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Intermittent blurry vision

  For approximately the last year, I have experienced intermittent episodes of blurry vision.  This is in addition to multiple other symptoms which have been occurring over a six-year period and include bowel and bladder difficulties, muscle weakness, myoclonic jerks, and extreme fatigue.  The blurry vision tends to be worse the more fatigued I am.  I recently had an eye exam with an ophthalmologist, who recommended a change in my eyeglass prescription, to include bifocals.  What I don't understand is, how come I can read small print (on the back of bottles) in the morning WITHOUT  my glasses, but later in the day, have trouble reading anything, with or without glasses?  Could the vision problems be related to the other muscle weaknesses, and not really indicative of the need for a new prescription? On a related note, I am having great difficulty getting use to the new glasses, they really seem to make my eyes tired.  Could it all be related?  How do I go about having it evaluated to get more definitive answers?
Thanks for your question.  Given the temporal evolution of your visual
symptoms during the course of the day (better in the morning, worse at
night), and the history of general fatigue, one should STRONGLY consider
the possibility of Myasthenia Gravis (MG).  It is a pathology of the
neuromuscular junction, that is, the communication between the nerve and
the muscles that it innervates.  In this disease, there are auto-immune
antibodies against certain cell surface proteins (AcetylCholine Receptors),
which interrupts the proper communication between nerves and muscles, thus
causing the fatigue that worsens with the use of the muscle.  A group of
muscle that are extremely active, and frequent affected in MG are the ones
that moves the eyes.  Your blurry vision might be an indication that your
eyes are NOT moving in perfect unisson (as they should be), therefore you
are actually experiencing a very mild form of diplopia (double vision).
Please discuss with your physician this particular possibility.  There are
a number of simple tests that can be done for the diagnosis of MG, including
the "Tensilon test", and detection of "Acetylcholine Receptor Antibodies"
in the blood.
I hope this information is helpful.  Best of luck.
This information is provided for general medical education purposes only.
Please consult your doctor regarding diagnostic and treatment options.

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