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Double vision when I look down.
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Double vision when I look down.

I am a 54 year old male, healthy.  Recently I woke up with double vision.  Close one eye and the double vision goes away.  Only have double vision when I look down.  If I go all day and put off eating or push past the point of being tired with little sleep the double vision seems to grow upward - meaning even if looking straight I get the double vision.  However, with sleep and eating proper I only have the double vision while/when looking down.  There is a slight pain on the left side of my head, like a headache between the ear and the temple, not behind the eye. Does anyone have any input?  I do wear glasses but on or off does not make a difference in the vision issue.
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Avatar_dr_f_tn
Hi there. You need to get a neurologist’s consultation in detail to check for the causes of double vision like migraines, ocular examination for refractive errors of vision,  peripheral vision fields, as an aura for seizures, other sensory deficits like tingling , numbness and weakness in limbs. An ophthalmologist needs to see the chambers of eye and a pituitary adenoma and multiple sclerosis need to be ruled out. Hope this helps. Take care.


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Avatar_m_tn
Thank you for the information.  I am not having migraines, it is a dull low type of head pain/headache and only on the left side which is very faint in the morning upon waking and progresses throughout the day but never to the point or magnitude of migraines.  No numbness or tingling of any type - anywhere and peripheral vison is fine.  
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144586_tn?1284669764
This is usually (but not always) caused by a palsy of the third cranial nerve.

The critical question is the etiology of the palsy. Diabetes is a common cause, but there is usually no concurrent headache, although there can be one from eye-strain. Infection and tumors are other possibilities.

The fact that the problem varies with eating strongly suggests an diabetic etiology.  The correlation between glucose levels (from eating) and nerve palsy are fairly definitive. You require a test known as an hbalc and a glucose tolerance test or insulin clamp protocol.

More ominously an aneurysm may be suspected.

You need a neurological consult as of yesterday, and they will undoubtedly order both an MRI and a dye contrast MRA. And of course a diabetic screen.
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Avatar_m_tn
Thank you for the comments and suggestions.  I also think it could be related to diabetes as this does run in my family - on mothers side.  Although the headache (not in the true sense of the word as it does not throb to the point of needing medication) does increase with discomfort during the day as I use my eyes (possible eye strain) I tend to agree with you linking this issue with diabetes.
With no insurance at this time it would be impossible for me to request test of any type.  I do appreciate your response and will proceed (on my own prompting) as if this is related to diabetes as I suspected this in the onset of the double vision issue.  I have cut out sugars, white breads, white potatoes, high fructose, etc. and it does appear that each day the symptoms are improving.  I have gone to 4 - 6 small meals a day and am preparing meals as healthy as possible.  The double vision is still there however only when I look down, the dull pain in the head is very slight upon waking as I stated before and does increase as the day goes on but I think because of eye strain and dim lighting.  I will increase the lighting and will keep all informed as the progress of my situation.  Thank you again.
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144586_tn?1284669764
Generally this is a manifestation of developing diabetic neuropathy.

Usually, the condition is self-limiting and goes away after three months or so.

However, if the glucose levels remain high, "double-vision" may come back a year later, and involve additional cranial nerves, which may "freeze" one eyeball. If the diabetes remains uncontrolled this condition may become permanant.

Treatment generally consist of wearing an eyepatch over the eye and ocasionally an anti-inflammatory, such as prednoisone.

Many clinics provide free diabetic screening and tests, and the medications prescribed initially are not that expensive (in the U.S. Metformin). This is money well spent.

Diabetes has several etiologies, and eating small meals may not be enough to ward off the progression of the disease. Losing weight, exercise and proper diet are, of course mandatory.

I really urge you to get an evaluation and a glucose meter. The meters are often free (with rebate). They make the money on the test strips.

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