fourth nerve palsy

Hi
I have had double vision (2 seperate pictures - side by side) for about 2 years. I have had CT & MRI scans, lumbar punch, many blood tests. No cause or anything sinister has been found yet.

The Opthalmolgist found 4th nerve palsy.
Can eye excersizes (from Fistibula Physio) help or correct this?
Is it wise to get prism glasses and might they correct the DV?
I have been on Cymbalta (for Fibromyalgia) for a few years. Could this be a cause?
Is the 4th nerve paralised with no hope of getting better?

MANY thanx!

[Michael J Kutryb, MD]

I suggest you see a neuro-ophthalmologist to find out exactly what you have.  If indeed you have a 4th nerve palsy then an appropriate workup would need to be undertaken, often involving an MRI.  They sometimes get better and often don't.  In some select cases surgery can be beneficial but in most cases, prisms can be helpful.  Exercises are generally not that helpful in my experience.  I want to stress, that if you are that interested in your treatment and prognosis you need to see a neuro-ophthalmologist!  FInally, yes, the cymbalta could have a negative effect on  double vision problems.

MJK MD