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Dr. A.S. Desai
Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2055
Experience:  MS Ophthalmology with 11 years of surgical expereince
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I lost center vision in my left eye 16 years ago and, so they

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I lost center vision in my left eye 16 years ago and, so they say after many, many clinics, professionals, university hospitals, that the very high fever I had at the time caused this because there is nothing within the eye itself that shows anything abnormal; just several vision field tests to confirm what I cannot see. I have never had an MRI of that part of my brain to determine if there is atrophy in the area that controls center vision. However, I now come to realize that this left eye has not been working properly and that the right eye has taken over; therefore, I have glasses with a prism lense to try and force it to work, albeit with the blind spot. However, over the past several months I have new symptoms: eyeball pain - very tender to the touch, the eye bulges more than the other eye, and the bone socket around the eye appears to be more swollen or larger than the right eye. I also get - almost daily as of late - headaches around the eye up to my brow. Any thoughts?
Submitted: 4 years ago.
Category: Eye
Expert:  Dr. A.S. Desai replied 4 years ago.
Hello,

You must have developed retrobulbar neuritis or optic neuritis which does result in central scotomas as you have.

The swelling of the eye could indicate proptosis( protrusion of the eyeball). You will need through evaluation to know the cause of this . You can get a thyroid function tests done such as free T3, T4 and TSH. Once thyroid ophthalmopathy is ruled out then other causes of proptosis can be evaluated. MRI can help in the diagnosis.

Thanks and best wishes

If you are satisfied with the answer , please press the accept button so that I get my dues.

A bonus and positive feedback are welcome.

Dr.A.S.Desai
Customer: replied 4 years ago.
Thanks for your answer. Can you give me a little more information, though? Since I did not have any pain when the blindness occurred, can this retrobulbar neuritiis develop over time if the area of my brain is atropied - is that what you are saying by "I must have developed"? Also, does my condition that happened 16 years ago actually have the name of central scotomas and what is the meaning of that? I have never been told anything at all except for what they can see from my vision field tests. The only person to suggest an MRI of this region of my brain was most recently about a year ago at an eye exam for contact lenses. Also, the thyroid function might be something to look at since I have not been eating hardly at all; I"ve just had a loss of appetitie for over a year now and I really can't figure out why. However, I am gaining weight and have put on about 15 lbs. in the last year even though I hardly eat. I was down to my goal weight of 128 lbs. and now am at 143 lbs. So this has concerned me a bit. However, though, can this occur only in one eye - the thyroild thing? Thanks much; you have helped me a great deal!
Expert:  Dr. A.S. Desai replied 4 years ago.
Hello,

The suggestions given are purely based on the information given by you .

Retro bulbar neuritis is one of the few conditions in the eye in which neither the patient sees anything nor the examiner sees anything abnormal. It is the inflammation of the back of the optic nerve ( which is why on examination no abnormality was detected in your eye).
As you said it was attributed to high fever, it could occur in encephalitis or meningitis both manifest with high fever. An MRI was suggested probably because demyelination of the nerves is a common cause of optic neuritis and shoule be ruled out in all cases of optic neuritis.

Central scotoma means a defect in the central part of your visual field. It is a finding and not the name of the disease.It is typically seen in optic neuritis.

Thyroid ophthalmopathy can occur in one eye to begin with and has an asymmetrical involvement when the other eye is eventually affected.

After your thyroid function tests are done , you can follow up with your ophthalmologist with your reports for further course of action. If the reports are normal then other causes have to be looked for after a through examination.

Thanks and best wishes

If you are satisfied with the answer , please press the accept button so that I get my dues.

A bonus and positive feedback are welcome.

Dr.A.S.Desai
Customer: replied 4 years ago.

Thanks again. I do have a couple more comments/questions. I'm sorry to keep coming back at you, but you are the only one in 16 years to give me any sort of answers and I will take your suggestions with me to my new opthamologist. I was fine for several years until, as I said, just recently - over the past year - that I have started to notice real symptoms of this vision loss such as the headaches, bulging, pain in my eye (like a bruised pain) to the touch mostly but it sometimes hurts like a throbbing when not being touched. as well as the eye wandering and poor depth perception (per tests at the optometrist).

 

I did have an MRI of my head/brain a few years ago related to issues that turned out to be herniated discs in my neck. They did note back then (probably three years ago) that the optic nerve was in tact and fine. Therefore, could all of this have further manifested since then? If it is not the optic nerve, then what area of the brain would be affected and what would an MRI show if it is in the brain?

 

Thanks again.

Expert:  Dr. A.S. Desai replied 4 years ago.
Hello,

As I told thyroid ophthalmopathy could be one of the few causes which give rise to symptoms similar to ones you are experiencing. It can also be seen in orbital pseudotumour.

If you want to know what is seen on the MRI in optic neuritis, then if the cause is demyelination as in multiple sclerosis, areas of demyelination are seen in the brain ( brain stem or peri-ventricular). But such a condition is usually associated with drastic reduced vision and may be left with a central visual defect later.

Thanks and best wishes

If you are satisfied with the answer , please press the accept button so that I get my dues.

A bonus and positive feedback are welcome.

Dr.A.S.Desai
Customer: replied 4 years ago.

Thanks again. Okay, I promise, couple more comments/questions. I have been tested for MS several times - in my 20's and 30's when pain and weekness were present without explanation. I was not dx'd with it then. However, since you responded, I have now read up on this and this very well may be the cause - MS. However, in reading about MS, I came across GCA and I do have several of the symptoms of that. I did not mention to you my other concerns along with the eye b/c I didn't think they would be related. However, I have been having alot of jaw pain, earaches (actual infections and once had mastoiditis in 2002), and neck pain - neck pain I thought is/was disc related, as well as chest pains, left arm pain/weakness (I've had this many times before but they say the heart is fine - that was several years ago and I think it is the nerves coming from my herniated disc, but now I don't know), and stomach issues. Also, and this is quite bothersome, I do have jerking sensations lately as well - usually only at night, but one occured the other day while driving - in my leg forcing the gas peddle down, but it was mild. I was dx'd with DDD three years ago as well and have had surgery on my back and neck already. However, it is the inflammation part of all of this that is concerning and with all of this bundled together, it appears something is amiss. Your final thoughts, please, would be greatly appreciated. Also, do I go see my neurosurgeon for all of this? Lastly - I am only 45 years old!

 

If you answer these questions, I will accept your answer. You may also use my story for research if you like; it is quite interesting. You have so much more information about my eye than any doctor who has ever looked at it; new technology and research has really come a very long way since this happened to me 16 years ago, and now I think it is time I get to the bottom of it. Thanks again.

Expert:  Dr. A.S. Desai replied 4 years ago.
Hello,

GCA ( giant cell retinitis) is seen in elderly usually in the seventh or eight decades and is characterised by thickening of the arteries especially the temporal artery( at the temple) .Though you may have signs and symptoms suggestive of it , it is very unlikely in your case considering your age.

You must consult your neurosurgeon for your other neck and spinal cord problems as they seem to be related to most of your symptoms apart from the eyes.

Thanks and best wishes

If you are satisfied with the answer , please press the accept button so that I get my dues.

A bonus and positive feedback are welcome.

Dr.A.S.Desai
Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2055
Experience: MS Ophthalmology with 11 years of surgical expereince
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