double vision (sixth nerve palsy) without a cause

[enkeedu]

Hello,

I am a 32 years old American of Chinese descent with no allergies, previous medical history.

I was diagnosed with sixth nerve palsy by a neuro-ophthalmologist, after experiencing lateral double vision when looking at far (more than 3 feet) objects that started and worsen over the past few weeks.  There was no clear cause as far as I could remember, no trauma / infection / etc.

I had MRI / various blood tests / nerve tests (no lumbar puncture) and all the tests came back unremarkable.

And today I opted in for a prism for my left eye to help reduce double vision, but it caused my vision to be blurry and I removed them.  Upon removal, I noticed that my double vision has gotten worse.  I was able to see normally within 3 feet and was able to read the monitor from the sceen perfectly, and now I couldn't do so without closing one eye.

I am pretty much at a lost right now as for what to do next to help diagnose the underlying cause / improve my vision back to before prism so I can get back to work at a job that I just accepted a few days ago.

Please let me know if you have any suggestions to help further diagnose the issue and help improve my vision or point me to the right direction to find out more about my condition.

Thanks!

[John C Hagan III, MD, FACS]

1. Many cases of 6th nerve paralysis/paresis are "idiopathic" that means a cause cannot be found. Studies done after death in cases like this often show very tiny strokes in the brain stem
2. Ask for a referral to a strabismus Eye MD (often called a pediatric ophthalmologist)

JC HMD

[enkeedu]

Thank you so much for the reply.

I am already seeing a neuro-ophthalmologist, should I ask for a referral to a strabismus Eye MD as well?  

At this point my neuro-ophthalmologist just suggested that I wait and come back to see him in a few weeks, and mentioned that sometimes these conditions might come and go in a few months.  And my neurologist said that my tests are quite unremarkable as well, and doubt that further blood tests / lumbar puncture would yield other tell tale signs.

And since the double vision can be avoided by wearing an eye patch, is it a good idea to do so?  Could doing so make my condition worse or prevent my vision from recovering?

I just started a new job on Monday and I want to decide whether I should continue doing so and learn to work with one eye (in case the condition is long term) or just take some time off and wait for the condition to get better / stable enough for operation and then resume to work afterward.

Thanks again for your advice.

[John C Hagan III, MD, FACS]

/Wearing a patch is a bad idea as it causes contraction of the eye muscles plus eliminates the fusion reflex that will try and align the eyes. Only patch if you have to as for driving.

Discuss with your neuroophthal    Many cases improve over 4-6 months, if not better then further improvement unlikely

JC ND

[enkeedu]

Thank you so much for your professional input Dr. Hagan.

I will discuss with my neuroophthal.  But I could probably do without working for a few months for now as I don't want to make the condition unrecoverable / worse.

[John C Hagan III, MD, FACS]

Working is not likely to affect your recovery one way or another. Good luck
JCH MD