filtered lenses combined with cognitive behavioral therapy. Most treatments only partially alleviate VSS or manage associated symptoms like headache and palinopsia, rather than the visual snow itself.

Conclusion: The subjective nature of VSS has posed challenges. Among pharmacological treatments, benzodiazepines and lamotrigine have the most favorable therapeutic ratio in managing VSS. FL-41 tinted lenses consistently provide symptom relief, with cognitive behavioral therapy showing promise as an emerging intervention. Due to the small sample size, further research is recommended to enhance the applicability of findings.

Keywords: nyctalopia; palinopsia; photophobia; visual snow syndrome.