Twin sisters with visual snow syndrome

Introduction
Visual snow is a rare neuro-ophthalmology disorder. Visual snow syndrome can be diagnosed if visual snow lasts longer than three months and is accompanied by at least two additional symptoms. To our knowledge, there are no other case reports of identical twins suffering from visual snow syndrome.

Case presentation
Two patients, twin sisters, were admitted to the Ophthalmological Department of Infant Jezus Clinical Hospital in Warsaw with similar symptoms of bright, flickering dots seen with opened and closed eyes. Both patients had additional symptoms. The first patient experienced photophobia, nyctalopia, oscillopsia, transient photopsia, palinopsia, and tinnitus. The second patient experienced palinopsia, floaters, scotomas, and tinnitus. An extensive ophthalmological examination was performed on both patients, and no abnormalities were observed. Magnetic resonance imaging, serum studies, and cerebrospinal fluid analysis were normal.

Conclusions
The presented cases suggest that a predisposition for visual snow syndrome may be genetically determined. Patients experiencing symptoms of visual snow often complain about their situation in the medical care system as they pass between doctors to determine the diagnosis. The chronicity of the disease requires the development of a medical care procedure that supports patients.