Double Vision after Laser Surgery for Retinal Tears

[Twotwelve]

I posted (longer version) yesterday on the Community Forum and Dr O suggested I repost to Dr Hagan....  
I am a 55 y/o female, moderately nearsighted. On 6/26, I had laser surgery on my right eye for retinal tears. the dr numbed my eye & socket prior to the surgery. After the injection, he pressed gauze over my eye, told me to hold it very firmly against my eye & left for 5 minutes or so. He did the surgery & patched my eye. He told me I could remove the patch the next day and that I might have blurred vision, double vision or a droopy lid but it should clear up by Mon. When I removed the patch on Sat, I had severe double vision, which is probably considered hypertropia. My right eye appears to be focusing up (there is more white showing under it than the left eye) and seems to be off axis- what the left eye sees as horizontally level, the right eye sees sloping down to the right. The vision in the right eye seems to be somewhat distorted making me feel woozy. Needless to say, I cannot function without covering one eye. On Monday, I returned to dr's office and he said the repairs looked great and he told me he honestly thought my eye would be fine but that it was just taking me longer to get over the anesthesia. Now, it is Sat (5 days later) and my vision is still double. I can't help but wonder if I will be stuck with this situation and it has been very difficult to even imagine that. I do have an appointment to go back on Monday (in 2 days). My questions: Could my pressing so firmly on my eye have pushed my eye out of place and left it frozen there? Will it ever return to normal on its’ own and how long could it take? (It does appear sometimes now that there is less white showing under the eye but I can‘t tell that my vision has improved.) Or, if not, can it be returned to normal surgically or by some other means? Would a retinal/vitreous specialist (the one I'm seeing) do the surgery, or will I need to find another doctor? Thanks for any help you can provide.

[Michael J Kutryb, MD]

If it doesn't get better in a few weeks or so, It might indicate that there could be a permanant deviation and a consultation might need to be arranged with a pediatric ophthalmologist that also does adult strabismus surgery.  I have seen a few patients with cataract surgery done elsewhere that developed vertical double vision after the surgery, possibly related to the retrobulbar or peribulbar block.  The two  patients I recall, both had excellent resolution of symptoms after strabismus surgery.  It's very common for double vision to remain for up to a day or so after a retrobulbar or peribulbar block but I, myself, would be very worried if persistant after more that 2 days.

Michael Kutryb, MD

[Twotwelve]

Thanks, Dr. Kutryb....Just now saw your post from last night.  My vision started to improve last night (around the time you were posting) and now, to look at it, the right eye seems to be almost in normal alignment to the left.  I can focus with both eyes if I hold my head in the same position on the same level (as in watching TV) but when I look away, down (to a counter or the floor) or move my head to a different level, the double vision returns.  Sometimes I can refocus both eyes together and sometimes not.  It also seems to be much better in the evening (with a glass or two of wine!). Last night and tonight, I was able to walk around with both eyes open without too much trouble.  But at the office today, it was much more difficult. Also, I had to keep my rt eye covered to work on the computer & looking from paper to the computer would be out of the question.  When I did try to use both eyes, as in looking at one object, most of the time I couldn't.  However, right now (10:15PM), I am typing this with both eyes open.  Go figure!  By any means, it feels great to be able to use both eyes together, some if not all of the time.

Returned to the retinal specialist again today and he stills seems very optimistic that I will be fine. He mentioned that none of his patients had taken this long to get over double vision from the procedure but he does not seem to be alarmed.  I pressed him regarding what if I did not get over it and he said the only thing he would suspect is that it could be the muscle was damaged at the site of the anesthetic injection (which he said has never happened in his many other surgeries) and when I return in a month, we'll look into what to do next.  This may be akin to what you are saying about a permanent deviation.  I'm not sure if I will wait a month but since it is improving a bit now I will give it some more time.  (I'm going to the coast for a week day after tomorrow so maybe that will help!)  I have already made a list of board-certified pediatric ophthalmologists/strabismus MDs in the area so I will an idea of where to start. I really appreciate the encouragement regarding the two patients you recall that were helped with the surgery. It is good to know that I hopefully won't have to live like this. And, most of all thank you immensely for your time and the service you are providing.  It is priceless!

[Twotwelve]

Two things I forgot...

My eye was dilated this morning so that probably had much to do with not being able to focus during the day today.  I'll see how tomorrow goes.

Also, is there any disadvantage to waiting a few weeks to consult about the strabismus surgery?  Could that jeopardize the success of the surgery?  I wouldn't think so but wanted to see what yours thoughts are regarding that.  Thanks, again.