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Bilateral Monocular Diplopia Help!
I have been experiencing a number of symptoms associated with my eyes as well as other areas of my body but more recently have been experiencing bilateral monocular diplopia. My first vision problem was an awareness of floater which started out as one black dot in my right eye then later a dot in my left eye and now many dots and lines as well as transparent dots that I can only describe as water bubbles (clear transparent circles) in both eyes. These visual floaters are most noticeable against a bright background. I am also experiencing blurred vision that comes and goes in either eye as well as a glare from light sources in either eye if I am in a dark area. I have been to see an optometrist and in his opinion my eyes were in great shape.

Since the visit with the optometrist the monocular diplopia has become more of a problem and is most noticeable when looking at light sources but I can also see ghosts images of objects if they are dark against a light background or vice versa. The diplopia is vertical; the ghost image is overtop of the real image. The only way it seems to disappear is if I tilt my head down and look upwards at the object or sometimes if I squint the ghost image will disappear. I have also tried a homemade pinhole test. When the pinhole in directly in the center of my vision the double image goes away, however when the pinhole is slightly above my center of vision the double image comes back.

Other symptoms that I have been having include tinnitus, frequent headaches, muscle spasms, pins and needles, and numbness.

I have had a CT scan done which came back normal and am now waiting to see a neurologist in 6-8 weeks.

Do these symptoms sound like it is something wrong with my eyes or is it something wrong with my brain? I am afraid that it could still be a brain tumor that didn’t show up on the CT scan, or is that even possible? I am also afraid that this could be some malignant form of MS. Please any input would be greatly appreciated.
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284078 tn?1282620298
I don't understand what you mean by bilateral monocular diplopia.  I gather that you mean that each eye all by itself sees a double or ghost image.  This could be caused by such things as astigmatism, other refractive error, corneal scarring, dry corneas, corneal dystrophy, cataracts or other problems.  Now if when you open both eyes you see two of everything and it goes back to one image if you cover either eye then that is binocular diplopia and is due to a extraocular muscle palsy or paralysis, or something physically pushing one or both eyes out of alignment.
I recommend you see a board-certifed ophathalmologist as soon as possible for a complete work-up.  If needed he/she can send you for a second opinion to a neuro-ophthalmologist.  I wish you all the best.

Michael Kutryb, MD
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Thank you for your input. I do get monocular diplopia in both eyes. If i close one eye the ghost image stays above the actual image as well as if i close the other eye the same thing a ghost image above the actual image. I do not believe I am experiencing binocular diplopia. When i close either of my eyes the image stays the same. Its like i have stereo double vision. I find it odd at least from what i have read that this monocular diplopia is occuring in both eyes.  Do you know if this could be caused by CNS problem or a tumor or something else? I would appreciate any more input you have towards this issue. Thanks again!
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284078 tn?1282620298
Most likely due to astigmatism or corneal problems (statistically) but other things could be  possible.  A good ophthalmologist should be able to lead you down the right path toward some answers.

MJK MD
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Thanks again for the info Michael. I am going to see an opthamologist next week who I have heard great things about. I will keep this post updated as to what is going on in hopes that I can help others that may be going through this as well.

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152264 tn?1280358257
I have the exact same thing--vertical ghosting in both eyes separately. The ghosting does NOT go away if I cover one eye or the other. This has been going on for several years. I am 50 years old.

Differences with your situation:

My ghosting occurs only (1) when I'm very tired, sleep-deprived--in which case it occurs spontaneously; or (2) after I've been reading (or otherwise using my eyes, such as balancing checkbook) continuously for more than a couple of minutes WHILE LOOKING DOWN (and then it resolves slowly over the course of maybe half an hour or so after I stop reading). I can read straight ahead (as on the computer) forever without this problem occurring.

Another difference is that my ghosting goes away abruptly when I tip my head UPWARD to a certain angle--not downward as in your case. Up a little, up a little more, a little more--and then the ghosting resolves completely when I hit the right angle. Mine also goes away when I squint my eyes partway closed.

Also, my left eye often gets a distinct but odd, nearly indescribable feeling (I would say "weak," but that's not a good description) when the ghosting comes on after a short spell of continuous reading. The odd feeling resolves as the ghosting does, a while after I've stopped reading.

