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Dr. Susan
Dr. Susan, Ophthalmologist
Category: Eye
Satisfied Customers: 218
Experience:  Board Certified & Fellowship trained eye surgeon.
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so the Friday before Christmas, I was playing golf using a

Resolved Question:

so the Friday before Christmas, I was playing golf using a cart cover zipped up with a propane heater. I developed diplopia about 15 minutes after I started sitting in the cart with the propane heater and this continued until about 30 minutes after the round was completed and I was out of the propane heater environment. The total time during which the diplopia occurred was about 5 hours. My physician told me to go to the ER so I did where a neurologist diagnosed TIA which I do not believe to be true. I feel like carbon monoxide might have been an issue but cannot prove it. CT, CT-A, MRI, MRA, and heart echo are all clear.

Now that I am concentrating on this, I am noticing that I have diplopia that occurs for about 15-120 seconds after I wake up and then the images converge and I do not have any other trouble the rest of the day.

Got any ideas?
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. Susan replied 2 years ago.

Dr. Susan :

Hello are you available to chat?

Customer:

sure

Dr. Susan :

so the diplopia is only intermittent

Dr. Susan :

Does it occur when both eyes are open, or even when you close one eye?

Customer:

that is correct...just during the golf round and now just when I wake up which I just noticed (paying more attention now I guess)...I noticed it when I put my glasses on to see what time it is on the bedroom clock across the room when I wake up

Customer:

both eyes have to be open for it to occur

Customer:

i can see with great visual acuity (corrected) with either eye on its own

Dr. Susan :

how many times have you had the episodes of diplopia

Customer:

just playing golf and then consistently when I wake up from a nap or when I wake up in the morning...the latter was just discovered about 2 days ago but I might not have been paying attention to that before

Customer:

the golf item was just one round...played yesterday and was just fine...but not propane heater was involved

Dr. Susan :

It is highly unlikely that the after all this testing- it is related to the carbon monoxide poisoning (assuming that they test that too)

Customer:

they did not test that...unfortunately. I also tend to agree. When I woke up this morning, I grabbed my oximeter (I happen to have one) to see if it was occurring due to low O2 levels in my blood (which might have also occurred with the CO in the golf cart)...and that was not an issue...now I am seeking other explanations because I still do not believe TIA is the answer

Dr. Susan :

Your symptoms may be related to a decompensated phoria-

Customer:

say what?...try that one again

Dr. Susan :

allow me to explain

Customer:

sure

Dr. Susan :

In order for us not to have double vision the eyes must be perfectly aligned

Dr. Susan :

this a condition in which the directions that the eyes are pointing are not consistent with each other.

Customer:

ok...now what...I plan to see an opthamologist this week also...is it correctible without using a prism since the images coverge after such a short period of time?

Customer:

I also plan to get a second opinion with another neurologist this week

Dr. Susan :

In some people as they age, one of the eyes may start to drift,especially in times of high stress or fatigue. This will usually be intermittent and progressively worsen

Dr. Susan :

GREAT- it looks like you know about this condition

Customer:

not really, you are the first person to bring it up but the investigation is just getting started on my end

Dr. Susan :

yes- your ophthalmologist will test you for that and if it is necessary give you prisms.

Customer:

how would a prism work if the condition is intermittent?

Dr. Susan :

It really is not too worrisome- and easily correctable.

Dr. Susan :

If this is the condition

Customer:

true...if this is the condition

Customer:

so...not knowing how this forum works...are we done and I need to hit the accept button below or if you have other ideas I am listening

Dr. Susan :

There is also condition called myasthenia gravis which I am sure you will be evaluated for.

Customer:

yes, I have heard of this...the "weak eye muscle" thing?

Dr. Susan :

This is probably not the case of your symptoms because in myasthenia it occurs later on the day

Dr. Susan :

with fatigue

Customer:

ahhhh

Customer:

that is not occurring with me at all

Dr. Susan :

exactly- I am just putting it on the differential list but my suspicion is that you are having a decompensated phoria

Dr. Susan :

I am gladThat you will see your doctor this week.

Customer:

I see...so that is what I need to be talking about most likely in my appointment

Customer:

well, I want to get to the bottom of this

Customer:

I just don't believe this presents itself as a classic TIA at all and have said all along that it is ocular in nature

Dr. Susan :

your doctor will do extensive testing - as we all do when a patient has diplopia

Customer:

ok...I am looking forward to that....

Dr. Susan :

I agree- you would not have a recurrent tia in the SAME location and have a normal CT/MRI

Dr. Susan :

Keep me updated and gooodluck

Customer:

well thanks for your time...I will hit the accept button and you have a great new year.

Dr. Susan, Ophthalmologist
Category: Eye
Satisfied Customers: 218
Experience: Board Certified & Fellowship trained eye surgeon.
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Dr. Susan
Dr. Susan
Ophthalmologist
217 Satisfied Customers
Board Certified & Fellowship trained eye surgeon.