double vision problem

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ns29342@NO-SPAM.NO-SPAM - 07 Feb 2006 19:14 GMT

Hello,

I have a double vision problem in my left eye. I've been to see an
Optometrist and received the deluxe "medical" eye examination (i.e. more
thorough that the get-a-eyeglasses-prescription type exam). I was
pronounced healthy with 20/20 corrected vision. The optometrist could find
nothing wrong, so I'm hoping someone here has experienced the problem and
might have an idea.

The problem has persisted for at least two months. My left eye experiences
a vertically displaced double image approximately one half degree below
the main image. There is a kind of "smudge" or "trail" of images between
the main image and the double-image. When viewing a pinpoint light source
(like a stoplight), the effect looks like the following:

O
.
.
.
.
o

The big "O" is the primary image, the little "o" is the double image, and
the "." are the smudge of minor double images.

The problem is most dramatic at night or when viewing bright objects on a
dark background. When I watch cable news on TV with scrolling text at the
bottom, I can clearly see two lines of text with my left eye. The problem
is restricted to my left eye (i.e. if I cover my right eye, the problem
persists). When both eyes are open there is a kind of filtering-out
phenomenon where the double images are reduced in intensity.

The problem varies slightly from day-to-day in intensity. Twice I have had
more-severe symptoms of a vertically displaced double image two to three
degrees above the main image, making night driving difficult. In each
case, those severe symptoms lasted less than a day, and vision returned to
the milder symptoms.

I have had a few instances of waking in the middle of the night with a
moderate itching sensation in my eye. It felt like my eye was being
scratched by my eyelid as I blinked. This has led me to believe tht maybe
I've had a dry-eye problem and/or slept with my eyelid open during the
night. However, when you wake up to something like that in the middle of
the night, you're disoriented enough from sleep not to be able to evaluate
the situation.

I'm 30 years old, generally healthy, with no known diseases and on no
medication.

Thanks.

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Mike Tyner - 07 Feb 2006 21:03 GMT

> pronounced healthy with 20/20 corrected vision. The optometrist could find
> nothing wrong, so I'm hoping someone here has experienced the problem and
> might have an idea.

Monocular diplopia can be caused in different ways.

Most common is corneal distortion; that's either normal anatomical
variation, or abrasion/scarring, or deformation from a chalazion or
hordeolum under the upper lid. Typically it disappears when you look through
a pinhole, because you're isolating a smaller sample of the corneal
curvature.

Similar distortion (diplopia) can arise from the crystalline lens inside the
eye, but that's usually when you're older and beginning to form cataracts.

Corneal topography might reveal a bump or dimple in your cornea, but it's a
pretty academic exercise. I wonder if the optometrist everted your lid
(turned it inside out to look for bumps).

> The problem is most dramatic at night or when viewing bright objects on a
> dark background. When I watch cable news on TV with scrolling text at the

Bright objects on dark backgrounds are best suited to demonstrate the
problem.

> I have had a few instances of waking in the middle of the night with a
> moderate itching sensation in my eye. It felt like my eye was being
[quoted text clipped - 3 lines]
> the night, you're disoriented enough from sleep not to be able to evaluate
> the situation.

That's a reasonable cause. To test it, try a small squirt of Lacrilube or
Refresh PM in the lower lid at bedtime. These are bland ointments that
protect the eye overnight if it's exposed during sleep.

-MT

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RM - 08 Feb 2006 01:00 GMT

I would suspect either astigmatism, or corneal problems (which can induce
astigmatism). Since the effect seems to come and go I would guess their is
a corneal problem. It would be nice to have corneal topography done to see
if the overall shape of your cornea. Perhaps your optometrist has already
done it or can have it done.

I would recommend trying an aggressive round of artificial tear supplements
as suggested by MT. Use thicker gel-like supplements at nighttime and
semi-thick supplements at least four times throughout the day (recommend
Refresh Plus or Systane).

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> Hello,
>
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ns29342@NO-SPAM.NO-SPAM - 08 Feb 2006 05:34 GMT

Hello,

I wanted to thank Mike and RM for your advice. I'm going to give one of
the artificial supplements a try next time I stop by the drugstore and see
if it does any good.

In response to your questions, I did have a corneal topography performed
when I visited the optometrist, but it wasn't definitive. Nothing severe
enough to justify the problems that I was having. He didn't check my
eyelid or perform a pinhole test; I'll suggest those next time I visit an
optometrist.

I tried a pinhole test myself (well, a pen-sized hole punched through a
sheet of paper, held at close range), and it does seem to filter out the
double images, so I guess that means we're on the right track.

Thanks for your advice!

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