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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3204
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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Today, within a few seconds, I developed clear diplopia. In

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Today, within a few seconds, I developed clear diplopia. In the first seconds, stereoscopic vision became accentuated (as in a 3d film I saw a couple days ago). Double vision is both horizontal and vertical. In both cases withe an angle of about 10 degrees, In some positions of the head (looking ahead, head slightly tilted down) image is Ok. Any deviation R or L up or down accentuates progressively diplopia. Lots of stress this year. Sudden generalized loss of hair. Thyroid function analysis ok. No indication of diabetes. Could have eaten some freozen shrimp or another preseve that was not ok. Lots of blood analysis done a month ago, all ok, except some erythrocyte vol didt slightly off. Cortisol ok. Past life: cell biologist with 30 years of eye use: electron microscopy in US. I am now in tiny italian north italy village, no ophtalmology urgencies at nearest local hospital. Can you help. ? i am concerned with vascular incident. What do you advise?
New observation may help you:

Start position looking out, head slight tilted down: all ok more or less. LOOKING AT HORIZONTAL RAIL:

Then move head to eight cardinal positions , scale of diplopia 0-5 (max)

North.....2

NE ........5

E............0

SE.........0

S............0

SW........0

W...........1

No great changes with istance: seing a painting hanging on a wall is already uncomfortable a closer range, simply more noticeable 2-3 meters away.


LOOKING AT VERT BEAM:. NE...5; east ...5. All other nothing or little
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. Dan B. replied 2 years ago.

Doctor DanB :

Hello and thanks for your question. Are you available to chat?

Doctor DanB :

Can I assume the double vision goes away if you cover one eye?

Doctor DanB :

If that is the case, does it go away regardless of which eye you cover?

Doctor DanB :

Any significant headaches, changes in the height of either eyelid, differences in the pupil sizes?

Customer:

I am available now.

Customer:

Yes, it goes away if I cover one eye

Customer:

any eye

Customer:

no differences that I can see in pupil size;no headache; eyelid height the same

Customer:

From my internet reading :-)... it changes with attitute (tilt or turn) of the head (incomitant?)

Customer:

also, images are one above the other (vertical?)

Customer:

also there is this small angle; a horizontal rail can look normal if my head is slightly looing down and slightly tilted sidaways to the lefe. In other positions a doublr rail appears. At its extrem right it almost joins; the moving to the left ift diverges at a small angle (less than 5 degres) but this divergence (angle) acan increase depending on position of the head. In this conditions driving ith both eyes open is impossible.

Customer:

Three years ago I fell from a bike and banged my head on concrete step (brain trauma around 2+. i lost memory of event . I was in intensive care, just for observation. This was on the left temple. About three months ago, my (then) wife hit me one one eye. Xray and mri done , all normal. This was the right eye. Just hematoma; but for about a month i had this feeling that might right eye felt larger than the left.

Customer:

Today nothing changed. Symptoms all the same. Must tell you that I have been under a real lot of stress this last year and even now; also spent time with tv and computer. Also three days ago i saw this 3d (Hugo Crouet) and I found the glasses and the whole experience not very agreeable (except fotr the movie..)-

Customer:

my skype name: pedrophoenixpedro

Customer:

my skype name pedrophoenixpedro

Customer:

i am here

Customer:

I am here looking forward to chat

Doctor DanB : By your description this sounds like it could either be a fourth cranial nerve palsy or even a skew deviation. The fourth cranial nerve palsy would likely be due to trauma (given the amount of recent trauma) but it is unclear what traumatic event would've caused it. It's much less likely but still possible that this is a congenital fourth nerve palsy that has been uncovered through numerous traumas. But since you don't have signs of mass effect in the brain, this doesn't sound like you need to see a doctor emergently but I would recommend seeing an eye doctor as soon as you are able. Does this make sense?
Customer:

In the meantime I have touched with the pulp finger tip very gendly the expernal sides of both eyes. Gentlest of pressure markedly improvers symptoms, even skew. But also, my eyes feel tender end swollen/soft to the touch. As you know, I am a cell biologist , know nothing of medicine. I was 2 years at NCI, NIH. So, you do not think this has anything to do with a minor episode of stroke. I got alarmed because several places reffered the need to go immediatly to get help if the onset was SUDDEN; and it was. Is an ophatlmologist or a neuroophtalmologist I should look lor?

Customer:

Is this something that can go simply away? or else needs prolongued care, surgery, concern etc; any advise to lifestyle?

Doctor DanB : I can't say that this wasn't from a mild stroke but you don't seem to be evidencing other signs of a stroke. This could very well have been caused by a mild stroke in the brain that controls the movement of this muscle. Ideally a neuro-ophthalmologist would be the best person to see but an ophthalmologist is plenty good enough to diagnose this. If not, then a neurologist would be the best. I would recommend seeing one of these doctors as soon as possible, though.
Doctor DanB : It's difficult to know whether this will require surgery or will just go away on its own until we know what it is.
Customer:

Thanks. I have just been very gently massaging the eye balls: 2-4pm on right eye; 8-10 on left eye and symptoms remarkably improve. I will follow your advice.

Doctor DanB : You're welcome. Please help me get credit for my expertise and the time spent in answering your questions and press the ACCEPT button for this encounter; this allows part of the funds that you have deposited to the website to be released for my efforts to assist you. This does not end our conversation, however-we can continue to discuss any of your concerns without further charges until you are satisfied.Any positive feedback and/or bonus you may feel prompted to provide would be welcomed and is appreciated. Thanks for your inquiry!My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor.
Customer:

Ok, I will come back tomorrow to continue. Thank you !

Customer:

However, as punched the acept button it informed that I was satisfied, and that was it. I hope that it is you who is correct and even if I "accept" i can come back until we finish.

Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3204
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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