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Diplopia vs. constant extropia/convergence insufficiency

So I don't have a dx yet but I have been having vision issues, double vision and blurry vision (almost like it doesn't quite double sometimes).  My opthamologist diagnosed me with constant extropia and convergence insuffiency.  She asked if I had an MRI recently and I told her I had and that it was clear.  She asked for the reason for the MRI and I said the possibility of MS and she replied that is what she was thinking but she wasn't going to say it unless I did.  I went onto have the LP which came back clear as well.  So May 15, I am taking all of my imaging and test results and trucking on over to a new doc.  That being said, wouldn my vision dx be another name for diplopia?  

I also have ice pick pains from time to time in the corner of my eye by my nose.  Thesse are brief shooting pains that don't last long but definitely stop me in my tracks and take my breath away.  Also, my vision issue vary day to day.  I have been to the eye doc countless number of time swearing my Rxhas changed only to find that on the day I go it is exactly the same.  This vision dx came from me finally switching docs and she listened and did further tests to see that there was significant weakness in my left eye...my other doc just kept telling me I had dry eyes so my contacts were blurry. Grrrr!  

Thanks for the feedback!

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645800 tn?1466860955
I have Sjogren's as well as MS.  The DX for Sjogren's is actually, if I remember correctly, 4 different tests of which you need to be positive on 3 of them. As such I would think that a negative on the blood test would not rule it out.  So if I were you I would do some more checking into this.

Dennis
Helpful - 0
1475492 tn?1332884167
I am dx with MS.

I have double vision that is constant. I have double vision in each eye (a ghost image) that makes everything seem blurry. I sometimes (intermittently) see double vision with my eyes together. That is usually in a flare or when my eyes have trouble adjusting from near to far.

They initially thought, like you, it might be dry eyes or refractive. It was only after I had optic neuritis and was treated for it with IV steroids that the double vision cleared up which proved it was neither dry eyes or refractive. That was the proof the Neuro-Ophth needed.

This is all due to my MS. It is not typical. Course, I have learned I don't think they know what it "typical" with MS. :)

I do think that if your eyes are dry, lips that dry and you had a relative with Sjogren's that I would seek another look at with asking for regular tests. I thing sometimes these auto-immune diseases take some time to show in tests.

I wish you well.
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Avatar universal
I never had any problems with this as a child.  I've had glassed since I was about 10 but just your run of the mill near sightedness.  I feel like I see double constantly.  Sometimes it is "more double" than others, if that makes since.  It is almost like it isn't quite doubled and therefore just blurry.  I have been to the eye doc numerous times swearing my Rx had changed only to find out once she checked that it really hadn't.  My old eye doc said my blurry vision was because I have really dry eyes but no matter how many drops I put in, it is still blurry.

My new doc is the one that gave me this dx based on about an hour long exam.  Again my Rx had not changed and is similar.  What made her do all the tests was I told her that recently to read or sometimes even to see the TV, I would have to close my left eye.  So the problems (extropia and CI) are only in my left eye.  I've always been able to cross my eyes and now I can't.  My kids think it is hillarious that I try but my left eye doesn't move inward at all.  Glad I can at least give them a laugh...and I laugh as well!  What else can you do!??

She did suggest I do therapy to try to help it out and keep it from getting worse any quicker.  I have an appt at the end of the month to get started on those.  She just said that it is rarely dx'd for the first time in adults and if it is, there is likely a neuro cause of the weakend muscle.  At least that is how the explanation came across to me.

Is that any clearer?  Does that make sense?

BTW, my eyes are crazy dry, my lips are cracked all the time, and I am constantly drinking water so I don't have a horribly dry mouth.  I've thought Sjogren's b/c I had a 1st cousin eho died from Sjogren's but the basic bloodwork that my rheum did came back neg so he sent me on my way,  And I'm not sure how the vision thing would play into a Sjogren's dx.  Basically, I have a boatload of sx and no idea what is causing them...join the club, right!??! ;)
Helpful - 0
645390 tn?1338555377
Hi,

Diplopia is the medical word for double vision.  

