neurological eye problems

[Anne0]

I’m 24, + have type 1 diabetes.(7 years) Lens implants (surgeries for cataracts) 6.5 years. (Yearly vision checks, rest of eyes no D problems) About 4 years later, started seeing double on the mid- right side (two horizontal images, side by side, central image is slightly above the other) Didn’t assume it to be unusual, ignored it. In Feb. of this year, during a gastrointestinal illness started seeing the same thing on the left side of my vision. Several times, when I’m really tired it’ll be double all the way across. Otherwise- double vision on left and right sides is constant.Opthamologist did a myasthenia gravis antibody test(negative), referred me to the neuro-opth. (Whom I see in Dec.) In October I got Lyme Disease, cleared up with antibiotic therapy but now I’m having a problem with facial weakness/lopsided smile, occasional difficulty swallowing. Is this likely to be due to the Lyme Disease? Or getting general MG?
Thanks!

[CCF-Neuro-M.D.-PW]

Double vision is an important symptom to evaluate in a diabetic - double vision that stays when you cover one eye (monocular double vision) may be due to causes like retinal detachment, whereas double vision that does go away when you cover one eye (binocular double vision) can be from a diabetic related lack of blood supply to the nerves controlling the eye muscles. THis is a clinical diagnosis based on the history and examination. A stroke can cause similar symptoms but is usually associated with more than just double vision from the onset. It usually resolves over 3-4 months.
MG can occur more commonly in people with other autoimmune diseases (like diabetes) so is also something to consider, and is usually diagnosable by a tensilon test or needle EMG - antibodies are not always reliable. Yout neuro-opth should be able to do this.
Lyme disease can cause bilateral facial weakness, but so can myesthenia, tests such as the above mentioned can differentiate between the two

Good luck