alternating exotropia

[normanclyde]

50yr old that just was diagnosed with alternating exotropia.  I took a bad fall 1 1/2 yrs ago and have been seeing gp and neurologists.  Double and blurry vision led me to eye exam.  I have worn glasses for years with no change.  Now I am prescribed 3 sets of glasses with prisms. Have two Pd values.
Od -5.75x-050x096 1 dbi
Os -6.50x-025x148 1 dbi
What are your thoughts? I have read how you can get alternating exotropia.... a mri of brain is next step..but what about eyes?

[John C Hagan III, MD, FACS, FAAO]

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[normanclyde]

That is what I was trying to say, that all my symptoms and health were in check, and MS layed dorment until agitated by the fall...
anything I can do to stave off an episode of optic neuritis, knowing symptoms I have. And the VEP test?
My eyes have not settled down of blurry, double vision that occurs daily. MS symptoms they say
Thank you

[John C Hagan III, MD, FACS, FAAO]

I'm glad you finally have a diagnosis, I'm sorry it is MS. Pardon my putting this is capital letters but YOU NEED TO UNDERSTAND A FALL WILL NEVER CAUSE MULTIPLE SCLEROSIS.

It is not possible to tell you if you had a latent outward deviation held in check by the fusion reflex (exotropia) that became manifest because of 1. the fall and a concusion 2. by itself that happends all the time without trauma or MS  3. as a result of the MS.

While MS in some way affects about 65-70% of people with MS and starts with the eyes in about 35-% it is extremely rare to cause bilateral blindness. Most people with MS die with functional vision. Most cases of severe loss or blindness its just inone eye.

Live a healthy lifestyle, don't smoke, don't abuse alcohol, don't get fat, have a great diet with little or no red meat. Avoid high temerature like saunas, steam baths, running in heat and otherwise follow the advice of your physicians.

JCH MD

[normanclyde]

Because of double vision,  The only Neurologist in our small town told me to go back to GP.  My GP had MRI done of brain. The small hospital said it was a cold.  Go home. My GP sent me to a Neurologist in a bigger city who looked at the MRI, and immediately did more test to rule out lyme, and other. He saw lesions in the corpus callosum, along with some older ones.
A lsep test of electrical probes from brain to feet were done to measure the response time was done.
The Spinal tap came next which showed oligoclonal bands in the fluid.
More blood work.
A VEP test with probes at the back of the head and me looking at a checker board pattern that changed. And another LSEP test.  Both were positive, meaning I Failed or was out of the normal range.

The eyes, along with my gait (walk) being off, my hands not keeping temperature, and being doughy and ruling everything else out led to a diagnosis of Multiple Sclerosis. This took 2 years.

A ophthalmologist exam said the fall triggered the alternating exoteopia... which may of exacerbated and brought out the MS. Which in turn exacerbated the alternating exotropia.  And untill things calm down, vision will keep changing.

My Neurologist just told me I may go blind from MS
Optic Neuritis.  Any preventive measures?

[John C Hagan III, MD, FACS, FAAO]

Hope it turns out well.
JCH MD

[normanclyde]

Thank you for the reply.  Since then a mri of brain was done.
Neurologists today said fall I took could be causing muscles in eyes causing double vision...
Some spots seen on mri have him doing a spinal tap.
Norman

[John C Hagan III, MD, FACS, FAAO]

Norman, I have told you all I can in a forum like this and my advice remains the same.  

JCH MD

[normanclyde]

Pd of 63/60 was given with three prescriptions for eyeglasses.  One for reading with prism. One for far with prism. And one for far without prism.
I have not had exophoria.  Double vision along with multiple other symptoms has me seeing gp- pain Dr and neurologists since. I fell.  They are now looking to the brain as process of elimination of major items. Mri of brain is next.  
Question in meantime is alternating exotropia.  I did not have this before fall. None of my siblings or parents have this.
what are options?  I have ordered glasses and am awaiting to see if they help.  Any cures? Could this be. MS?  Or tumor or another disease causing the alternating exotropia?  
Thank you for your time.

[John C Hagan III, MD, FACS, FAAO]

The amount of prism in your glasses is miniscule and unlikely to be helpful. PD meand pupillary distance and is how far the centers of your pupils are and should be the same all the time. My advice would be to see a pediatric/adult strabismus ophthalmologist.  If you live in the USA you can find one near you at www.geteyesmart.org

trauma would not be a common cause of alternating exotrophia, trauma typically causes a 6th cranial nerve or 4th cranial nerve or 3rd cranial paresis and that causes other symptoms and "crossed" eyes or vertical deviation.

The most common cause would be the deterioration of a longstanding exophoria. That can "just happen" or it might be related to trauma.

JCH MD