Bilateral monocular diplopia...Contd....

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This is in continuation of my previous post on 09/28/07 with title of “Bilateral Monocular Diplopia”. Adding here few additional informations and some new findings.

His monocular diplopia appears earlier and is more sever in RIGHT eye.
His vision gets CRYSTAL CLEAR when he sees through a PIN HOLE.(Detected recently)
He’s related to a profession that needs continues near work (But due to this problem, He’s out off the work since a long)
His Ophthalmological checkup is going on, but he, as well as his Ophthalmogist is seeking for your opinion. Please help them……
Also, can it be an early stage of Occular Myasthenia gravis...???

[John C Hagan III, MD, FACS]

Hello Search-Search

1. Monocular diploplia that clears with a pin hole is (in order of frequency) 1. a refractive error requiring correction with glasses or bifocals often astigmatism 2. irregular astigmatism such as keratoconus, corneal warpage from contact lens wear, pressure on the eye (example chalazion, lid droop (ptosis). In older adults a certain type of cataract can cause that.

2. All other causes are very rare. If you want to take this to your ophthalmologist I suggest referring to the text book "Ocular Differential Diagnosis" by Frederick Hampton Roy MD, Williams & Wilkins publisher. The extended differential of VERY RARE causes of one eyed double vision in the 6th Edition is found on pages 709-711.

A careful exam should rule out most of those. A corneal topography is a must.

Ocular Myastnenia Gravis is NOT a likely cause at all. It causes double vision with both eyes open, usually when fatigued or tired, is often associated with drooping lids. It does not cause double vision or ghosting out of one eye.

John C. Hagan III MD

[Nancy T]

Same here--my ghosting disappears through a pinhole.

As for myasthenia gravis, when I first saw the ophthalmologist two years ago about this problem, I told him I'd had some minor odd neurological stuff going on, and he asked if I had trouble breathing or holding my head up, and I said no (and that I'd had a negative blood test for myasthenia gravis six years earlier), he said "Well, myasthenia gravis can be hard to diagnose..." which suggested he was thinking about myasthenia gravis.

I did (and still do) have some trouble with muscle stamina in my jaws (chewing, singing, sometimes even talking) and arms and legs, but nothing definitive and no eye drooping or actual double vision. So, MG was one idea, but although I haven't had any follow-up on that one blood test, it seems I don't have it.

I am eager to hear any other ideas or knowledge anyone has about this ghosting.

Nancy T.

[Estiben]

I have monocular triplopia (which you can Google to get more information). It appears to be a result of my cataract. Needless to say, I am looking forward to the surgery that should correct the problem. I tried the pinhole - it helps a little, but not much.

[John C Hagan III, MD, FACS]

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