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Medical Forum / General / Vision / October 2005Physiology of Eyestrain
Hi, When one is said to have eyestrain. What really goes on in the eye. Is there more blood to the optic nerve or retina?? I don't know what is wrong with my right eye. When I read books or other activities for two hours. My right eye experiences discomfort while the left nothing. How come my right eye can suffer eyestrain in so short a time compared to my left which can't suffer as fast. Anyone got any idea?? I wonder if my right eye has smaller artery or blockage or what. Note there is no inflammation just much faster eyestrain in my right now which can become a bit painful after a certain time. To know why. I need to know what goes on physically in the eye during eyestrain. Pls. share. Thanks. Kyle >Hi, > [quoted text clipped - 14 lines] >To know why. I need to know what goes on physically >in the eye during eyestrain. Pls. share. Thanks. I'm not a doctor, but I know ... too darned much about eyestrain, unfortunately. Simplest way I could explain it: the ciliary muscles are responsible for focusing the lens (accommodation). Sustained accommodation is to the ciliary muscles what holding a car battery at arm's length is to the shoulders and arms: very taxing ... if your muscles aren't up to it (mostly genetic, I presume). Is your right arm stronger than your left (or vice versa)? It's not unusual, especially if you /actually/ need glasses and have a differing refractive error in each eye. Some vision therapists believe that accommodative amplitudes (the ability to shift your focus) can be increased through their methods. Perhaps. You can search (Google, etc.) using keywords like: - accommodative fatigue - accommodative stress - accommodative infacility - ill-sustained accommodation - accommodative spasm I'd get a good cycloplegic (eyes dilated) eye exam. Best of luck ... and don't forget good visual hygiene: http://www.pavevision.org/stressreduction.htm http://www.healthy.net/oep/HYGIENE.HTM  SignatureLive simply so that others may simply live > Hi, > > When one is said to have eyestrain. What really goes on > in the eye. Is there more blood to the optic nerve or > retina?? No. There could be an increase in blood flow to the various eye muscles, but neither the optic nerve nor the retina have any pain neurons in them at all. > I don't know what is wrong with my right eye. When I > read books or other activities for two hours. My right > eye experiences discomfort while the left nothing. How > come my right eye can suffer eyestrain in so short a > time compared to my left which can't suffer as fast. > Anyone got any idea?? One or more of the eye muscles in the right eye are "doing all the work". I'm guessing it's your better eye? I wonder if my right eye has > smaller artery or blockage or what. Note there is no > inflammation just much faster eyestrain in my right now > which can become a bit painful after a certain time. A blockage of an artery would not cause pain in that eye. There could be inflammation of a minute amount that you could feel. These are tiny, tiny muscles we're talking about. > To know why. I need to know what goes on physically > in the eye during eyestrain. Pls. share. Thanks. If it goes away when you stop reading, then stop reading when it starts to bother you. Better yet, get a good eye exam and be sure to mention this symptom. No doubt it can be helped, possibly eliminated, with the right glasses. w.stacy, o.d. > When one is said to have eyestrain. What really goes on > in the eye. Is there more blood to the optic nerve or > retina?? Lots of things cause eyestrain, just as lots of things cause headaches. Most eyestrain when reading comes from your focusing muscles, maybe because nature gave you one eye that focuses differently from another. In this case, wearing a lens that "evens out" your eyes can make you more comfortable. Some eyestrain comes from the extraocular muscles, the ones that move your eyes and keep them seeing single. Sometimes it's a combination of those two systems. Sometimes it's a medical problem that reduces vision in one eye and results in "eyestrain." We could quiz you all day on symptoms but it won't be as good as a real eye exam. Once you can post your refraction, we'll have all sorts of suggestions. > Anyone got any idea?? I wonder if my right eye has > smaller artery or blockage or what. That doesn't usually hurt like "eyestrain," but it does cause blur in one eye. That's why your best option is to visit an eye doctor. In less than an hour you'll have far better answers. -MT Thanks guys. Well. I already visited an opthalmologist last week. He said my cup-to-disc ratio is normal and I don't have any eye pathology. He has many patients waiting so I couldn't ask him to lecture me about physiology of the muscles and eye in eyestrain. Anyway. I have the book "Your Eyes: User Manual" for reference. My problem is eyestrain. So it is the muscles in the right eye that is the problem and not the optic nerve (thanks for this information guys). I