torsion

[stacey2286]

Hello. I had surgery one year ago for an eye muscle imbalance called intermittent exotropia. It was my first surgery and I am in my early twenties. I've been having follow up visits with my doctor since the surgery and have tried many things to bring out regular measurements since my surgery. I have a lot of double vision which is worse when I look to the right. I was told to wear a patch for some time and after doing so while reading for about thirty minutes, I noticed a twisting in the two images I was seeing from each eye. Both eyes have excellent vision. This was just recently measured by my doctor a few days ago. My doctor calls it torsion but did not go into depth about it with me. I'm seeing him again in a week to further evaluate the measurement of the torsion. Is this common? And is it likely to be corrected by further surgery? I was upset upon this finding, though grateful that it is on its way to being treated. It has caused me much confusion. I believe he said there is also a bit of hypertropia involved with the torsion. Any information about this condition would be very helpful. Thank you in advance.

[Ray T Oyakawa, MD]

The procedure I had is only for a few diopters.  You cycloplegic refraction is important since you had been given bifocals.

Dr. O.

[stacey2286]

Dr. O.

Thank you. I agree with you that the main problem is horizontal. I have stick on prisms for my glasses that I will try. I will see if they help to eliminate the torsional double vision. The thing that makes it difficult is the fact that my operated eye will drift both ways. The inward drift causes the most double vision. I wear a 15 base out prism. But at near my eye drifts much more outward. So the prism will make that problem worse. I will mention to my doctor the procedure which you mentioned to me.

[Ray T Oyakawa, MD]

You main problem is horizontal.  Prism should allow the two images to fuse and eliminate the slight tortion and vertical.

You should get a second opinion.

Dr. O.

[stacey2286]

Dr. O. I'm currently seeing a pediatric strabismus specialist. Since my surgery for what was originally intermittent exotropia, my eye still drifts outward but also drifts inward if I truly relax. It's difficult to make the double vision go away in any gaze. I also do not understand how a vertical element has been added to my condition through surgery, considering only the outer and inner muscles were re-positioned. But I also have a twisting in the image of the operated eye compared to what I see with my other eye, mainly while looking to the right. The following two images describe what I see.
http://www.eyesapart.com/images/2picture-frames.jpg
http://www.eyesapart.com/images/2hairspray.jpg

Could it be possible that the procedure you had for your hypertropia could help me? Is it common and should I mention it to my Ophthalmologist? To be blunt, my eye drifts inward (due to AC/A ratio?), outward, and my ophthalmologist recently noted it seems to be drifting a bit upward and is also twisting since my first surgery one year ago. I also had an adjustable suture which was adjusted the following day due to a great amount of double vision and being a bit too over corrected, according to my Ophthalmologist.

[Ray T Oyakawa, MD]

Torsion means a twisting of your eye.  It is caused by a muscle imbalance.  The hypertropia is due to a vertical muscle imbalance.  I do not understand how you now have this when you started out with intermittent exotropia.  Hypertropia involves the vertical muscles and your initial problem involved the horizontal muscles.

I had very small hypertropia after retinal detachment surgery and It was fixed in the office by a new procedure called a "mini tenotomy."  It was done topical anesthesia.


Are you seeing a strabismus specialist?

Dr. O.