Strabismus exotropia post Vitrectomy Cataract

[Beverly914]

Hi,

Brief history 53 yr old, last year had a detached/torn retina that was repaired via Vitrectomy ( no buckle) I developed a cataract that was repaired and IOL implanted last month. Only one eye has been affected. My good eye is nearsighted and I wear a -7.00 contact lens all the time. The IOL corrected my bad eye to mini-monovision so I can read a computer screen

As seems ok when I look at things individually but when looking at things with both eyes there is an overlap now, especially when looking at letters  

Today I saw a pediatric Ophthalmologist who determined I have a 4 degree outward tilt Strabismus exotropia  on my Vitrectomy/cataract eye

He said either the Vitrectomy or the cataract surgeries "may" have caused the problem. I had never heard of this as a side effect

He is going to try to see if Prism glasses will help

Trying to find out what other options I may have and if this is a know possible side effect with the 2 surgeries I had

Thank You

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

Your situation is complicated and you have a cataract surgeon, retina surgeon and strabismus specialist.

You will need to discuss your options with your team.

If your good eye does not have a cataract you could even consider a PRK laser.

JCH MD

[Beverly914]

Thank You Dr Hagan for your reply

It seems to have begun a few days after my Cataract Surgery. What is odd ( or maybe not so odd) is that the closer my vision is to each other the less the double effect

I am wondering and will ask my Dr the next time I see him, what would happen if instead of a -7.00 contact in my good eye I use an Rx that gets my eyes closer to each other, my IOL implanted eye is now at 20/40, I could make my contact corrected eye 20/40 as well with a -4.00 for example ( instead of the -7.00) then see what that looks like. Or am I off target with that thinking ? If course then I would need glasses but the glasses Rx would be near the same for both eyes to get them to 20/20

I realize my eyes are now drastically different from one another, one has an IOL and no Vitreous, plus a scar near the macula where the tear was repaired

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

You were told correctly.  Double vision after retinal detachment surgery is extremely common and often unavoidable. You can use the search feature and archives and read the many posts about the problem. Double vision after cataract surgery,e xpecially with injection (retrobulbar) anesthesia is very common and I have written 4 research papers on the subject. Lastly you have such a huge difference in the glasses RX of your eyes (aneisometrophia) that alone can disturb the "fusion reflex" and make small misalignments that many of us have (I have one) asymptomatic. Then the eyes do not "fuse" and a person see's double.  So you have a lot of reasons to have double vision.

JCH MD