have nearsightedness in my left eye -9.0 and right eye -7.0. They are corrected by wearing gas permeable contacts and the rating confirmed by chart tests. The right eye has lesser refractive error but the eyestrain can get worse than the left. I don't have any eyestrain on the left eye. Just the right. This is only apparent when using them at longer time or bad lighting. So anyone got any idea how to relax the muscles in my right eye. Put ice? Say. When you close the eyes. Do the muscles still work? I'm very left brain and think a lot even when lying down at night with eyes closed. I can feel my right eye being strained further by much thinking. Could the left brain be activating the right eye muscles. Is it possible my right eye muscles is still being strained when I think a lot even when it is closed? Thanks. Kyle > > When one is said to have eyestrain. What really goes on > > in the eye. Is there more blood to the optic nerve or [quoted text clipped - 26 lines] > > -MT >Thanks guys. Well. I already visited an opthalmologist last week. >He said my cup-to-disc ratio is normal and I don't have any eye [quoted text clipped - 14 lines] >So anyone got any idea how to relax the muscles in my right >eye. Put ice? I'd say just the opposite: warmth. http://snipurl.com/iuj7 >Say. When you close the eyes. Do the muscles still >work? IME, yes. Absolutely. Ever overwork your leg/arm muscles, then wake up in the morning with the /real/ pain having set in overnight? >I'm very left brain and think a lot even when lying down >at night with eyes closed. I can feel my right eye being strained >further by much thinking. Could the left brain be activating >the right eye muscles. Is it possible my right eye muscles >is still being strained when I think a lot even when it is closed? You're really getting into gray area here, but I have an opinion on it: accommodative stress used to be thought of as a psychogenic issue. I genuinely think they got the cause and effect wrong. People whose minds are always going may be avid readers and computer users. Take somebody like that who also has subpar vision and ... you get problems. Stress exacerbates my eyestrain issues, but ... it exacerbates many overall conditions that we would define as contributing to overall 'wellness,' no? How old are you? If you're a high myope, corrected to 'optical infinity,' then you try to bring your visual world close-in for extended periods (reading) with limited accommodative amplitudes ... you're gonna' have trouble. I would definitely get a cycloplegic exam from a qualified eye doc (since pathology has been ruled out, use an OD this time <g>). There are likely things that you can do (including, possibly (and paradoxically), reading glasses) to ameliorate your symptoms. Good luck! SignatureLive simply so that others may simply live > >Thanks guys. Well. I already visited an opthalmologist last week. > >He said my cup-to-disc ratio is normal and I don't have any eye [quoted text clipped - 55 lines] > -- > Live simply so that others may simply live My eyestrain is a threshold effect. For example. I can read for 4 hours with no problem if the lighting is good and I rested. But if I already feel fatique in my right eye and I over read for even a few minutes. I'd get eyestrain afterwards that last for hours. However. If when starting to feel fatique I rested. The eyestrain would not continue and I can continue reading for another 4 hours. So what do you say about this threshold effect. Ever heard of it. I have high myope of -9.0 nearsighted in my left eye and -7.0 nearsighted in my right eye. Even though the left eye is worse, how come it is the right eye that gets fatique while my left eye never gets fatique. You mean my offending right eye has to do more accomodations. Does it makes sense. For those who constantly suffer eyestrain. I think there should be something organically and marginally wrong. Look, my left eye nevers get eyestrain even when continously reading. While my right eye has less stamina. There are those of you can read for long hours even under bad light without suffering eyestrain while some can chronically suffer it. Something should be wrong with the ciliary muscles.. perhaps lack of some required nutrients or parts? What do you think? I wonder if there is a CT scan of the ciliary muscles. Kyle >My eyestrain is a threshold effect. For example. I can read >for 4 hours with no problem if the lighting is good and I [quoted text clipped - 4 lines] >reading for another 4 hours. So what do you say about this >threshold effect. Ever heard of it. That's where the visual hygiene comes in. Think of the analogy I gave about exercising other muscles. They need rest to continue to perform. >I have high myope of -9.0 nearsighted in my left eye and >-7.0 nearsighted in my right eye. Even though the left eye >is worse, how come it is the right eye that gets fatique >while my left eye never gets fatique. You mean my offending >right eye has to do more accomodations. Does it makes sense. Lots of possibles, including different accommodative amplitudes (overall