eye trauma, 6 months point

[ghm]

I am looking for help with terminology as well as any comments about my condition.  I am a late 40's male that has always had glasses: astigmatism + myopia. Three years ago I was treated for a conjuctival lymphoma with biopsy and radiation.  Then, six months ago I was struck by a softball in the other eye, causing orbital fracture, among others (nose, zygo, maxillary).  Traumatic mydriasis. Diplopia since the accident.  Disconjugate gaze. One reconstruction placed titanium plates for fractures, and titanium mesh for sinus cavity and for floor of orbit.  The inferior rectus muscle formed scar tissue (hematoma) and anchored into the mesh, and the orbital implant had slipped.  A revision surgery and forced duction test one month later restored 80% of motility by replacing the orbit floor mesh with MedPor, but upgaze is affected because the muscle cannot relax enough. The orbital globe is maybe 2mm+ lower than before accident. There was not much left of the orbit floor to support the implant.
Now I am still seeing three doctors: cornea/disease, ped ophthalmologist and ophthalmic plastic surgeon.   Recently tried  prism lenses with 14 degrees of correction (split 7 degrees up/down for each eye) and really had trouble reading with the 1.5 x bifocal.  I became nauseous from walking with them.  The damaged eye has a shadow (mydriasis +astigmatism?).  Besides the general 20/40 corrected vision in the damaged eye (still taking pred forte and combigan) because of perhaps a cataract and remaining iritis,  I cannot seem to fuse the two images easily.  Every time I blink things go back to double for a second or two.  When I move my head to look at something, I have to re-focus and get the images to fuse again.   Things are fine if I am sitting and watching TV but I really don't do that much since my team exited the NCAA tourney.

My strabismus doctor says that surgery cannot fix the problems and delay in fusing images. He said that 14 degrees correction is treatable with corrective lenses, but if it were say 3x that much he would recommend surgery.

Is there any experience in this area, will this problem in fusing images get better?  I cannot imagine trying to drive like that, seeing two roads for a time. Not to mention photophobia from the mydriasis.   Is there a term for this delay in fusing two images?

Is the vertigo/nausea/general problems using the prism lenses something that can be gotten used to, or perhaps there is really something wrong with the lenses -- I admit it must be hard to fill this Rx with all the things going on.

grasping for info, or even looking for what questions to ask my doctor at the next visits, in 2 months.
Should I just keep wearing the eye patch and call it -- good as it gets?  of course a doctor doesn't want to discourage a patient, and every case is different.   Surely someone has had a similar injury.

thanks for any help or comments.  

George

[John C Hagan III, MD, FACS]

The term for failure to fuse is "diplopia) double vision.  photopsia is sensitivity to light and mydriasis is a dilated pupil.

Ask your strabismus surgeon about the patch. You have a difficult case with no easy fix. The only think I can suggest is a secon consult with a squint Eye MD

JCH MD