When Vision Doesn’t Let Go
Some patients notice that an image disappears, but their vision does not fully reset. Lights may trail, words linger on the page, or objects seem to echo briefly in space. These experiences can be confusing and unsettling, particularly when they occur without warning.
This phenomenon is known as palinopsia. Although it affects vision, it reflects altered processing in the brain rather than a problem with the eyes themselves. Recognizing this distinction helps patients and clinicians approach symptoms more clearly and calmly.
What Is Palinopsia?
Palinopsia is a neurologic symptom in which visual images persist, repeat, or distort after the original image is gone. The term comes from Greek and means “seeing again.”
Unlike ordinary afterimages, which are common and fade quickly, palinopsia tends to be more vivid, longer lasting, and less predictable. Images may appear spontaneously or interfere with what a person is seeing in real time. The underlying issue involves how the brain processes visual information, most often in regions responsible for visual perception.
How Palinopsia Can Appear
Palinopsia generally presents in two broad patterns. In some cases, previously seen images reappear clearly, as if replayed by visual memory. These images may involve objects, faces, or scenes and can occur minutes or much later after the original exposure.
In other cases, palinopsia alters current visual input. Moving objects may leave trails, lights may streak, or afterimages may persist longer than expected. These experiences reflect changes in visual perception rather than memory recall.
What Causes Palinopsia?
Palinopsia occurs when normal visual processing in the brain is disrupted. Many conditions can contribute, including migraine (especially migraine with aura), seizures involving visual pathways, stroke or transient ischemic attack, traumatic brain injury, brain lesions or tumors, infections or inflammatory conditions affecting the brain, and visual processing disorders such as visual snow syndrome.
Certain medications are also associated with palinopsia, including some antidepressants, antiseizure drugs, antipsychotics, and hormonal therapies. Nonmedical drug exposure, particularly hallucinogens, is another recognized cause. In some individuals, no single cause is identified.
Palinopsia in Patients With Complex Illness, Including Lyme Disease
Palinopsia may also be reported by patients with complex systemic or neurologic illnesses, including Lyme disease. In individuals with Lyme, persistent visual symptoms may arise in the setting of neuroinflammation, migraine activity, medication effects, autonomic dysfunction, or coexisting neurologic conditions rather than from a single identifiable mechanism.
For this reason, the presence of palinopsia should prompt careful neurologic evaluation rather than assumptions about infection activity or disease progression. Visual symptoms deserve the same thoughtful assessment as other neurologic complaints, particularly in patients with overlapping conditions.
Why Palinopsia Is Often Missed
Many patients find palinopsia difficult to describe, and the term itself is unfamiliar outside neurology. Symptoms may be mistaken for eye strain, anxiety, or normal afterimages.
Because presentations vary and episodes may be intermittent, palinopsia is frequently underrecognized. For many patients—especially those already navigating chronic illness—simply having a name for the experience can be validating and reassuring.
When to Seek Medical Care
New or sudden onset of palinopsia should prompt medical evaluation. Although uncommon, palinopsia can be associated with serious neurologic conditions such as stroke or seizures.
Urgent assessment is especially important if visual symptoms occur alongside weakness, difficulty speaking, facial drooping, confusion, or severe headache. Even when symptoms are brief or resolve, evaluation helps ensure that serious causes are not missed.
Diagnosis and Treatment
There is no single test for palinopsia itself. Diagnosis relies on clinical history and neurologic examination. Depending on the presentation, evaluation may include brain imaging, EEG testing, medication review, or referral to neurology or neuro-ophthalmology.
Treatment focuses on addressing the underlying cause rather than the visual symptom alone. In many cases, symptoms improve when contributing factors such as migraine activity, seizure disorders, medication effects, or other neurologic stressors are appropriately managed.
Clinical Takeaway
Palinopsia is a recognized neurologic symptom reflecting altered visual processing in the brain. While it can be unsettling, it is not an eye disease and is often manageable once the underlying cause is identified.
In patients with Lyme disease, lingering or repeating visual symptoms warrant the same careful neurologic evaluation as in any other clinical context. When vision lingers, it is a signal worth evaluating thoughtfully rather than ignoring—or over-interpreting.
References
- Ophthalmology Gersztenkorn, D., & Lee, A. G. (2015). Palinopsia revamped: A systematic review of the literature. Survey of , 60(1), 1–35. PMID: 25877246
- Brain Schankin, C. J., Maniyar, F. H., Digre, K. B., & Goadsby, P. J. (2014). “Visual snow” — a disorder distinct from persistent migraine aura. , 137(5), 1419–1428. PMID: 24713250
- Infectious Disease Clinics of North AmericaHalperin, J. J. (2011). Nervous system Lyme disease. , 25(2), 241–253. PMID: 21288993
- Cephalalgia,Viana, M., Sances, G., Terrazzino, S., et al. (2016). When migraine mimics stroke: A systematic review. 36(2), 115–129. PMID: 26163446
- Dr. Daniel Cameron: Lyme Science Blog. Visual Snow Syndrome: When the World Looks Like Static
- Dr. Daniel Cameron: Lyme Science Blog. Brain Fog and Lyme Disease: The Overlooked Symptom
- Dr. Daniel Cameron: Lyme Science Blog. 25th anniversary of first study describing chronic neurologic Lyme disease