capacity to focus from far to near), improper (excess minus) correction in the right eye ... probably even slight alignment trouble (-phoria) that manifests under accommodative stress. I might be reaching with that last one, but you never know. >For those who constantly suffer eyestrain. I think there >should be something organically and marginally wrong. Look, [quoted text clipped - 5 lines] >some required nutrients or parts? What do you think? I >wonder if there is a CT scan of the ciliary muscles. Ciliary spasm can be caused by -large refractive errors (which you, technically, have, though it'd be more common in farsighted people (uh, that's me) as a result of ciliary hypertonicity -spontaneously after head traumas -unknown etiologies/genetic predisposition/?? Very little is really known ... and I wish there was more knowledge ... believe me. I asked a neuro-ophthalmologist if she would CT or MRI the ciliaries. She wasn't interested, primarily because it wasn't actionable. If this is genuinely what you have going on (also called 'pseudomyopia'), a good ophthalmologist ought to be able to elicit it pretty quickly, then treat it pretty minimally, likely through: -cycloplegic exam -verification that your current prescription is correct -evaluation of accommodative amplitudes, and -appropriate reading glasses to wear over your contact lenses, if appropriate. These are the prophylactic steps. If you, indeed, have ciliary spasm that persists or recurs, it would require more aggressive treatment, but (again, trust me: I know a bit too much about this one) it's pretty rare, especially (I believe) in nearsighted folks. As to the nutritional, or other 'fuzzier' approaches: I just found this site the other day. Take from it what you will: http://www.causeof.org/nutrition.htm#Habitual SignatureLive simply so that others may simply live > >My eyestrain is a threshold effect. For example. I can read > >for 4 hours with no problem if the lighting is good and I [quoted text clipped - 72 lines] > -- > Live simply so that others may simply live I have visited 3 opthalmologists already. My eyes with my prescribed contacts is 20/20. They even did pupil dilation tests to see the inside retina, etc. They all said I have no eye pathology. I know but I need the exact cause of my easily eyestrain right eye which their equipments have not able to pinpoint. Tomorrow I'll visit another one with larger laboratory and requests for more specific and high tech accomodative amplitude scan. What equipments must they have? Or it simply refractive error tests using lenses and stuff that normal optometrists can do when determing accomodative amplitude of the ciliary muscles and lens? Anyway. Here's my theory of what goes on in my right eye. Somewhere there is a very narrow artery in my eyeball. When I read a lot. The increase effort of the ciliary muscles use more blood. This makes my body pump more blood to my eyes. The increase level of the blood passes thru the eyeball, etc. narrow artery which cause pain in my eyes. What do you think of this? Flourescene Angiograpy is supposed to see the blood vessels at the back of my eyes. Are there tests to check the blood vessels in my eyeball, retina and ciliary muscles? The left eye just never gets eyestrain no matter how bad is the lighting and length of reading. Something should be wrong physically with my right that is subtle but exists. kyle > The left eye just never gets eyestrain no matter how bad > is the lighting and length of reading. Something should > be wrong physically with my right that is subtle but exists. I'm not answering your question, mainly because I have no clue, but if you just want a cure for your eyestrain while reading, do you think wearing a patch over the right eye would help? SignatureDan Abel dabel@sonic.net Petaluma, California, USA > I'm not answering your question, mainly because I have no clue, but if > you just want a cure for your eyestrain while reading, do you think > wearing a patch over the right eye would help? Good suggestion! Not an ideal cure but it'd be interesting to know what happens with the patch on either eye. -MT I think you are looking for a solution for your eyestrain by looking at the wrong type of specialist. The symptoms you describe suggest that you have a breakdown in your accomodative system, and I doubt that any ophthalmologist will find a physical manifestation of your problem. Keep in mind that vision consists of a complex system of higher level processes that can cause eyestrain that has no physical manifestation. There is a large body of knowledge that is shared by optometrists who believe in the "functional model" of the human eye. In essence, there are two models of the eye. The medical model views the eye like it were a hand or a foot. If it is broken, you fix it. The functional model views the eye as a gateway into a complex system that can break down anywhere along its path. The "medical model" is the basis of most ophthalmology residencies, the "functional model" is taught mainly to optometrists. The sub-group of optometrists that