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Diplopia and MS
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Diplopia and MS

Hello everyone-
I got an eye exam with the following information in the report:
"Disconjugate horizontal smooth pursuit. Dyplopis."

The eye Dr. said it means I have double vision when I look to the right (kind of knew this gong in). He thought I had Myesthenia Gravis but the blood work showed neg for MG.

Is this of any significance to the possibility of having MS? thanks for any input!!
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13 Comments Post a Comment
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Sorry I can't be of any help on this one. I don't know anything about Dyplopis to be honest never heard of it but I am sure someone will chime in and let you know. Just wanted you to know that I hope you find the answers you are looking for.

Take care,
Paula
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Double vision is fairly common with MS.  But, there are many other things that it goes with also.  Dry Eyes could cause it, some medications are two I can remember right now.  I know there are more but my mind is blank.  

If you have it only in one eye, you can possibly get fitted for prism glasses.  This has been helpful for many people who suffer from it.  I, unfortunately, have it in both eyes so no prisms for me.  

I hope this helps...
Addi
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Thanks for that figurepa. I hope to find answers soon too.

Addi- I think it is more than something like dry eyes. You can actually watch my right eye drift in a different direction than my left when I look off to the right. fortunately the double vision is only when i look right with my eyes so I turn my head instead or if I am laying down watching TV. I am so sorry that you have it all the time. That has got to extremely frustrating. Thanks for sharing your thoughts with me.
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I am glad that you have found a way to compensate for the eye drifting on you.  What did your eye doctor say about the results of the testing as far as treatment and/or cause?

I have diplopia, too.  It has affected my left eye for 2 years now.  I have not driven since then because i feel that i would be a risk on the road.  My right eye it seems to come and go, which is why I cannot do the prisms.  I also have severe dry eyes and astigmatism.  Last month I had tear duct plugs inserted to try and help.  I used to read about 5-7 books a week.  I love to read.  I barely get through 1 book a week now.  I can read okay if I can increase the font size and wear my glasses (to help with the blurry vision).  I still see double, but it is bigger and I have learned to read with the shadow, if the words are bigger.

I am undx'ed, as far as MS is concerned.  My neuro thinks my problems are in the Hereditary Neuromuscular Disorder family.  Which one, he hasn't figured out yet.  MS has not been ruled out.  I have way other problems than just with my eyes.  My journey is six years long so far and I am in a wheelchair most of the time since June 2010.

I am sorry that you are having neuro problems.  It is quite scary and I definitely remember how I felt when this all first started for me.  I have to admit that this process has made me a stronger person, no doubt.  And I thought I was pretty strong (mentally and emotionally) before all this.  And the fear of the unknown...nothing compares.

When the issues move into your eyes, it is even scarier, to me at least.  The thought of losing my eyesight or my eyes getting any worse than they already are is something that I don't want to have to experience.  I think it would be worse than the chair I am in...and I opted for counseling for acceptance when I landed in the chair on a mostly regular basis.  It helped!  :)

Are you seeing an ophthalmologist or an optometrist?  I would encourage you to see an ophthalmologist or better yet, a neuro-ophthalmologist would be even better if you can.  I finally found a neuro one fairly close to me and have my first appointment on Monday.  My ophthalmologist was more than happy to refer me there and hopes he can find some answers.  

I mentioned the dry eyes only because my ophthalmologist mentioned this as being a possible cause.  And he mentioned some meds could do it, too.  It can be due to weak eye muscles and it can be neurological, too.  I just wanted you to understand that there are many things that could cause the double vision.  Some of it is correctable.  Some of it is irreversible.  I hope both of ours is on the reversible end.

My ophthalmologist believes my eye trouble to be neurologically based.  My MRI's do not show lesions.  This is why I am going to see a neuro-ophthalmologist.  I am hoping he can figure this all out.

I hope I explained myself better in this post.  Sorry I was kinda short and sweet in my other one.  I am kinda druggy today and am in some pretty good pain and have cognitive issues too.  I just originally kinda wanted to let you know that you aren't alone and to maybe ease your mind a bit.  

Hugs,
Addi
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Hi Addi-
No worries on your short explanation :D I am just glad to have others to share with. I am pretty alone on this journey right now with no one to talk yo about what is going on with my health so this forum is really helpful!

My dr. is an opthamologist. He is the one who asked me if the Neuro was looking at the possibility of MS because the 2 active lesions that did show on my MRI were in an area that has something to do with "high order" eye movement. He also discovered I had cataracts so the focus switched to that and now am scheduled for cataract surgery. He never made any suggestions as to any thing I could do about the double vision. maybe he is waiting to see what comes from all the Neuro tests. I still have an EMG scheduled and an LP later this summer. The waiting is tough!

When I was sent to the Neuro for the first time it was only in response to my left hand weakness, numbness and tingling as well as left sided facial numbness and sudden vision change. This was all after almost 2 years of my right leg going weak and staying that way.

To date I have no dx.

