Double Vision (Monocular Diplopia)
May 15, 2015 7:16 AM   Subscribe

For the past 6 months or so I’ve been having a problem with double vision after a day of work in front of a computer screen. This is monocular diplopia, that is, double vision that still occurs when one eye is closed (it’s about equal in both eyes). I’ve seen an ophthalmologist who said it appeared to be caused by dry spots on my corneas and the artificial tears he had me tried don’t seem to alleviate the double vision. Has anyone dealt with anything similar?

More details:

• The double vision is vertical, which is most obvious when I look at a stop light. I see two stop lights, one below another, the lower one dimmer, sometimes overlapping. One time, I had triple vision, with the ghost images of the stop light above and below.

• I don’t have the double vision in the morning, or after a few hours after not staring at a screen 18 inches in front of me.

• On days where I’m not in front of the computer, it doesn’t happen.

• It first started happening when I was on a prescription for FloMax. I stopped the FloMax when I realized that my vision problem could be a side effect. There’s been no improvement since I stopped the FloMax months ago, and my ophthalmologist said it was unlikely the FloMax caused the problem.

• When it started, I had recently moved into an office with windows on two sides, and thus a fair amount of sunlight. To see if it was the amount of light when working, I’ve spent a day working in an interior office to see if that prevented the double vision. And although my eyes felt less strained at the end of the day, I still had double vision that evening.

• I wear glasses and am nearsighted, with a prescription of about -6.0 diopters in both eyes. I do have some astigmatism.

• I’m in my 50s, and thus due to age-related presbyopia, my glasses are progressive.

I’m seeing the ophthalmologist again this week.
Has anyone experienced this before or have some some insight on this?
posted by anonymous to Health & Fitness (9 answers total)
I have exactly this. I'm in my 50s. I first noticed it about 4 years ago, driving at night, when every oncoming car looked like it had four headlights! I had never even heard of anyone having vertical double vision before!

Unfortunately, I don't have a "cure" but my optometrist says it is due to my astigmatism. It totally comes and goes depending on how tired my eyes are. I recently had my eyeglass prescription updated, and it seems to be somewhat better, even though the change was very minor. I can only guess, but maybe the new prescription keeps my eyes from getting as tired.

Sorry I don't have a solution, but I hope this can put you at ease to not worry about it being a symptom of something worse than it really is.
posted by The Deej at 7:51 AM on May 15, 2015

A couple of thoughts:

Have you tried adding a protective screen to the computer to reduce raditaion on your face? I used to look sunburned when on certain medications and spending a lot of time in front of the screen. A change of screen helped, but you can also buy something to put over the screen. If dryness is causing it, maybe that will help.

Dryness is something you can mitigate nutritionally. Electrolyte deficiency seems to promote dehydration. Excess acidity seems to do the same thing. There are a few other things that seem to have this side effect. If you can figure out what nutrients are at suboptimal levels, even if it isn't technically a deficiency, you may find that helps.
posted by Michele in California at 8:14 AM on May 15, 2015

I have this. For me, scleral rigid-gas-permeable lenses do the trick - they trap moisture against your cornea, and eliminate any astigmatism. I have the contact lenses set for the distance of my monitor, then wear regular varifocals (without any astigmatism correction) for when I need to do close work or driving.
Some people prefer them set for distant work, and wear readers.
They are very comfortable for most of the time (sclerals are more comfy than most types of lenses) and I do also have a pair of regular glasses with astigmatism correction for when I don't want to wear the contacts (such as when flying).
PM me if you like.
posted by blue_wardrobe at 10:12 AM on May 15, 2015

I have this, at a significantly younger age. I'm also pretty near-sighted, with some astigmatism. What my doctors and I looked into:

-The original thought was corneal abnormalities, but a bunch of tests found nothing.
-Dry eyes or tears with an incorrect refractive index seemed like a possibility too, but artificial tears do not help.
-A retinal specialist ruled out anything wrong elsewhere in the eye
-A neuro-ophthamalogist & MRI ruled out non-eye causes.
-My glasses prescription doesn't seem to have changed.

