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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 10893
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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My wife was diagnos with Tolosa-Hunt Syndrome on the 06.8.2013 She spend 6 days in the ho

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My wife was diagnos with Tolosa-Hunt Syndrome on the 06.8.2013
She spend 6 days in the hospital.
She was initiated on a pulse steroid course of Solu-Medrol 550mg IVI daily for 5 days, with supportive treatment, including potassium and calcium replacement and omeprazole, to prevent side-effects.
She significantly improved on treatment while still in hospital on the steroid pulse. The headache decreased in severity, and abduction of the left eye improved.
She was discharged on oral Prednisone 60mg per day per os with a gradual taper.
All her blood test came back normal.
She completed the oral Prednisone 60mg on the 10.9.2013
Her vision was almost back to normal (no double vision)
She went for a follow up on 19.8.2013 to be re-evaluated!
After a MRI brain scan on the 25.10.2013 the doctor put her back on a 2 mouth steroids course!
A day after taking the steroids her vision started getting bad and a couple days later she started seeing double again!! Why?????????

Dr. Rick :

Hi. I'm Dr. Rick and I have two decades of ophthalmology experience. I'm online and happy to answer your question today.

Dr. Rick :

First of all, from what you have posted, your wife is getting excellent and appropriate care.

Dr. Rick :

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.

Dr. Rick :

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.

Dr. Rick :

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.

Dr. Rick :

Does this make sense to you?

Dr. Rick :


I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS

Dr. Rick and other Eye Specialists are ready to help you
Marike,

Dr. Rick says:
7:29 AM
Hi. I'm Dr. Rick and I have two decades of ophthalmology experience. I'm online and happy to answer your question today.
7:29 AM
First of all, from what you have posted, your wife is getting excellent and appropriate care.
7:32 AM
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.
7:36 AM
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.
7:37 AM
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.
7:38 AM
Does this make sense to you?
7:38 AM

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS