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Dr. James
Dr. James, Board Certified Ophthalmologist
Category: Eye
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Experience:  Eye Physician and Surgeon
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I have developed diplopia at age 49. As this seemed to come

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I have developed diplopia at age 49. As this seemed to come on suddenly, the tests that address serious issues are done and results were clean for MRI of brain, blood work-ups for Thyroid, Diabetes and Myacenia gravis all ok. So last check was with Opthamologist and he sees this as Decompensated phoria. Maybe stress related. I also need to mention I had total left hip replaced in Sept, and have Nacolepsy. Any suggestions what else I may need to check. I now hve 3 degree prism in both lenses to correct the 6 degree issue. Also, I may not have had this suddenly come on as I first thought 3-4 weeks ago. I had noticed being "off a bit" while driving, especially when dark in morning - things werent clear.... possibly for a few months until brain could no longer correct and overlay the shift.
Submitted: 4 years ago.
Category: Eye
Expert:  Dr. James replied 4 years ago.
Hello,

Is the double vision side by side or up/down?
Have you had a recent head injury?
Are you having any trouble adjusting to the prisms?
Customer: replied 4 years ago.

It is side to side - thus the prism (thicker on outdide of both left and right lens) is working. The prism glasses make things sharp, especially in distance as I am near sighted (3.50 right eye, and 2.75 left eye) I can see close fine with no adjustment needed for reading or computer monitor if within 20 inches.

It was when I was seeing two cars side by side until I got close enough that the one on right joined the one on left that I got real concerned. Side note, I take 4 medications regularly. Xyrem (nacolepsy), Lisinopril w/ HCTZ 10/12.5 (moderate hypertension) , propanalol 10mg for familial tremors - hand tremors mainly, and 81 mg aspirin. No head injury of any kind.

 

Expert:  Dr. James replied 4 years ago.
Thank you for the additional information.

I agree with your doctors that it is likely a decompensated phoria. It appears you have already have had extensive testing to check for any serious causes. Thyroid and myasthenia gravis are common causes of double vision as well.

Another possibility could be a cranial nerve 6 palsy. This is commonly associated in people with hypertension. This is a condition where the small blood vessels to one of the eye muscles are blocked and causes dysfunction of that nerve and muscle. The double vision worsens depending on which direction you are looking. There is no treatment needed for this condition and often improves in 4-6 months.

You can talk to you doctor about the possibility of a cranial nerve 6 palsy.

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Customer: replied 4 years ago.

decompensated phoria - if that, is something that I just live with forever, and maybe it will go away, maybe it will worsen needing stroger prism?

Similarly, if it is cranial nerve 6 palsy, it may go away when stress and any hypertension lessens?

Which makes more sense if this has really been more gradual than a sudden onset, and was more like over months from start to now. It could explain those times I felt "off, or out of sorts" a few months ago because I was unknowingly struggling with the diplopia where maybe brain could overlay sometimes, and sometimes it couldn't.

Expert:  Dr. James replied 4 years ago.

decompensated phoria - if that, is something that I just live with forever, and maybe it will go away, maybe it will worsen needing stronger prism?

 

It is unlikely to go away. It may increase and you may need a new prescription periodically.

 

Similarly, if it is cranial nerve 6 palsy, it may go away when stress and any hypertension lessens?

 

A cranial nerve 6 palsy improves as the nerve regenerates and regain function. It is important to control the hypertension, but the healing happens on its own.

 

Which makes more sense if this has really been more gradual than a sudden onset, and was more like over months from start to now. It could explain those times I felt "off, or out of sorts" a few months ago because I was unknowingly struggling with the diplopia where maybe brain could overlay sometimes, and sometimes it couldn't.

 

From what you have described, decompensated phoria is more likely because it has been more gradual. The double vision with CN6 palsy is generally abrupt in onset.

 

Dr. James, Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 2282
Experience: Eye Physician and Surgeon
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