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Dr. A.S. Desai
Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2436
Experience:  MS Ophthalmology with 13 years of surgical expereince
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After an incident involving my head being squeezed four

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After an incident involving my head being squeezed four months ago, I have been experiencing disturbed vision and pain in one eye. I have had an MRI scan and several opthamologists have looked at my eye, who say they cannot see a problem. Three opticians have done a cover test and on each occasion, a mild to moderate "slip" has been reported on the left eye, one optician telling me that the left eye sits higher than the right. When I look at a mid-to distant object first with my right eye and then the left, the object appears higher up when looking with my left eye. Also, when I relax my eyes, and let them drift into diplopia, the left image is always higher than the right one. Every day I experience headaches - which I assume to be eye strain fusing the images? - and an aching/pulling feeling in my left eye only. Could this be caused by the "slip"? Would a prism be able to correct this? Would it be base down or base up? Also, can I get prism contact lenses, as I do not like wearing glasses. When I got a stronger glasses prescription recently, the pulling feeling in my left eye was too uncomfortable to tolerate for the whole day.
I would be grateful for your advice. Thank you.

Welcome to Just Answer

I have been following your questions since the time you first posted it , I observe that your present symptoms are quite consistent with that of a superior oblique paresis ( not complete palsy). Superior oblique muscle is one of the extra ocular muscles which is responsible for movement of the eye downwards,outwards and turning inwards. Any weakness of this muscle leads to upward position of the eye. This is more obvious on the cover tests( as observed as a slip by the opticians). It is usually treated with prisms incorporated in the spectacles. Contact lenses are not fitted with prisms. You will need a prism with base down in order to bring the image down ( it is remembered as apex towards the direction of the palsy ie if eye has moved up , then place a prism with its apex up or in other words with its base down). The last option is to try ocular surgery , to bring about alignment of the two eyes and is done by a squint specialist.

It takes time to get used to prism incorporated glasses but if the discomfort is more then the strength can be reduced slightly. Usually for each degree , 3 diopter prism is needed.

Thanks and best wishes

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Views expressed are for information purpose only and cannot substitute a visit to an ophthalmologist
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