acute double vision - right eye drifts towards nose

[sweetielight]

Hi there:
I am trying to find out the possible causes of this condition of my mom (age 58). About 3 days ago, she complained about seeing double. When I looked at her eyes, it was very obvious to me that her right eye looked a little bit towards her nose. She can still move her eye from left to right, up and down. When she looks straight at me, it seems ok, however, when she looks a little bit to the left, her right eye looks a lot more to the left than her left eye does. Either eye has no vision change if she just covers the other, but with both eyes looking, she sees double, closer objects are better, but further objects are way off. Objects are doubled horizontally when she looks to the left, and vertically when she looks to the right. No pain in the eye area, a little headache, dizziness, probably due to seeing double. I took her to the doctor, found no problem with blood work (not sure what blood work), no problem with CT scan. MRI showed few minor aneurysm, and some kind of "looping", but according to the special care cordinator (not a doctor) on the phone when I checked her MRI result, they were minor issues that "shouldn't cause her condition with the eye". Now we are waiting for a call back to schedule her to see a specialist (neurologist I assume), not knowing how long this is going to take (up to 10 days), and her situation not getting any better, I was hoping that I can get some help here. Could it be some kind of sinus infection, viral infection, optical muscular degeneration, optical nerve problem? I am just at a lost here, I have no medical background what-so-ever, but to me, as an adult, you don't just all of a sudden see double with one eye crossed a little bit. She had a lot of medical problems after she hit 50, brain membrane infection, optical nerve ending infection in her right eye (all these happened and were diagnosed in china, so I am just translating the terms, not sure what the real medical terms are of these diseases).

[sweetielight]

You have my greatest gratitude for helping me!!! My mom has an appointment with an opthalmologist tomorrow morning, she was admitted into the hospital yesterday, because none of the symptoms (double vision, cannot open both of her eyelids) were going away, on top of that, she started having dizziness/drawziness, and pain (5 on a scale from 1 to 10 in her right eye, and 3 in her left). They did more blood work, and a lumbar puncture. Some of the results are not back yet, but the doctor suspect it's myasthenia gravis like you had mentioned. This test they were going to give her was no longer make in the US, and they were not comfortible with the replacement test, so they were thinking of giving her low doses of whatever medicine to treat MG to see if her situation improves. They also suspect it to be MS, I guess they will know for sure when the lumbar pucture result comes back.
Thanks again for all your help, and the information you provided me with! It is truly great to be able to get doctor's, your help on medhelp.org. I will let you know the end result!
Julia

[Michael J Kutryb, MD]

She needs to see any ophthalmologist as soon as possible.  The neuro-ohthalmologist can be seen later as soon as an appointment can be found.  An ophthalmologist needs to see her in person right away   Some things you described could even suggest a 4th nerve palsy.  A 3rd nerve palsy could make one pupil large and a droopy eyelid on that side only.  Finally, myasthenia gravis can cause both eyelids to be droopy also with intermittant variable double vision (also sometimes assoicated with weakness and difficulty swallowing) so myasthenia gravis also needs to be considered in this case.

MJK MD

[sweetielight]

Dear Dr. Kutryb,
Thank you so much for your replay! I checked with her, and she still said that the double images are better when she looks to the right without turning her head. She said one image (the one she gets with her left eye) is normal, a straight horizontal line looks like a straight horizontal line. The other image (the one she gets with her right eye) is not horizontal, a straight horizontal line is lower to the left, and becoming close to normal on the right. So the two images are way off to the left, and slowly getting better to the right because they are getting closer to each other. And when I look at her right eye, it's not stuck towards her nose, she can still move it around, it's just turns to the left a lot further than the left eye when looking towards the left.
Now, a new sympton had developed, SHE CAN BARELY OPEN HER EYELIDS! The left upper eyelid is worse, she can open about 1/4 of the normal length even she tries really hard. The right upper eyelid gets about 1/2 of the normal length!!!
I am really concerned! I located a neuro-opth docter in fremont, ca, I will call the office. Meanwhile, with the new sympton, does it confirm a cranial nerve palsy?
Thank you!!!
Julia

[Michael J Kutryb, MD]

Sounds a lot like a possible 6th cranial nerve palsy (but some of your description seemed a little off.)  If the right eye looks turned in toward the nose then I would expect the double vision to be much worse when her eye looked to the right.  You said the double vision is worse when she looks to the left - which confused me.  Basically she needs to see a neuro-ophthalmologist right away because she likely has a cranial nerve palsy which can be caused by many different factors.  If the neuro-ophthalmologist office can't get you an appointment soon, explain your symptoms and ask for an appointment as soon as possible.  In the meantime see a general ophthalmologist in your area.  Look at www.aao.org to use the search feature to find a neuro-ophthalmologist in your area.  If you get a chance try to check her movement again and see which way her eyes look to make the horizontal double vision better and which way to make it  worse (Not which way her head turns.)

Michael Kutryb, MD

[sweetielight]

These happened 6 and 3 years ago. Oh, and right side of her face had nerve paralyses about 4 years ago that was not caused by a stroke, it just happened one day.
Any help/suggestion is greatly appreciated, I didn't want to sit and wait, and miss the oppotunity to get her treated for whatever this is...

Thank you!
Julia