Double Vision After Cataract Surgery

My husband had cataract surgery two months (left eye) and one month (right eye) ago.  His left eye has a lens that allows him to see close up, and his right eye has a lens that allows him to see at a distance.  He was having no trouble at all with this arrangement for the first 30 days after the second surgery.

One week ago, he suddenly developed double vision, which has gotten slightly worse since he fist noticed it.  His eyes are clearly not tracking quite the same.  His opthamologist thinks this is a microvascular nerve palsy which will resolve over time.  However, he has no diabetes or hypertension or other risk factors.  He is 68 years old.

Questions:
1)  Can this have been caused by the cataract surgery?  It is strange to be 30 days post-op (rather than immediately afterwards) but also strange in that he has never had such a problem prior to the surgery.
2)  How long is improvement likely to take?  Will it be gradual?  We are quite worried about this, especially because the condition seems to be getting worse, not better.

[Ray T Oyakawa, MD]

I doubt it.  It would be helpful if you mentioned which nerve was involved.  If the 6th, (most common),it will take 6 to 10 weeks to resolve.  It will not get better it it is not from a micro vascular cause and can be due to an anerysm or tumor.

Dr. O.

[kemory]

Thanks for this quick answer!  And in the four hours since I posted the question, we have discovered people complaining about developing double vision as a result of monovision lasik surgery or contact lenses.  I am wondering if THIS could be the cause of his problems.  Looking at him, I can definitely see that his eyes do not track the same as one another.  Does this point away from a monovision cause?

We think it IS the 6th, since the double vision is side-by-side.

[kemory]

I am still hoping for a response to the last question, but another one has come up: his affected eye, the left, tracks left and right, just not in concert with his right.  So it appears to be a coordination issue rather than a problem with the ability of the eye to move left and right.  Is this  consistent with a 6th cranial nerve microvascular palsy?