Vertical Double Vison

3 years ago a friend of mine had sudden onset verticle double vision.  Multiple test MRA's MRI's and Stimultion test were done and only thing scene was a single minute foci in t1.  Myasthenia Gravis was considered, but new blood test at the  time to help rule it out were negative.  Doctor also tried a trial by treating her with medication for MG with no results.  She has been to several neurologist, nero-opthal, regular doctors...etc.  About 2 weeks ago it started again with slight numbness under her cheek on one side. In order to correct vision, she tilts her head down to try and see 1 object. Not sure what to do next or where to go....Any help or guidence would be appreciated.  Patient family has a history of Charcot Marie Tooth.  But father is negative as carrier.

[John C Hagan III, MD, FACS, FAAO]

Hello ck3471  I assume from the way you wrote this that eventually the verticle double vision (3 years ago) cleared up and has now reoccured.

Charcot Marie Tooth should not be a factor.  The face turn and head tilt to try and acheive single vision and the vertical component indicate the problem is likely the inferior oblique, superior oblique, superior rectus or inferior rectus eye muscles that are not working properly.  Of these the superior oblique (4th cranial nerve paresis) is the most common.

I would suggest she see a strabismus specialist since she's alaready seen a neuo-ophthalmologist.  Re-evaluation is appropriate with the reoccurence.

JCH III MD Eye Physiciand & Surgeon

[ck3471]

Patient is age 41....

[ck3471]

yes intermittant 3 years....lasts a few weeks than goes back to 20/20 vision ....saw a strabismus specilaist...refered back to neuro-opto

[Nancy T]

Does she have any other odd symptoms?

Does the double vision go away when she covers one eye?

Is it actually double vision, or is it just ghosting?

When she has the double vision, is it all the time, or on and off during the day? Does anything bring it on, such as reading, or heat?

Just asking out of curiosity. I have a longtime unexplained problem with vertical ghosting (in both eyes separately) after I read or when I'm very tired. The ophthalmologist didn't seem to know what is causing it nor apparently even what to call it, but he gave me some reading prescription that prevents it from occurring when I read. Mine was not "sudden onset," and it never goes away.

I have to tilt my head UP in order to lose the ghosting when it occurs. That is what I don't understand. Once my head reaches a certain upward angle, the ghosting abruptly and completely disappears. The neuro-ophthalmologist (in a five-minute visit after I saw the ophthalmologist) had me look through a pinhole, which made the ghosting disappear, and thus he determined that it was a refraction issue (eye problem as opposed to nerve or muscle problem, I presume--neither doctor then said anything more to me about the nature of the problem, just gave me a new prescription, but it worked!).

It sounds like your friend has certainly had the full workup... it's a bit surprising to find out how much the doctors CAN'T explain, as I assumed earlier in life... in your 40s all kinds of weird stuff can start happening! Many things can remain unexplained.

Nancy T.

[ck3471]

A related discussion, Vertical double Vision now with face numbness was started.