Hi. I'm Dr. Rick and I have two decades of ophthalmology experience. I'm online and happy to answer your question today.
First of all, from what you have posted, your wife is getting excellent and appropriate care.
The reason that your wife has started to see double again, and the reason that her doctor put her back on steroids again after the MRI, is there there is most likely inflammation in her cavernous sinus and many of the structures that pass through it.
The good news? While Tolosa-Hunt syndrome causes significant pain and physical problems, especially involving the eye, it is a self limited disease. The steroids your wife is taking have been shown to cause a dramatic reduction in pain and visual issues. Unfortunately, in some patients, there can be permanent cranial nerve weakness leading to persistent double vision. If this occurs, prism glasses or even eye muscle surgery can help.
So. What is the take home message? Your wife's double vision is not a sign that something is going wrong but, rather, is just part of what is to be expected from Tolosa-Hunt syndrome. In the vast majority of cases the double vision will resolve.
Does this make sense to you?
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