I finally went to an ophthalmologist, and later he called in a neuro-ophthalmologist to see what he thought. Neither could tell me why this was happening--apparently neither of them had ever heard of it--but when they had me look through a pinhole, this made the ghosting disappear.

So they told me it was a refractive problem. The ophthalmologist prescribed some special reading glasses (somehow different from my previous ones) which keep the ghosting from occurring when I read. I'm very happy to have these, as I can now read comfortably as long as I want with a book in my lap. (Without having to tip my head up to read, which is not comfortable at all!)

From what I've read, it seems that if such bilateral monocular diplopia (or ghosting--I'm not sure if you'd call it diplopia when there aren't really two different images, but just the vertical overlap) goes away through a pinhole, it has to do with the eye itself, it's a refractive problem. If it does NOT go away through a pinhole, then it might be a brain problem.

Thus I think that what you are describing (so similar to mine) is likely NOT a brain problem (which would apparently be very rare anyway).

My eyes are also healthy otherwise, except that in the past year I've had elevated pressure and thus am on a six-month checkup schedule to make sure I don't get glaucoma.

I do not get floaters at all.

Please be sure to let me know what your ophthalmologist says. I'm very interested in this.

Also please take a look at this article, "Symptomatic Corneal Topographic Change Induced by Reading in Downgaze," which seems to fit at least partly with my symptoms:

http://tinyurl.com/yo62qs

I have also had, over the past 9 years, odd symptoms including dizziness, sudden hearing loss (when I sneezed hard), trigeminal symptoms, widespread paresthesias, Lhermitte's syndrome, a minor arm-coordination problem that lasted many months, trouble walking continuously (hip/upper leg muscles get very strained after a couple of blocks--another unsolved problem!). MS has been considered (in fact I was essentially told that at first, by a neurologist) but pretty much ruled out, and the neurologists gave up on me (and I on them--haven't seen one in five years). They never did a spinal tap or other extensive testing, but whatever I have is pretty mild anyway, so I've given up. Once you've been labeled a hypochondriac (even if it's supposedly only "part of the differential diagnosis,") that BECOMES the diagnosis, and you might as well stop talking to doctors! Because they will have stopped listening.

I have no idea if the eye thing is connected to everything else, but it's odd and sometimes frustrating to have so many odd problems that doctors say they have never heard of. At least the ophthalmologist did not brush me off or treat me like a hypochondriac. He was one of only two doctors who never did (the other was my ear doctor).

Nancy T.
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Well I went to the ophthalmologist today and again my eyes checked out fine. The Dr is a professor at a university and highly recommended by a lot of people around home so I am content with his examination. Not only was he very thorough today while looking over my eyes, but he is sending me for an orbital CT scan to make sure again that there is nothing wrong in my head as well as a scan of my peripheral vision. I had a CT scan about a month ago and it checked out fine so i am hoping that this one comes back ok as well! If anyone has any comments or opinions about this matter again I am grateful for any input.

I was wondering if this could be all psychogenic? I was under a lot of stress for a while, but have resolved all the matters about a month or so ago and a lot of these symptoms are still bothering me!
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152264 tn?1280358257
Doesn't sound psychogenic to me (a layperson), certainly not the vision problem.

Keep your neurologist appointment and let us know what he/she says.

Glad the eye doctor found nothing wrong with your eyes. But did he recommend any type of glasses prescription to try?

Nancy T.
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I know my 'ghosting' is different in each eye because my left has 3 images when looking at a light/moon and the right only has 2 images. This is a progression from 2 in left and none in the right eye. MMMMM. Irritating is the nicest word to describe the problem. If it were cataracts I'd have it fixed....darn, corneas are fine.
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152264 tn?1280358257
Marilyn, do you know the cause of your multiple images? Have you seen an ophthalmologist, and what have they told you? Is there anything you can do that makes it go away temporarily?

Nancy T.
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I, too, suffer from bilateral monocular dipolia, beginning maybe 20 years ago.  It comes on when I read or work on the computer too long, and gradually goes away if I distance focus for 1/2 - 1 hr.  It starts with ghosting, but can progress to two full, essentially equal, images if I keep working/reading.  At the time I was first 'diagnosed', I was told that little was known about such conditions and no 'cure' was known -- so I've lived with it - taking 'eye breaks' as necessary.  As time goes on, the period of reading or other close work seems to decrease before the symptoms reappear.  I wear bifocal reading glasses and have needed bifocals for many years.  About 8 years ago I had Lasik surgery for my severe near-sightedness (to allow me to function in snow storms without glasses).  It seemed that the diplopia diminished somewhat after the Lasik, but has come back, now worse than ever.  (I am now 66.)

