hx retinal detachment 1999 recent increased double vision

[anicknamethatsnottaken]

Hi, I am hoping that someone may have experienced similar symptoms and can help me decide how to persue this. My history:  I am a 35-year-old female with a history of nearsightedness and retinal detachement in 1999 treated with gas bubble, lazer, and sclera buckle. I had only minor complications after the surgery and did end up with some loss of peripheral vision in my eye. Overall, I was thankful for the success of the surgery. Here's the strange part. A few years later I began to experience binocular double vision. This is particularly increased when I look up. Most of the day I can seem to merge the two images together, but as the day goes on it becomes more difficult... to the point that I cannot read or simply have to close one eye to do anything like use a computer or watch TV and I get a great deal of pain behind my eye.. This was explained to me that it may have been caused by trapping of one of the muscles during the buckling surgery. OK, maybe, but then why did it occur years later? The other odd thing is that when I look up or to the side, I get large dark circles in my "good" eye. These occur in the direction I am looking. If I look up or to the side for longer than a few seconds then I see bright stars (the sorts you see when you are about to pass out) in my "good" eye and occasionally everything turns dark, with vision returning when I look back to center. Also, when I am applying eye shadow and very lightly touch the inner corner of my eye lid I get the same dark circles in my vision. I am not applying pressure on my eye at all, but rather on the area above it and towards my nose. Finally, I can often see my pulse in my "good eye" (vision gets lighter and darker with my pulse), certainly disconcerting, but not more than slightly annoying.  I have mentioned these strange symptoms to my eye doctor only to have them look at me funny and dismiss these concerns. One eye doctor told me that when he looked in my eye while I looked up he could see the blood vessel pulsing and said he could understand why my vision would go black, but never really explained it to me. He ordered an MRI, but then moved his practice before I could follow up. My regular doctor said my MRI was normal. I didn't mention these symptoms to my doctors again for years because I felt silly, or thought maybe I was imagining things. Now recently, the double vision has become quite problematic. I did ask my new eye doctor about it, but she sent me to a retinal specialist who only could say it was not related to my retinal health (he only looked in my "bad eye"... the one where I'd had the detachment). In fact whenever I mention any eye problems to my doctors the immediately worry about a detachment and I feel like they are ignoring my other issues. So, I don't know how far I should persue this. Does any of this really seem like something to worry about or should I just learn to deal with it? They did put prisms in my glasses, but these were only helpful for a short time. If these symptoms are related to my previous surgery, then why does all of the strange stuff seem to be occuring in my other eye?
Thank you for any suggestions or similar experiences you can share!

MJ

[JodieJ]

Who said that double vision is nothing to be concerned about??? It IS a concern (and a diagnosable medical condition), and your double vision can probably be treated/corrected.  Apparently your buckle procedure resulted in an eye alignment problem--maybe totally unrelated to the reasons I had such problems.  I brought up my situation as an example of a case of double vision that (like yours) took years to develop.

I really hate HMOs, and I hope that you are able to convince someone to refer you to a pediatric ophthalmologist.  They absolutely will NOT suggest that you wear an eye patch--guaranteed!  Hopefully, your double vision can be eliminated with the correct prism prescription.  It's been my experience that only a specialist in binocular vision problems can get the prescription right.  Best of luck!  

[anicknamethatsnottaken]

Thank you so much for your responses. I will try to locate the doctor you both described, however I live in a fairly small town and I doubt we have anyone that specialized here. My insurance is also an HMO so I would have to convince my PCP that I need a referral, which is not always possible and may be complicated by the fact that my insurance is medical only and doesn't cover vision.  Yes, the double vision is extremely bothersome, but I am still left to wonder why the odd visual symptoms seem to be occuring in the eye that didn't have the buckle. I may speculate perhaps, that the muscles are pulling or straining because the movement of the other eye is restricted? I don't think I will ever get a clear answer about the pulsing vision in that eye. I have looked on the internet and have seen several people ask, but no one has ever offered an explaination. In the cases I read about, no one ever seems concerned so I will chalk it up to just an annoying fluke of they eye. If the double vision is nothing to be concerned about medically, but rather a quality of vision problem, then it looks like I will just have to wait for better insurance or winning the lottery. :)  

Jodie, I am not sure what monovision is except it has something to do with eye dominance, correct? What did your doctors do to correct yours? I am hesitant to have the scleral buckle removed since I dread the idea of surgery especially since it would probably be considered an elective surgery and once again I don't think my insurance would cover it since it is vision. Ugggg! I was under the impression, from friends' children that pediatric opthamologists just put patches over one eye? Forgive my ignorance if this assumption is incorrect. Given the choice between a pirate patch and double vision, it looks like I may just have to cope with the double vision. I will certainly check into it though. Thank you again for your advice! I do truly appreciate your response!

MJ

[JodieJ]

It was definitely my experience that only those doctors who specialize in binocular vision problems would be compent to answer your questions.  At least in my case, other doctors (both optometrists and ophthalmologists) were not at all helpful.  They gave me incorrect information (e.g., my double vision was "normal," "uncorrectable") and prescribed prisms that didn't help.  So schedule an appointment with a board-certified pediatric ophthalmologist--they see adults, too.  (Your current eye doctor should be able to give you a referral.)

I can't tell you why it took your double vision problem years to develop, but I can certainly relate to your account.  I developed binocular diplopia related to monovision contact lens wear.  However, it was not until my 4th year of monovision that I began to have problems.  (According to a paper by Bertram Kohler at the University of Wisconsin, double vision has been known to develop as late as 8-9 years after monovision.  It can apparently take this long for a mild phoria to decompensate.)  Like you, my double vision defintely got worse by the end of the day, when my eye muscles were tired.  But this is probably not something that you have to just "live with," regardless of what you've been told.  See a specialist.    

[John C Hagan III, MD, FACS, FAAO]

Eye muscle problems are common after scleral buckles either immediately or down the road, which often occure because of scar formation or tissue contraction.

I would suggest you see a strabismus-pediatric Eye MD since you biggest complaint seems to be your double vision.

Find one at www.aao.org

JCH III MD