Convergence insufficiency is a problem at near, when reading.  Many college students can get this, primarily from doing extensive near work.  There are exercises that can help with this.  Most of the time, this works.

Exotropia is the medical term for an eye turning outwards.  

I don't understand why the eye doc would have been thinking MS from the above.  Do you have other eye issues as well?

Did you have a eye turn as a child?  Such as the exotropia?  Do you have constant double vision?  Do you have similar vision in each eye?  Meaning 20/20 vision in each eye?  Doesn't have to be 20/20 , I just mean equal.

Michelle
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Avatar universal
That's kind of how I was feeling.  I have gotten two new docs names from folks on the forum and will pursue a second opinion and additional MRI as soon as I can.  I just wished I had asked the question sooner :(  
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429700 tn?1308007823
A mobile open MRI is completely bogus for MS diagnostic purposes. None of them are strong enough to detect MS lesions.  There's your problems right there.  As far as the negative LP, many people on this forum that have an MS diagnosis have had negative LPs.  A negative LP doesn't rule out MS.

You definately need to see a neurologist--preferrably an MS specialist.  Open MRIs are bogus unless your doctor is ruling out strokes and brain tumors.  
Helpful - 0
1 Comments
Is a Tesla 3 open MRI okay for dx?
Avatar universal
Thanks for the comments.  My eye doc commented that it was very unusual to see these problems in an adult who never had them as a child.  I've worn glassed since I was 8 and have never had these problems.  My MRIs have all been done on a mobile, open MRI.  I don't know the strength.  I keep meaning to call and ask but I forget...shocker! ;)   I am picking up a cd with my MRIs on Monday and will  be sure to ask then.  
Thanks again for the input.
Helpful - 0
429700 tn?1308007823
The pain in the corner of your eye by your nose sounds like it could be trigeminal neuralgia.  You described the pain I had perfectly.  I usually feel the pain in one of my nostril or above my ear.  My neuro prescribed gabapentin.

I've also had a number of problems with my eyes.  Before my MS diagnosis, the eye doctor said it was convergence insufficiency.  I was sent off with eye exercises that didn't do a thing.  When I looked up this problem, I saw nothing that related to adults either.  I still continue to have this problem with extreme fatigue and heat and now I know, and my current ophthalmologist knows, that it's related to MS.  Prisms were recommended, but never did get them as the problem started to get better.  

I've had nystagmus at that time as well (which I noticed mostly when trying to read) and in the morning, I found that my eyes were crossed.  Later on, during the first year of diagnosis, I was also diagnosed with optic neuritis in my right eye.   I had some pain in my eye when I moved it and reds were  dulled out.  

A note about MRIs . . .  I also had an MRI that was negative.  It was not done on very powerful machine (open MRI) with MS protocol because my regular doctor was looking for strokes and brain tumors.  When the second one was done on a 1.5T machine lesions showed up to my surprise.   Just sayin' . . .

There's other diseases and problems that cause these symptoms:  myasthenia gravis, lupus, MS, Devic's Disease, to name a few.  Hopefully you're seeing an MS specialist or a neurologist that has a lot of  experience with MS patients.   These people can help rule in or out MS.  You don't have to have a diagnosis of MS to see an MS Specialist.  They would be the best physicians to see in my opinion to rule in or out MS or MS mimics.  

Helpful - 0
645800 tn?1466860955
After checking the Internet it is saying that you're eyes are having trouble moving inward in order to get a single image.  So yes it does mean diplopia. But more importantly it seems these two terms indicate causes of the problem more than the general term of diplopia. The constant  extropia seems to indicate a problem with the muscles to keep your eyes centered ( your eye turns outward on its own) The convergence insufficiency seems to indicate that when you are looking at something close your eyes don't turn inward to make a single image. Most of what I read was related to children so I'm not how relevant it is to you.

Dennis
Helpful - 0
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