specialize in the management of visual problems like accomodative disorders are called "OEP Optometrists", which refers to the Optometric Extension Program. You can view the OEP website to learn more about accomodative disorders any eyestrain, and find a referral to an OEP optometrist in your area. That website is www.oep.org > some required nutrients or parts? What do you think? I > wonder if there is a CT scan of the ciliary muscles. MRI can reveal the ciliary but that won't really help eyestrain. Do you understand that if your contacts are "right" you should see with equal clarity in both eyes? You make it sound as if your contacts aren't equally clear. -MT > I have high myope of -9.0 nearsighted in my left eye and > -7.0 nearsighted in my right eye. > > Kyle When you are in the reading position, you would normaly look down some distance away from the optical center of the lens. Looking down this lens, say 10mm would produce a relative verticle prism of two diopters. This may be the cause of your eye strain. By the way, the eye with the higher power, needs to accomodate less then the other eye, but the difference in your case is insignificant. However when both eyes are used together, they will accomodate by the same amount. Roland J Izaac > > I have high myope of -9.0 nearsighted in my left eye and > > -7.0 nearsighted in my right eye. > [quoted text clipped - 9 lines] > > Roland J Izaac I see. Say. In a normal reading distance of 1 1/2 foot or so. What really happens to the ciliary muscles when the reading is done under poor lighting and good lighting. In the case of poor lighting. What I can't understand is that since the distance is the same, the accomodation should be the same. So how can the ciliary muscles be strained in this manner. Could it be that the processing powers of the brain and optic nerves get more strained when the book reading is done under poor lighting?? kyle >I see. Say. In a normal reading distance of 1 1/2 foot or so. What >really happens to the ciliary muscles when the reading is done under [quoted text clipped - 4 lines] >brain and optic nerves get more strained when the book reading is done >under poor lighting?? Again, I'll hazard a guess (I'm not all that busy at the moment). The "Near Reflex Triad" is what happens when you look at a near object. It involves three things: - Accommodation - Convergence - Pupillary Constriction These three processes are, IIRC, inexorably linked. If you inhibit one, you put the extra load on the others. Think about dim light reading. The eye fights to prevent pupillary constriction, forcing additional accommodation and convergence. If you have lower contrast sensitivity, or unequal pupillary reflexes, or--I imagine--any of a couple of other issues that create a variation in the Near Reflex Triad, you'd experience this sort of dim light issue. Little more "light" reading for you: http://snipurl.com/iw30 So far (and, again, I'm not an eye doc), I have to agree with Bill Stacy: you may be overthinking this while what you're experiencing may be relatively simple to address. MD's likely look for pathology. I'd still offer that you should see a good OD. SignatureLive simply so that others may simply live > These three processes are, IIRC, inexorably linked. If you inhibit > one, you put the extra load on the others. IOW you can't inhibit one without reducing the others. Actually I believe you can dissociate accommodation and convergence to some degree, but it takes special training and manipulation. > Think about dim light > reading. The eye fights to prevent pupillary constriction, forcing > additional accommodation and convergence. The retina can adjust a couple of f-stops in the scotopic range, even without shifting to low-light rod vision. Pupil constriction is usually beneficial because it reduces the need for accommodation. Most "dim light" problems are focusing problems, brought out by decrease in depth-of-field. -MT >>These three processes are, IIRC, inexorably linked. If you inhibit >>one, you put the extra load on the others. > > IOW you can't inhibit one without reducing the others. Actually I believe > you can dissociate accommodation and convergence to some degree, but it > takes special training and manipulation. Do you mean you can actually change the AC/A ratio with training? I didn't think that was possible. w.stacy, o.d. > Do you mean you can actually change the AC/A ratio with training? I > didn't think that was possible. In practice, I don't think it is. It's been a long time but I recall some measurable short-term changes were produced with computer anaglyphs. -MT > I see. Say. In a normal reading distance of 1 1/2 foot or so. What > really happens to the ciliary muscles when the reading is done under [quoted text clipped - 4 lines] > brain and optic nerves get more strained when the book reading is done > under poor lighting?? When all you've got is a hammer, everything looks like a nail. There are a number of different parts to the eye, and the ability to focus is controlled not only by accommodation, but by the pupil size. It's