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Dr. JLB
Dr. JLB, Ophthalmologist
Category: Eye
Satisfied Customers: 86
Experience:  General Ophthalmologist, Fellowship trained in Refractive Surgery
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What might be the possible causes of monocular triple vision

Customer Question

What might be the possible causes of monocular triple vision if a retina problem has been ruled out?
Submitted: 5 years ago.
Category: Eye
Expert:  Dr. JLB replied 5 years ago.
HiCustomer

Monocular double or triple vision occurs secondary to some disturbance along the visual axis. The visual axis implies all the structures that light has to pass in order to reach the retina. For the sake of this discussion, I will refer to the problem as diplopia (double vision) since the number of images seen is usually irrelevant. The pathology lies in seeing more than one image. It is very rare for a retinal problem to cause diplopia.

The most common reason for this phenomenon, is an optical irregularity in either the cornea (the front of the eye) or the lens (behind the pupil, used for proper focusing).

In the cornea, one can suffer from irregular astigmatism. This is a type of astigmatism that causes two or three images to be detected by the retinal cells. Irregular astigmatism may be caused by a condition termed keratoconus. Another reason may be a decentered contact lens on the eye. About 40% of monocular diplopia is caused by cornal problems such as the ones just described.

Another common reason for monocular diplopia occurs when cataracts affect the lens of the eye. In particular, nuclear sclerotic cataracts can cause this type of symptom.

I recommend a complete eye exam including a corneal topography that will help determine if irregular astigmatism is present. Also the lens of the eye can be carefully examined.

I hope this is helpful....

Sincerely,

Dr. JLB
Customer: replied 5 years ago.
I have had two complete eye examinations and an optical cause for this condition has been ruled out, although I do have early stage cataracts in both of my eyes.
Expert:  Dr. JLB replied 5 years ago.

HiCustomer

 

It is not unheard of that even minimal cataracts can cause diplopia. It is really more about the location of the lens opacity and not the density of the cataract.

 

Also, corneal topography is not a test normally performed as part of a complete exam. You may want to obtain this test in order to unequivocally rule out irregular astigmatism as a possible cause for your symptoms.

 

Good luck as you search for a solution to this problem...

 

Sincerely,

 

Dr. JLB

Customer: replied 5 years ago.
I was told that it was more likely caused by a neurological problem because it is not a shadow.
Expert:  Dr. JLB replied 5 years ago.

HiCustomer

 

This possibility does exist; however, it is so rare that it is not documented in most ophthalmology texts. If you have been told this, I would encourage you to be examined by a neuroophthalmologist. These are specialists in just this type of situation and certainly there is no substitute for a complete exam by one of these specialists. He or she may decide further management that my include radiology testing and a full neurological evaluation by a neurologist.

 

Sincerely,

 

Dr. JLB

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