The upshot is that it's still there, and has been for almost two years. The doctors have collectively decided it's idiopathic - it doesn't seem to be associated with anything dangerous, so we keep an eye on it but don't otherwise worry too much (beyond me getting periodically annoyed by it.) Obviously I have no idea if you're dealing with the same thing, but as unnerving as it is, especially at first, there's at least the possibility that it's not related to anything worse.
posted by ubersturm at 10:13 AM on May 15, 2015

P.S. part of the reason for going for scleral contacts in the end was because although I could get glasses that would help, the prescription needed changing every couple of months. With the sclerals, especially if set for distance, I can just go buy a pair of readers from the pharmacy if I need to.
posted by blue_wardrobe at 10:17 AM on May 15, 2015

I get the fun monocular double vision. In both of my eyes, now and then. One is corrected only for astigmatism, the other has a little distance correction too. The one with added distance correction that is the worst, but it has slight double vision anyway. In my case it seems to be caused by eyestrain. It is usually gone by morning, unless I've spent several days in a row staring too hard at one thing without taking vision breaks. Dry eyes makes my eyestrain worse, but the double vision is not contingent on dryness.

I envy blue_wardrobe. I'd go for scleral contacts if I didn't have what seems to be a genetic problem with dry eyes, really bad allergies, and a terrible phobia about contact lenses!
posted by monopas at 10:41 AM on May 15, 2015

@monopas: I had tried soft contacts years ago, and hated them. Sclerals are so comfortable by comparison. The eye guy should test you with a plain pair to see how you cope just for a minute or two.
posted by blue_wardrobe at 11:13 AM on May 15, 2015

I think you are exactly right that this is due to taking Flomax, because Flomax can cause intraoperative floppy iris syndrome (IFIS):
Intraoperative floppy iris syndrome (IFIS) is a complication that may occur during cataract extraction in certain patients. This syndrome is characterized by a flaccid iris which billows in response to ordinary intraocular fluid currents, a propensity for this floppy iris to prolapse towards the area of cataract extraction during surgery, and progressive intraoperative pupil constriction despite standard procedures to prevent this.[1]

IFIS has been associated with Flomax (tamsulosin), a medication widely prescribed for urinary symptoms associated with benign prostatic hyperplasia. Tamsulosin is a selective alpha blocker that works by relaxing the bladder and prostatic smooth muscle. As such, it also relaxes the iris dilator muscle by binding to its postsynaptic nerve endings. Even if a patient has only taken tamsulosin once in their life, that dose is enough to cause IFIS during cataract extraction indefinitely.[2][3] [my emphasis]
I'd argue that in your case, floppy irises are causing double vision after staring into a bright computer monitor all day because, at the end of such a day your iris is completely or almost completely relaxed -- and therefore almost fully contracted, making your pupils very small -- but when you turn away from the monitor and go into a situation with dimmer light, your pupils are unable to immediately expand because the Flomax has permanently weakened the smooth muscles of the iris which should cause them to dilate.

And in this circumstance, your contracted pupils function like the pinhole in a pinhole camera and produce an image on your retina which is superimposed on the brighter image produced by your lens and cornea, causing you to see double. That pinhole image is there in the bright light of your monitor too, of course, but is not perceived because it's washed out by bright background, and because your retina enhances its response to dim light relative to bright light in overall dim conditions.

It goes away after a couple of hours because though weakened, the smooth muscles of your iris are able to dilate it eventually.

This doesn't immediately explain the instance of triple vision, but conceivably your progressive lenses might, and I think it would be interesting for you to take a photograph of your eyes during episodes of double vision and look at the size and shape of your pupils, and how well centered they are.

I think I'd try turning down the brightness of my monitor and/or wearing sunglasses, and taking a 10-20 min. break from the computer every couple of hours if I could.
posted by jamjam at 12:55 PM on May 15, 2015 [1 favorite]

Have you tried a one of those "computer reader" glasses? Not the Walgreen kind, but something a little bit more advanced... "Gamma Ray" (cheap) or "Gunnar" on Amazon. I've also had decent experience with Ducco Optiks.

You can get Gunnars sometimes at Best Buy, but they want $70-100 for them. Gamma Rays on Amazon are as low as $20-25 and Duccos are about $40-45. Gunnars on sale or refurb are about $50. New are in the $70-100 range.

I have a few pairs (keep buying them to fit my very large head) and they work well enough I always wear them in front of a PC (even LCD monitors). That, and some eyedrops like Visine or such keeps my eyes relatively happy.

NOTE: If the cheap ones work but you need prescription, you can get Gunnars with prescription, by taking them to an approved optician, and there should be one near you if you check on Gunnar's website. I'd try a cheap pair and see if that helps a little.
posted by kschang at 9:32 PM on May 15, 2015

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