I had not heard of the pinhole test and just tried it.  My double vision does seem to go away when looking thru a pinhole -- but I can't read or work like that.  Tilting my head doesn't seem to change anything.  My eye doctors have never found any observable 'health ' problem with my eyes.

I'll now follow this thread in case anyone has found a real cure for this condition.

Bill I.
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152264 tn?1280358257
Maybe I should ask my ophthalmologist at my next appointment exactly what he "put" in my special reading glasses to prevent the ghosting from occurring with reading. I do remember he said that the optician would think the prescription was for bifocals when it wasn't.

However, in my case the ghosting only occurs when I read looking down (e.g., with a book or papers in my lap or on a table). It doesn't occur when I'm reading straight ahead, as on a computer screen.

But it does occur without any previous reading if I'm very tired (sleep-deprived).

Surprised to hear so many others have this problem--the two ophthalmologists I saw, one of them a neuro-ophthalmologist, had never heard of it.

Did anyone read the article for which I posted the link? What do you think about it?

Nancy T.
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It seems to me that everyone else that has this problem only acquires it after reading or doing some sort of concentration with their eyes for an extended period of time. My diplopia lasts from 80-100% of the day after doing nothing to provoke it. I simply wake up with it and fall a sleep with it. It is very annoying for the most part but it seems that I am now getting use to it and just ignore it. It is very similar to the constant tinnitus, or ringing in my ears, it is there but my senses are just use to it and ignore it. I am very interested in the prescription that you received Nancy as my ophthalmologist had mentioned nothing about glasses at all but if it could help me I would be forever in your debt. As I have mentioned before I have tried the pinhole test and it seems to clear up the double vision so as Nancy has already stated and from what I have read it is most likely a refractive error and not neurological (fingers crossed). I am going for a CT scan of my ocular area (I forget exactly what the area is called) tomorrow and should be in contact with my ophthalmologist soon so i will post again any findings they see or not see. Thank you everyone for sharing your stories. It is a good feeling knowing im not going through this alone and others have experienced to some degree what i am going through.

Brock
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152264 tn?1280358257
Brock, I would really try to find an ophthalmologist who is willing to work on solving your problem. I know next to nothing about the eyes, but I would think that if your problem IS a refractive one, they ought to be able to do something about it with glasses.

Perhaps after your CT results the doctor will discuss all of this with you and find a solution.

I think it would drive me nuts to have double vision all the time. Tinnitus is one thing--you can tune it out--but not seeing clearly is not something I could ignore!!

I don't see my ophthalmologist again until July 1, but I'll try to remember to ask him then what is different about the glasses he gave me. I have no idea what my prescription is--I can't ever remember numbers like that--I just hand it over to the optician and forget about it.

Best of luck to you, and keep us updated.

Nancy
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I too have recently started getting ghost vision in both eyes and it is in each separately.  I am 33 years old and pregnant - so the optician said to wait and see what happens after I have had the baby.  With a pinhole mine clears up fine.  I have a slight astigmatism in my left eye so that might be the cause of that.  I obsessed about brain nasties too - but from the little I have read that seems very unlikely.  I noticed the problem in November but thought my vision had been a little odd for a month or two before then.  Mine is not very noticeable during the day or in good light, but as soon as light starts to fade in the day I start to get ghosting.  So I guess if it were a brain problem it would not be linked to light - wouldn't that be more a refractive issue?  The optician said I had good vision otherwise and did give me some glasses that have helped a little with my left eye.  Any comments gratefully received :)
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152264 tn?1280358257
Why did the optician think it might change after having the baby? Did s/he give any reason for thinking that?

My comment is that you should see an ophthalmologist (MD).

Odd how it seems we all have different things that make the ghosting worse--in your case low light, in my case reading looking down...who knows??

I wish one of the doctors would comment on your "ghosting is worse in low light" problem.

