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Eye & Vision Message Board


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Hello all,

I am just thinking aloud my thoughts here....
From your medical and eye history, sounds like you are quite healthy and to have this happened out of the blue, it must be disconcerting to say the least. And then having to deal with the professionals who are supposed to have the expertise to fix the problem can also be frustrating especially when you feel like you are being brushed off.

Ok. It is possible that you may have this for a long time but were able to compensate for it until now that you are approaching presbyopia. But I am not so convinced because generally for someone with high amount of exotropia, it is impossible not to have some trace of symptoms in the past years. Also, pseudomyopia may occur as one could use the accommodative ability to compensate to eliminate the deviation/diplopia (except in suppression cases). Whether you were compensating using intra- or extraocularmuscles, I doubt it would go completely unnoticed.

Your left eye is going outward; turning to the left. My question is: Is it just staying out constantly, or you are just having hard time trying to look toward your nose? Assuming it is just out there, it indicates the paralysis of the muscle that pulls the eye inward which is the medial rectus. However, Medial rectus is innervated by the third nerve which also controls the superior rectus, inferior rectus and inferior oblique muscles. Since you are only reporting that your left eye going out and not down or with ptosis, unilateral third nerve palsy is unlikely. So now we have a possible Unilateral Left Medial Rectus Palsy. If this is a medial rectus problem, the differential diagnosis would be midbrain lesion which is extremely extremely rare (you are not reporting other symptoms), Internuclear Ophthalmoplegia (which can be ruled out by checking convergence, abducting nystagmus, and ocular tilt reaction etc). Systemic conditions such as MS or Myasthenia Gravis can also affect MR. The fact that you are not having any systemic complaints or other ocular symptoms, are these likely the "zebras"?!

So what other differential diagnosis are there? Convergence Insufficiency: may or may not be associated with accommodative insufficiency? Convergence Paralysis? When this incident first started, do you remember if you were ill? When was your last complete physical examination? I don't mean to doubt that you are not as healthy as you said, but sometimes patients do say out of purely subjective observation without actual evidence.

I hope you will be able to rule out any serious disorders. The best case scenario is that it's an adult acquired strabismus of unknown etiology. However, it is better be safe than sorry, a diagnosis of exclusion is probably the best way to get to the bottom of this. I hope you have your MRI result soon. I would see a neuro-ophthalmologist as others had suggested.

Cheers!

p/s: sorry for my longwindedness!
[QUOTE=davtpt;4294824]2nd surgery on June 25, 2010 and diplopia still remains, in reality as I look in different angles I get different deviations of my secondary vision....
Out of the frying pan and into the fire.... Doc wants to try the injections to see "if" they work.... I'm done.... no way JOSE.........
Keep in touch EW[/QUOTE]

Hi Dave,
So sorry for the late reply. From your most recent post, it definitely didn't sound too reassuring. I hope that things have settled a bit since then. The fact that you were experiencing non-concomitant deviations at all secondary gazes is definitely a problem. But what about your primary gaze? Is your eye still turning in as prior to the surgery?

As to your other question of needing to move your eye out a bit (prior to surgery), I really couldn't understand why the prism wouldn't do it for you. When one couldn't move the eye, then one would try to move the image to your fovea by way of prism to merge your images into one. Hmmm...So there may be something that I missed.

When you did the second surgery, did you have the adjustable surgery and how muscles were operated on?

I hope the initial issue you had after the surgery had resolved so that you can lead a normal life without this constant heartache and headache.

So sorry again for the late reply. Take good care of yourself!

Cheers,
EW





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