Hi. I can help you tonight.
Does he have any medical problems or take any medicine? Can you have him follow your finger, with one eye at a time, up, down, left, right and then both eyes together and see if his eyes move normally?
No, he is 6 feet tall, 190 pounds, active. He in on no meds. The lazy eye that has gone "wall" cannot follow the finger lead. He sometimes can bring it back to the center but has limited focus in that right eye.
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It is possible that he has had an ischemic event to the nerve that runs the muscle in that eye.
Can you explain ischemic?
Make sure he has an appointment with an ophthalmologist and not an optometrist.
He will see the opthamologist.
It is like a vascular stroke, but not like what you think about in the brain but rather somewhere along the course of the third cranial nerve. Is his eye a little droopy on the affected side?
Yes, but since it's been "lazy'''
oops... it is somewhat droopier than usual.
If the lid is droopy and the medial rectus muscle is weak that would be consistant with a partial third nerve palsy. A complete eye exam will be able to fully evaluate if this in indeed the case. In any event he needs to be seen. When is his appt?
Ok. That is good.
Can you tell if his pupil is larger on the affected side?
As for the up, down , left, right finger exam..is there something indicative in those movements that he should be aware of ahead of time?
I'm not sure about the pupil.
No. I was just having do a quick partial ocular motor function exam....
I will see him again shortly...what should I look for with the pupil size?
ok. Sometimes the pupil is larger, sometimes not, sometimes it is hard to tell....The ophthalmologist will check his pupil function closely.
Is a nerve palsy correctable? I know what Bell's Palsy is.
yes, but in the case of third nerve palsy, it is important to find the cause. In the majority of cases it is just a minor microvascular event that resolves on its own, in some cases it is things more concerning like an aneurysm in an area of the brain called the circle of Willis.
Is the loss of equilibrium normal?
I have seen it in a few cases where the problem was microvascular in nature, but I would have to say that loss of equilibrium does not normally accompany the other signs of a third nerve palsy.
Is third nerve palsy consistent with the lazy eye problem or is it just an anomaly?
It is not related to his underlying lazy eye problem....just happened to occur in the same eye....
Yes...just recalling the info to see what else I need to ask before signing off
ok. You can print this out for future reference too...
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He has no pain, just the dizziness. Would I be safe in cautiously reassuring my "doubting Thomas" brother that has not suffered a TIA or a cerebral stroke? He is fearful and will be extremely uneasy until he gets it officially checked out.
Yes, it is to reassure your brother that he has not had a TIA or a stroke. As I said the vast majority of these things resolve on their own with no long term problems. I am glad that he will be seen by an ophthalmologist tomorrow....Keeping him resting easy is the best thing for him at this time.
He's lucky to have a sister like you to help him out. Have a great holiday season and I hope things turn out for the best.
Thank you very much...you have been extremely patient and helpful!
my pleasure. Have a good evening.