Nancy T.
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Thanks for your reply.  I think it indicates it is a refractive issue.  With a pinhole at certain angles my sight is perfect - so this rules out brain issues as I understand it. :)
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Hey everyone...great to see all the coments and it is funny how every gets this ghosting differently. I am still waiting on the results from my CT scan (I should here back from the doc soon and to be honest if it was any kind of emergency i think i would have heard from him by now). Anyhow I have been searching the web for more info on this phenomena and came across this interesting website. It has a simulator on it to display what your double image, or "ghosting" as they put it, looks like. My settings are - ghost light colors - opacity at 50 - and the one circle is set about halfway up the other one. Was wondering what everyone else was seeing, or how similar we all are to each other. Anyhow again if I get any news from the doctor i will pass it on.

Thanks,

Brock
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http://www.thevisioncommunity.com/index.php?option=com_content&task=view&id=52&Itemid=145
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Thanks for that.  Well mine is light colours although I do get some dark but only on light backgrounds and faintly.  Opacity 27 and really I needed to position the yellow circle above and below by about 1/6th.  Good luck with your scan results.  Out of interest how come they do not use MRI imaging? :)
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I am scheduled to see a Neurologist towards the end of the month. It was my GP's advice to wait and see if the neurologist wanted to have the MRI done but i am sure it will be done eventually. The waiting list around here is sooo long. My GP said for him to book it, it would be like booking an appointment with God but if the neurologist thinks that it is necessary than it would be a lot quicker for her to do so.

Brock
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Why a neurologist?  Is it not an eye issue?  How long has it been going on for?  Are you concerned?  Thanks :)
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"First, determine whether the diplopia is monocular or binocular. If the diplopia is still present with one eye covered, it is monocular. The common causes of monocular diplopia include cataract, refractive error, corneal abnormalities, retinal surface abnormalities, and psychogenic. If diplopia clears with the pinhole test, one can assume that the etiology was optical."

Taken from http://www.aan.com/familypractice/html/chp2.htm just over halfway down. :)
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Like i said in my first post this is one symptoms of many. It is definitely monocular diplopia in both eyes, hence title "bilateral monocular diplopia". My other main symptoms at this time are floaters in vision and constant tinnitus but my condition started with many other symptoms which have not been bothering me for a couple weeks to a month now. But because of all the symptoms that I was experiencing and finding no physical explanations for them my GP decided to send me into a neurologist.  
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152264 tn?1280358257
Interesting site! I guess for me the opacity is around 50 percent; the ghosting is slightly above the real image; and I guess all colors seem to do it--can't tell very well from the picture. My ghosting is lots more noticeable with items closer up, and especially in reading.

Larshy, I'll be interested to hear what your neurologist says. I've had lots of weird symptoms unexplained by neurologists, but I never told them about the ghosting because it began after I was all through seeing neurologists (or, rather, they were through with me) in the early 2000s. Only the ophthalmologist has heard this from me.
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I have had floaters and tinnitus for over a year now.  Similar symptoms!  Be interested to hear you results.  Although I put mine down to Post Natal Depression after my youngest was born - I suffered from terrible anxiety which caused many, many physical problems.
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Well I went to the neurologist Tuesday. She did a general neurological exam and told me that I seemed fine from those findings but has ordered an MRI to be done just to make sure. My floaters have been getting less prominent as of late while my double vision and tinnitus is going strong. I asked the neurologist what she thought they could be caused from and she told me most likely stress and that they would hopefully, eventually go away. I will keep checking and posting on here, especially if I find out any more information that could help.
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152264 tn?1280358257
Hi larshy, thanks for the update. The answer your neurologist gave you sounds about typical. They like that diagnosis of "stress" for symptoms that "will go away."

I wasn't ever actually told "stress," but I was certainly painted as a hypochondriac after the MRI didn't show anything significant.

Fortunately my ophthalmologist has never suggested "stress" or any other doubtful diagnosis. He just says he doesn't know. Lord knows what he's thinking, but thank goodness he isn't one of those doctors who ASSUME they know everything about you and your symptoms.

Hopefully your  neuro will talk to you more seriously once the MRI is done, even though it may well not show anything (usually they don't).

How long has your double vision been going on, and do YOU think it's due to stress?

Nancy T.
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152264 tn?1280358257
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