a simple fact of physics that a small aperture gives a greater depth of field than a large one. When you are reading with more light, your pupil closes down, giving you a larger range of focus. The light level has nothing to do with accommodation. SignatureDan Abel dabel@sonic.net Petaluma, California, USA Sorry, I did not read your post carefully, of course my previous does not apply to contact lenses. They would only apply when wearing spectacles. Roland Izaac > > I have high myope of -9.0 nearsighted in my left eye and > > -7.0 nearsighted in my right eye. > [quoted text clipped - 9 lines] > > Roland J Izaac >> >Thanks guys. Well. I already visited an opthalmologist last week. >> >He said my cup-to-disc ratio is normal and I don't have any eye [quoted text clipped - 11 lines] >> >right. This is only apparent when using them at longer time or >> >bad lighting. Have you had your contact lens fitter check your contacts by looking at them and checking the fit and the over refraction, not just the distance acuity with them? Maybe the right one is coated or scratched which would make it dry out during reading leading to discomfort and blur. Or maybe it is not fitting properly or not the right power. What patients call "Eye strain" is seldom due to eye muscles, much more commonly due to eye dryness, lid disorders, poorly fitting contacts, migraine headache and so on. Dr Judy >> >So anyone got any idea how to relax the muscles in my right >> >eye. Put ice? [quoted text clipped - 66 lines] > > Kyle > >> >Thanks guys. Well. I already visited an opthalmologist last week. > >> >He said my cup-to-disc ratio is normal and I don't have any eye [quoted text clipped - 23 lines] > > Dr Judy Hi, It's not just reading. I got eyestrain too when watching TV or movie more than 2 hours. The eyestrain never happen on the left eye. Just the right eye. Guys, I don't put patches on my right eye. Why should it. Sometimes closing both my eyes increase the right eye eyestrain as long as I think concretely. Therefore. If it's not ciliary muscles or pupil contriction. I guess it may have to do with the fact that the left brain is connected to my right eyes and somehow it is overactive. That is. I'm overactive in my left brain and almost minimal right brain activity (I can't draw nor sing nor write poetry). I guess I have to balance them to *improve* the right eye eyestrain. Also I'll ask for opthalmologist for CT scan in case there is a narrow blood vessel somewhere in my right eye having congestion when there is increase demand for more work in the pupil or ciliary muscles blood sytem. Maybe they can prescribe blood pressure medicine for the heart to treat my eye? It's been going on for 10 years. I'm mid 30s. Thanks. Kyle > >> >So anyone got any idea how to relax the muscles in my right > >> >eye. Put ice? [quoted text clipped - 66 lines] > > > > Kyle >> >> >Thanks guys. Well. I already visited an opthalmologist last week. >> >> >He said my cup-to-disc ratio is normal and I don't have any eye [quoted text clipped - 123 lines] >> > >> > Kyle You're overthinking this. Go see an optometrist. SignatureLive simply so that others may simply live Whoa. You MUST do a trial patching of one eye, then the other, before you do anything else. An hour or two will do. It will either have an effect or it wont. Either result will be helpful. Forget the CT scan, the ophthalmologist, and the nutrition for now. Save those for when all else fails. And study up a bit on the anatomy and physiology of the visual system. Both sides of the brain are connected to both eyes, for starters... w.stacy, o.d. > Guys, I don't put patches on my right eye. Why should it. Sometimes > closing both my eyes increase the right eye eyestrain as long as [quoted text clipped - 14 lines] > medicine for the heart to treat my eye? It's been going on for 10 > years. I'm mid 30s. > Whoa. You MUST do a trial patching of one eye, then the other, before > you do anything else. An hour or two will do. It will either have an [quoted text clipped - 7 lines] > > w.stacy, o.d. After much asking around from eye doctors. This is what happens. During eyestrain and reading over bad light. There may be activities in the ciliary muscles, pupil contriction, etc. But these are not enough to cause the eyestrain I have. So what happens is like this. When you are closing your eyes and think hard. Do you notice that somehow you are tensing your eyes as if its part of the thinking process. So when there is little eyestrain caused by the muscles. The brain can aggravate it by keep focusing on the eyes and further stressing the muscles. So what one must do it learn to disassociate between the brain and the eyes especially when the eyelids are close and vision is not required. Music can relax eyestrain because you are shifting focus to the ears and other parts of the brain that disassociate the visual complex and hence eye muscles. BTW.. during very bad eyestrain. I notice the blood vessels in the white of the eye around my cornea is bigger and redder and I used "Visine" drops to treat it. What I want to