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Shadow letters after reading
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Shadow letters after reading

I have pretty normal 50-year-old eyes (one congenital cataract and a couple of drusen) but with one oddity that has stumped two optometrists, an ophthalmologist, and a neuro-ophthalmologist. It started 4-5 years ago and seems to be slowly worsening.

When I read or otherwise use my eyes for more than a very few minutes WHILE LOOKING DOWN, I get vertical "ghost" images. (Reading straight ahead, as on the computer, doesn't cause it.) I see shadow letters above the real letters, and slight ghosting above all other objects.

When I tip my head upward to a certain angle, the ghosting abruptly disappears. Worse when I'm tired. It slowly goes away within maybe 1/2 hour of stopping reading.

Finally the doctors had me look through a pinhole, which made the ghosting disappear, and they said it was thus a refractive problem. They gave me some odd Rx for reading glasses (saying the optician would think it was for bifocals, but it wasn't), and hallelujah, it prevents the ghosting!

They still couldn't tell me why this occurs. I later found some references on the Internet to corneal topography changes with monocular diplopia after reading in "downgaze"--do you think this could be the cause? Or any speculations?

I've had odd, mostly minor neurological and neuromuscular symptoms for 8 years that could be an autoimmune disease, but nothing diagnosed. Had a negative test for myasthenia gravis in 2000.

Thanks much for any info or speculations!

Nancy T.
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Hello Nancy T.  This is brainstorming and speculation on possible causes. Hopefully the extensive examinations you have had will exclude all or most of them. Corneal topography changes such as a cornea scar, keratoconus for instance, might cause monocular diplopia but it should not be exclusively positional like yours.

Possible causes (speculation):

1 Misalignment of the eye in downgaze-verticle heterophoria/tropia, thyroid eye disase, partially paretic (weak) vertically acting eye muscle, orbital pseudo-tumor, scarring or symblepharon of conjunctiva, vertical differences in the heights of the eyes/orbits, unstable cornea due to injury or refractive surgery,

2. Deformation of the cornea in one eye in down-gaze (some of the above could cause this) plus growth or tumors of the upper or lower eyelids.

3. Differences in the tear film height in downgaze (tear meniscus).

4. Holes in the iris (usually a laster iridotomy).

5. Optical defects such as bifocals that are not level, misalignment of the optical axis with the visual axis of the eye, looking through the lines on lined bifocal/trifocals, looking through blended area in no-line bifocals, irregular corneal astigmatism,

I'm glad that the 'odd' reading glasses corrected the problem.

JCH MD
6 Comments
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P.S. Forgot to say that the ghosting does NOT disappear when I cover one eye or the other. The "height" of the shadow letters sometimes changes slightly depending on which eye is covered, but usually not.

Nancy T.
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That additional information would eliminate the casues listed under 1 misalignment of the eys.
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152264_tn?1280358257
Wow, that's a lot of possibilities! But I realize the cause is unlikely to be determined for sure, after having seen two specialist eye MDs. I'm sure they ruled out lots of stuff, though giving little in the way of explanation or speculation (originally dryness and eyelids possibly needing to be pulled up were mentioned, but those apparently aren't the case).

No history of injury, surgery, and no bifocals, and whatever it is occurs pretty much equally in both eyes.

Thanks VERY much for taking the time to offer some speculations. My yearly exam is coming up and I'll see whether the ophthalmologist might have any new ideas. At the least, I'll get a second pair of those ghost-busting glasses! :)

Nancy T.
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152264_tn?1280358257
At my yearly exam with my ophthalmologist this week, I mentioned the theory of the cornea changing shape due to eyelid pressure when reading while looking down, but he didn't seem to think this was the case, or at least didn't say anything about it.

I got a good reminder the other day, in fact, that there is another thing besides reading that causes bad "ghosting," namely being sleep-deprived. I got only 4 hours sleep for two nights in a row (finishing a project) and the ghosting was pretty bad with NO reading at all. Hmmm.

Nancy T.
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A related discussion, vertical ghosting was started.
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A related discussion, Note for nancy was started.
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