Double vision with an unknown cause: where do I go from here?

May 1, 2012 1:47 PM

Double vision with an unknown cause: where do I go from here?

I have had intermittent vertical double vision for the past year and a half. Episodes have been spaced months apart, though there have been days where double vision has occured more than once. The episodes last from a few seconds to a few minutes. Occasionally my eye feels sore afterwards. It seems to happen in one eye in particular.

I have seen my doctor several times about this, screwing myself over with my insurance and resulting in nasty preexisting conditions to go on my history. I have had blood work done for B12 and blood pressure and blood sugar, all being found with normal limits. I have had sinus and headache problems, so I had a CT scan of my head done. It showed mild sinus inflammation. I had a MRI which required no followup. I got both my inner ear and optic nerves checked for swelling or abnormalities. In addition, I was checked for allergies.

I think that I've pinpointed the connection between the episodes: increased blood pressure around my neck. Sometimes it comes without warning, but past instances have occurred when I've gotten hot or overexerted myself or changed positions. Other times, double vision came on without warning.

I don't know where to ask my doc to go from here. I am getting so sick of trying to figure this out. I want something to suggest to her when we meet this month--though I am afraid of messing up my precarious insurance situation even further.

Episodes seem to increase when I am having bad sinus and allergies. My thyroid is fine, but I have some hormonal imbalances.

posted by anonymous to Health & Fitness (9 answers total)

Have you seen an optometrist or opthamologist?
posted by griphus at 1:51 PM on May 1, 2012

Have you seen an F.C.O.V.D.? When I am tired, wrought, and stressed, convergence insufficiency kicks in.

http://www.optometrists.org/optometrists_name.html

Scan of the head, what about the heart? Wondering about DVT (I am not a doctor).
posted by tilde at 1:52 PM on May 1, 2012

thirding the suggestion to see an eye doctor. Double vision due to strabismus is, in my experience, worse when I'm tired or stressed.
posted by oblique red at 2:01 PM on May 1, 2012

I have double vision due to ambliopia, it gets worse under stress or when I'm tired. Don't worry about pre-existing conditions, I thought HIPPA reforms addressed it, besides, who cares? This is your health, today. If you have a condition, you should know about it.
posted by Ruthless Bunny at 2:15 PM on May 1, 2012

When you call the eye doctor, you might mention the symptoms on the phone and see if they're the right place, or if they think you should go to a specialist (which they could point you to).

I know a couple of strabismus specialists in Baltimore. If you're having a hard time with a referral, maybe their offices could help you find someone where you are. Mefimail me if you need that.
posted by spbmp at 2:25 PM on May 1, 2012

Totally projecting my own experience here, but headache plus weird visual problems sounds like it could be migraine with aura.

I think I would ask to be referred to an ophthalmologist and then to a neurologist. But then I'm in Britain and on the NHS. I'm so sorry your insurance is making things so hard.
posted by Perodicticus potto at 2:47 PM on May 1, 2012

I only found out I had strabismus my senior year of college, when stress/total lack of sleep made it impossible to ignore; it tends to be more noticeable when I'm looking at things at a certain distance or when I'm doing something like running, when my innate muscles reflexes can't correct the movement. I can see how sinus pressure or general pain would exacerbate your own ability to deal with whatever is causing this. This doesn't really sound very parallel to strabismus aside from the double vision, but I think you really should see an optometrist or opthamologist, as they will be much more knowledgeable than a GP and able to tell if there is a physical reaction or reason during these episodes. It doesn't really sound like you've uncovered many preexisting conditions aside from allergies though, so I don't know how much of a hit this really will be to your health history. The strabismus guy I went to was fantastic if generally aimed at the pediatric set; if you're in DC or suburban MD and would like his name, please let me know.
posted by jetlagaddict at 3:11 PM on May 1, 2012

It's not entirely clear to me from what you've written, but I'm assuming you mean double vision in one eye that persists when the other eye is closed.

There are a lot of different possible causes, but the ones mentioned by the page I linked that seems most likely to me to be intermittent with a period of months are wrinkles in your retina, followed by dislocation of the lens.

If it's retinal wrinkles, I'd get the pressure in my eyeball measured to make sure it's not too low.

A dislocated lens is often associated with Marfan's, and if you have that, you would be exceptionally flexible.
posted by jamjam at 3:13 PM on May 1, 2012

You didn't mention what sort of doctor you're seeing throughout all of this. If it's your primary care vision and you have an unresolved issue of double vision that's gone on for 1.5 years, you need to see a specialist. You want to see an ophthalmologist or, ideally, an orthoptist. I wouldn't see a neurologist unless one of those specialists gives you a referral, because chances are its optical.

The tests for strabismus and other common causes of double vision are inexpensive and would have been performed by an ophthalmologist. If your doctor didn't perform them before sending your for MRIs, CTs, and blood work then I would consider getting a new primary care physician too.
posted by Frankieist at 7:02 PM on May 1, 2012 [2 favorites]