I hope for both of us to have our eyes restored. I am a professional photographer so my eyesight is really really important!

i hope you are having a nice Saturday :D


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One thing I forgot to mention that even though the opthamologist suggested MS he then retracted and said he didn't think it was an indication of MS. That is why I asked the original question because there seems to be a search for MS but the doctors keep telling me it is not MS. Very frustrating,
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It is worth mentioning that the blood test available for myasthenia gravis can confirm the diagnosis but can't rule it out (as the only test used).  People with generalized MG test positive about 80% of the time.  People with MG limited to the eyes have a 50/50 shot of testing positive.

I know it's frustrating but keep on searching until you feel confident you have an accurate diagnosis and the best chance for effective treatment.

Mary
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This whole process is so very frustrating.  Especially when you have symptoms and it feels like none of the doctors are really listening.  Why the wait for the EMG and LP?  What did the neuro say to you about your symptoms?  Did he do a complete neuro exam on you?  Did he discuss how you did on the test?  Did he have some sort of treatment or diagnostic plan for you?  Most importantly, what does this neuro specialize in?  If the doc keep going towards this not being MS, do they tell you what they do suspect?

I would really try and see if you could get a referral to a neuroophthalmologist if I were you.  Eyes are definitely not something to hold off on in finding answers, ya know?  If you are having issues with your optic nerves or suspect your problems being there, do not wait.

I am sorry that you are alone on this journey.  That has got to be rough.  This forum should take a portion of that loneliness away.  I don't know where I would be right now if I didn't come across the wonderful and intelligent people that make up our very special forum.  

I am having a very relaxed day in bed today and probably tomorrow.  I had an epidural steroid shot in my c-spine yesterday morning.  I don't think it did what it was intended to do.  I actually hurt more.  :(   I was suppose to go visit my dad this weekend, but had to put it on hold.  

I hope you are enjoying your weekend though.  We always need to remember to go do when we can and step off the medical path and place your mind and emotions somewhere else for a bit.  I hope that is exactly what you are doing this weekend.  :)

Hugs,
Addi
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I didn't know that about MG, Mary.  MG has been mentioned in passing to me so that is good to know.   I am glad I saw this.  

Hugs to you, haven't talked to you in a while!

Addi
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Good catch on the delayed timing of that testing Addi.  I had noticed but lost track of a lot once I was writing my response.  Good questions too.  You gave MissL excellent things to think about.  That's the best strategy when developing an action plan.

For yourself, good for you for deciding to take time for Addi.  Steroid injections almost always make things worse before making them better.  I don't know why doctors leave that little detail out.  

I've had two rounds of lumbar epidurals (three injections each time).  I was encouraged to rest and use heat or cold packs to relieve pain the first 24-48 hours afterwards.  Heat worked better for me but not too hot and not for more than 20-30 minutes at a time.

It was several weeks after the first series was completed before I realized one day that I hadn't needed any pain pills for days.  Funny how pain and the drive to relieve it consumed my life until the moment it was gone and I was able to pick up life again.  I barely looked back for a year.

The second series hasn't been as successful --- yet.  It has improved to a place where we can co-exist without too much complaining from either side so I'll take that for the moment.
Hope you see this.  Apologies for detouring the topic.

Mary
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Mary, I caught it.  Thank you.  I don't wanna highjack MissL's post either so I am going to start a new thread for the epidurals, ok?  I hope you catch it...

Hugs,
Addi
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There are two basic types of double vision.  If you cover one eye and it goes away, that is "Movement disorder."  That is anything from the common "cross-eyed" condition to movement of one eye where the other eye fails to "keep up."  These all seem related to issues with cranial nerves 3,4 & 7 that have to do with eye motion.  All of these cranial nerves come from the pons.  

The second problem is double images that persist when either eye is covered up.  In my case I have a vertical "ghost" that is about 80%-90% more transparent than the main image and is vertically below the main image.  The "difficult vision" ophthalmologist say the is a neurologic issue with cranial nerve 2 (which is a cerebral cranial nerve and is not associated with the pons) - a second "lower, slower signal" arriving at the optic cortex. Makes sense since my right optic nerve is almost 30 milliseconds slower than my left.   This seems to be a result of my attacks of optic neuritis and the damage to the right optic nerve and left optic tract that show up on MRI and VEP.  The right optic nerve carries all of the signal from the right retina.  The left optic tract carries 1/2 of the information from the right eye and 1/2 of the information from the left eye.  So up to 75% of my vision information can be effected.

Bob

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Hi CoBob- It sounds like maybe mine is the one coming from the Pons, Would that mean it isn't related to MS? I am so sorry to hear about the trouble you are having with your eyes, that is so hard.

Mary and Addi- thanks for all the things to think about. It is OK to go off topic because I learn more :D

To date all my neuro said was to wait for the MG test to come back, So it came back neg. for MG and so he said the next thing to do us an EMG and then an LP. The delay I think is due to it being an HMO. He does not specialize in MS. He specializes in strokes.

Once we have gone through these two tests I assume he will give me his diagnosis. It just seems that most of what I see points to MS along with something that may be pulmonary.

That is one reason I was wondering if you can have MS and MG??? I think I will post that question to the community and see what they say.

Thanks to both of you for your help. It is tough going this alone. I am married...but my husband is removed from the process at this time.

Hope your weekend is good and that you feel better.
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