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Treatment for eye strain due to ageing.

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My father will be 68 next week. He is a very fit and active man and has never had any health issues to talk of in the past. He attends the gym some mornings and has never been a smoker. Last week he spent 3 days sea fishing on a boat. For some lengthy periods he was focused on a rod tip. He wore sunglasses to help with the bright glare of the sea. The sea was quite rough and he was thrown about a fair bit on the boat but does not recall any specific injuries aside from hurting his thumb trying to hang on. On his return from his fishing trip he says that his vision was a bit strange and not clear. He put it down to eye strain and got an early night. In the morning it was worse. He had blurred/double vision. This continued and on Monday we went to A&E. The double vision is when both eyes are open. It goes if he looks in a certain direction or if he puts pressure on the eyes or lifts an eyelid etc. At the hospital on Monday he had a heart reading, head scan, eye examination and blood tests. We left there late on Monday being told that nothing had shown up on any of these tests and the next step was an eye clinic. The following day he spent at Moorfields eye hispital. Here he was seen by numerous doctors etc, had lots of examinations and an eye scan. The day concluded with them reporting that they could find nothing wrong. They then suggested the eye clinic at a local hospital to check the eye muscle. He has had this appt cancelled and he reports no improvement in his vision now a week later. Over the last couple of days he has alse described a weepy left eye (messy in the mornings) and a hot feeling around the eye like a bruise is coming out etc. He is now looking to arrange a private appt. The questions I have are, is eye strain realistic and if yes what typically can we expect to happen in terms of the improvement in vision and the duration? Is an infection possible and once again what next? Given the tests he has had, most unpleasant possibilities feel like they have been ruled out. Are there any serious causes that remain a distinct possibility? If he arranges a private appointment, which speciality would be the most approrpriate given the history and investigations to date? If eye muscle is the most likely problem, is there a certain speciality doctor that would be most appropriate? Aside from a slight dull pain in the area of his left eye, he has no other symptoms accompanying the blurred / double vision.

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
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Hello.
Thank you for your query at DoctorSpring.com.

I understand your concern. As he has been extensively evaluated, serious causes of concern have been ruled out.
In order to get to the bottom of his problem, your dad needs to have the eye muscles re-examined. Double vision (diplopia) is usually due to paralysis of a muscle controlling eye ball movements. Blurring of vision can be due to the double vision itself. It has to be evaluated in detail with an examination testing each of his individual eye muscles. This can be corrected.
- Does he see two images side by side or diagonal and one on top of the other?
- What type of head and eye scans were taken? CT or MRI?
MRIis more sensitive to pick up small lesions. Since your father has been on a rough boat ride, a minor injury to the eye muscle nerves resulting in nerve palsy has to be ruled out. Some traumatic nerve palsies may occur even with a relatively mild blow to the head that is not associated with loss of consciousness or a skull fracture.

It is unlikely to be eye strain as it is persistent for more than a couple of days.
Since he has discharge from the eye, an infection can be possible, but that would make the double vision hard to explain. Anyway, if infection is confirmed, appropriate medications like antibiotics etc have to bee administered.

I would suggest that he schedules an appointment with a good Opthalmologist at the earliest, as the weepy eye is a new development and may be a guide to a diagnosis. The Opthalmologist can himself examine the eye muscles. If required, he/she can refer you to an Orthoptist (specialist in double vision, squint etc).

I hope this was helpful. Feel free to discuss further.
Regards.


Patient replied :

Thank you for this. In answer to your questions, the double vision is on top of each other with the top image sloping upwards left to right and the bottom image sloping downwards left to right. The scans performed were CT rather than MRI. A nurse at the eye hospital performing an exam did suggest an inflamed left eye (the one that has since felt warm and weepy) but no further mention was made of this. He hopes to have an appt on Monday with a orthoptist. If a muscle problem is diagnosed is surgery the likely method of correction? Do you know how long they would wait before seeing if the problem resolved itself or would it be immediate surgery if an eye muscle problem was the cause? Many Thanks


Hello. Thank you for posting the follow up.
I will request you to upload his CT SCAN report, in the dashboard. If the CT is inconclusive then MRI can pick up minor injuries and hence i will advise you to get a MRI done.
Since you're saying that he has a weepy eye, and it appears to be inflamed, it points more towards an infection which can lead to inflammation of the layer of the sclera causing scleritis, or of the uvea causing uveitis. Even corneal or uveal infections can lead to diplopia along with pain. Does his eye loom red now compared to the the earlier time when he got his tests done? If there is no redness or discharge from the eye, then serious infections can be ruled out and hence it will point entirely towards eye muscle disorder.
If diagnosed with ophthalmoplegia, then surgery is not the first line of treatment. The underlying cause has to be treated. Sometimes even viral infections can cause some damage to eye muscle nerve fibers leading to diplopia and squint. It resolves by itself and takes around a week. Hence MRI would have been a better option, but still once you upload the CT i will be able to guide you further. Sometimes ophthalmologists put an eye patch on the affected eye, and even that corrects the diplopia. Surgery comes way later. So please do not be worried right away.
Please upload whatever reports you have of him. If you have any problems in uploading in the dashboard, you can mail all his reports directly to [email protected]
I will get back to you after seeing his reports.
Regards


Patient replied :

Thank you for all your help. Here in the UK we are not given the scans so we are unable to upload them. Your reply however provides some reassurance and hopefully his appointment Monday will get to the bottom of the problem. Thanks Again



Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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