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.
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.
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