One explanation for the visual phenomenon of VSS is that they are ophthalmic in origin. Entoptic phenomena can also be experienced by those with otherwise healthy ophthalmic examinations because of vitreous floaters and white blood cells travelling through the microvasculature. Photopsia and other entopic phenomenon are reported in conditions such as posterior vitreous detachment, retinal tears, age-related macular degeneration (AMD) and retinitis pigmentosa [13]. Autoimmune retinopathy is characterised by circulating anti-retinal antibodies that cause photoreceptor dysfunction. Patients present with photophobia and positive visual scintillations that are often described as gold or silver shimmering in the visual periphery. The shimmering is most noticeable in the dark and persists with the eyes closed. A careful history can usually differentiate this from VSS, and diagnosis is based on fundus autofluorescence photography and electroretinography [14]. A case series of patients with glycine receptor autoimmunity describes symptoms of visual snow, palinopsia and positive visual phenomena which may be due dysregulation of the GlyRα1 inhibitory neurotransmitter in the human retina. [15]
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