understand is how eyestrain can cause larger blood vessels in the white of the eye. I forgot to ask this from them. Anyone know why? Kyle > > Guys, I don't put patches on my right eye. Why should it. Sometimes > > closing both my eyes increase the right eye eyestrain as long as [quoted text clipped - 14 lines] > > medicine for the heart to treat my eye? It's been going on for 10 > > years. I'm mid 30s. > BTW.. during very bad eyestrain. I notice the blood vessels > in the white of the eye around my cornea is bigger and > redder and I used "Visine" drops to treat it. What I want > to understand is how eyestrain can cause larger blood > vessels in the white of the eye. I forgot to ask this > from them. Anyone know why? Problems with your contact lenses will cause both the redness of the eye and the "strain". See your contact lens fitter! Dr Judy > > BTW.. during very bad eyestrain. I notice the blood vessels > > in the white of the eye around my cornea is bigger and [quoted text clipped - 7 lines] > > Dr Judy When I went to the ophthalmologist the other day and got my eyes dilation. He suggests Optical Coherence Tomography. I didn't bring cash so didn't do it. I should have. Anyway. When use put drops in my eye to make my pupil large and paralyze the accomodation in the lens. I can still feel pressure. So I guess somewhere in the eyeball I must have developed some pain sensors. I wonder if there is a DNA tests where they can get the genetic information of eyes and run it in computer from birth to my age now and see what possible hereditary mutations could occur. I solved half of my eyestrain problem too. When we are seeing far. Our ciliary muscles are being relaxed. When reading. It contracts and effort is exerted. When I see afar, my eye pain is minimized. Now when one is going to sleep with eyes close. Does the ciliary muscles relax or contract? I think if you think so hard and use visualization, your ciliary muscles are not relaxing so I guess this is why I can still feel tension when i close my eyes at night because the ciliary muscles is not being relaxed. Do you think this is possible. Kyle > So anyone got any idea how to relax the muscles in my right > eye. Put ice? Say. When you close the eyes. Do the muscles still [quoted text clipped - 3 lines] > the right eye muscles. Is it possible my right eye muscles > is still being strained when I think a lot even when it is closed? Yes and no. The ciliary muscles are yoked so if one eye is focusing up close the other will too, even when covered. The extraocular muscles are not so yoked, and covering one eye does relax its EOMs. So if you are certain that prolonged patching of the offending eyes (hours, not minutes) does not prevent the pain, then you've pretty much narrowed it down to the ciliary muscles. For that, the fix is (Otis is going to love this) plus lenses over your contacts for reading, or if you're wearing your glasses, a weaker pair for near only. w.stacy, o.d. > > So anyone got any idea how to relax the muscles in my right > > eye. Put ice? Say. When you close the eyes. Do the muscles still [quoted text clipped - 16 lines] > > w.stacy, o.d. Yes. Sometimes closing my eyes at night increases the eyestrain further. However. At times when I don't think and I used my right brain (such as the imaginative side). My eyestrain is gone in the middle of night. If I think a lot. I woke up in middle of night with strong eyestrain. So I guess I have to learn to shift the energy in my brain from left to right brain. Or disassociate the connection between my right eye and left brain neural default. Also I wonder if something is organically wrong with my ciliary muscles in my right eye that can tire easily. Is there a CT scan of the eye to image the ciliary muscles at microscopic resolution? Also the eyeball has pain muscles. So it is possible the eyeball itself can add to the eyestrain in addition to the ciliary muscles? Note if you press your eyeball. It becomes painful. Therefore it has pain receptors unlike the optic nerve, right. Kyle > Yes. Sometimes closing my eyes at night increases the eyestrain > further. That doesnt' sound like eyestrain. It sounds more like dry eye. > However. At times when I don't think and I used my > right brain (such as the imaginative side). My eyestrain is [quoted text clipped - 3 lines] > Or disassociate the connection between my right eye and left > brain neural default. I'm hearing Twilight Zone music. > Also I wonder if something is organically wrong with my ciliary > muscles in my right eye that can tire easily. Is there a CT scan > of the eye to image the ciliary muscles at microscopic resolution? It's almost never the muscle. If you don't focus as well on one side, it's usually something to do with your prescription. Rarely it's a problem with the nerve that stimulates the ciliary. But that's all irrelevant until we know for sure that your contacts aren't out of balance. When you hear hoofbeats, it's usually horses. Occasionally it's zebras, but it's almost never satyrs. -MT
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