Double vision can be one of the most troubling problems a patient can have. In the vast majority of cases, it occurs when the brain can neither fuse the images from both eyes nor suppress one of the images. The goal of the interventional neuro-ophthalmologist is single binocular vision. Medical, surgical, optical, and exercise techniques can be employed to correct the problem. It is also the goal of the neuro-ophthalmologist to find out why this has occurred.
In the worst-case scenario, double vision can be caused by aneurisms and brain tumors. MRIs and MRAs are needed to make sure nothing bad is happening. If these tests are negative, then blood tests are needed to make sure that there is no diabetes or myasthenia.
Prisms can be used to help correct diplopia. They work best when looking straight ahead and down. Typically, we place press on prisms initially. These press-on prisms are thin pieces of plastic that adhere to your lenses. They are one tenth the cost of ground in prisms. Press-on prisms frequently need to be changed as the double vision improves.
Exercises can also help. Exercises are particularly useful in convergence insufficiency. In this problem, the eyes turn out when looking at something up close. We prescribe convergence exercises to help with this problem. They do not work well in other types of double vision.
In some relatively unusual types of double vision, such as that which occurs when a patient has thyroid eye disease or myasthenia, medicines may help. With thyroid eye disease the tissues around the eyes swell. Corticosteroids help decrease the swelling and restore single vision. In myasthenia, immunosuppressives control the disease. Pyridostigmine helps increase neurotransmission. It can be used in other forms of myopathic, or muscle related diplopia as well.
Finally, a variety of procedures including surgery can be used to realign the eyes. Dr. McHenry is an expert with nerve palsies, paralytic and restrictive strabismus. If the eyes can be set close to straight, then the brain will lock in to increase the conoid, or three-dimensional space of single binocular vision. To achieve this, medicines, exercises and prisms may need to be used temporarily in the post-operative period.
We utilize all means to return your vision to normal. To that end even after all this is done some patients may require new glasses.