Ophthalmology & Optometry/Double Vision


QUESTION: I'm 47 yrs old and wear glasses (aaprox 4.0) Approx six months ago I started having issues - numbness and twitching various parts of body, cognitive issues etc -  and my GP suspected MS but my brain MRI was fine.  I was also having twitching in my left eye for a while on and off.  So I was in a "watch and wait" holding pattern.  Then about a week ago -  I woke up with double vision in the same eye (never had this before).  Obviously I thought OK another symptom of MS I better go to the ER.  I went to Wills Eye ER in Philadelphia and they found nothing wrong???  basic exam along with visual field test and OCT scan.  Along with this I have been waking with numbness in my left arm and left side of face.  Hard to believe Wills Eye just sent me on my way with no answer and basically no concern!!  Because the double vision did not go away when I covered my other eye they said it couldn't be related to MS.  So I went to my GP he is sending me for another brain MRI.  I'm so confused how there can be something that is causing double vision but not be picked up by the OCT scan and other tests. Any light you can shed is appreciated.  Thank you in advance.

ANSWER: Dear Karen,
Since you cover one eye and still have 'double' vision you have what's called 'monocular diplopia' not 'true double vision'.  this means it is an optical problem, not an eye misalignment problem which would be neuromuscular and concerning. for monocular diplopia, considered would be the lens, retina, pupil, glasses... but nothing medically alarming. Considering the other symptoms, you should see a neurologist, rule out Lyme Disease, and likely have other blood tests.
Hope you get better soon,
Mitch Axelrod, OD

---------- FOLLOW-UP ----------

QUESTION: thank you so much that is helpful.  Since it is monocular shouldn't any of the tests have shown the cause??  My GP is sending me for an MRI of the brain since everything else was negative.  If this doesn't provide an answer I'm not sure what to do.  (I had been to a nuerologist a few months ago - before eye issues - and based on physical test said I didn't have MS and couldn't find any other issue)
thank you for your expertise and volunterring your time - much appreciated!

Once the medical worries and bad news possibilities are removed, the hunt for the monocular diplopia cause can commence. See an optometrist for corneal topography, consider an experimental rigid contact lens fit, or pinhole aperture testing. something should change the doubleness. It may be internal to the eye and not fixable, but first try the external things. I assume you had a plethora of blood work, possibly an infectious disease specialist could be consulted.
Thank you,
Mitch Axelrod,OD

Ophthalmology & Optometry

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Mitchell Axelrod


I'm happy to answer questions about eye exam findings and procedures, glasses and contact lens types/prescriptions/problems. I can also answer questions about general eye conditions/diseases. I do not answer questions concerning surgical techniques/procedures. Please state your age or within a small range when asking questions, as it is often important.


Optometrist 19 yrs.

Doctor of Optometry, cum laude; Residency in Ocular Disease

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