can you explain some findings please

[wishforchange]

I was trying to find the meaning of some terms written by my optician in a letter to the hospital.  My main problem is sudden onset double vision.

In the ophalmoscopy test all was normal but there is a comment after stating my fundi were clear and healthy saying  " trace raised peripheral rim with small central cup"  I would be very grateful if you could translate this!

The other abnoramlity was in a cover test.  It says "In primary location small XOT.  Incomitant srabismus - greatest deviation in superior appearing as a "V" pattern divergent excess"

All other stuff normal so not worth typing the whole report out.

There is a comment at the end saying "Possible breakdown to diploplia is peri-presbyopic patient"
I currently have eye pain and the double vision is bad.  The optician advised me to ask that my hospital appointment at the strabismus clinic be brought forward but does not think I need to go to the emergency department unless the pain gets very severe or I get new symptoms.

He explained lots to me, just didn't get round to explaining the meaning of the written terms in his letter, which I have put in quotation marks.  I would be very grateful if you could explain them to me.  I know what my problems are, I just don't understand what he is saying!  Can you please go through the terms and findings with me

Thanks

[Sandy Feldman, MD, MS]

Dear Wishforchange,

A new onset of double vision is concerning and warrants an eye examination from an eyeM.  You can find one on the AAO www site, under find an eyeMD section.  You do not mention when the doubling vision is occurring, how often, new or old onset, worsening.  What the “incomitant strabismus” means is that the misalignment of your  eyes change as  your  eyes move  and are  worse  when you are  looking up than down.

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California

[wishforchange]

Thank you.

FYO the double vision came on about two months ago.  I have been assessed by orthoptics but due to errors in the hospital system never got to see a consultant, although that was supposed to happen within two weeks of my presenting myself to them as an emergency.  Over the last week I have had pain in the left eye and was advised by my optician that my appointment with the consultant be brought forward as urgent, or if it continues to worsen to again attend as an emergency.  It is a very busy hospital and it is hard any time to get attended to - the average wait for emergency cases is two hours if you are triaged as needing immediate help, and four hours for less serious or time dependent conditions.  Even with an appointments clinics are overbooked and you can wait several hours after your alloted time to be seen.

I still would like confirmation of your explanation of the other terms in the opticians report.  To remind you these are:

In the ophalmoscopy test all was normal but there is a comment after stating my fundi were clear and healthy saying  " trace raised peripheral rim with small central cup.  Distinct margin"

The other abnoramlity was in a cover test.  It says "In primary location small XOT.  Incomitant srabismus - greatest deviation in superior appearing as a "V" pattern divergent excess"

I understand from you that some of this means my double viision is worse when looking upwards?

The pain is concerning me most at the moment.  I have a range of health issues and am currently being seen by a neurologist, but not because of my eyes.  This is a recent develpment.  They actually do not yet know of this develpment as I am not seeing them for some months.  I have however been referred on to see a neurosurgeon, to assess the possibility of nerve irritation from vascular tumours in my back, I think.  Could there be a connection?

My initial worries on first experiencing these ocular symptoms were retinal detachment, but that has proved to be not the case on investigation, and now with the pain infection concerned me as a possible cause.  But there is no redness, although the affected eye is watering a great deal.  The pain is a pulling senation, like the muscle is being stretched too far.  I am prone to headaches in the left side eye area but this pain is more localised, not really a headache as such.  

Any further help would be apprectiated, as it all adds to the picture of what I should or should not be concerned about and to understand how much I should push for the early attention of a consultant or whether to make the trip and spend hours waiting in the emergency department, again. Last time I was triaged as urgent and was amazingly assessed withing 30 minutes.  They were clearly taking it all very seriously.  Still though  I am reluctant to repeat this unless necessary as it takes up the whole day, even with my prompt attention, and having already done it once, ultimately got lost in the system and failed to receive the urgent care I was told was needed.  After being sent to orthoptics on return I got mangled in the system and didn't see the right consultant.  Basically to date no doctor has assessed me medically as to the causes of this double vision, or now the pain.  It is a riddiculously overcrowded and busy hospital, and records and appointments, along with patients following poorly signposted directions, get lost all the time.  

I hope you can answer further and thanks again