Ophthalmology & Optometry/Double vision


QUESTION: hi - I was experiencing general eye twitching in one eye and also seeing my pulse in bottom left corner of same eye.  No pain but had it checked anyway.  Eye doc said everything ok.  A couple months later I woke up with double vision in the same eye. A little pressure - not too bad. Had basic eye exam and visual field and OCT scan.  All tests negative.  I was told b/c I did not have double vision when I covered the bad eye that there was no concern.  I'm baffled and not sure of next steps.  Somtimes I feel like it is getting worse.  what further testing could reveal the cause?

ANSWER: Karen,

I need a little more information - you have 'double vision' but does it involve both eyes?  
Two examples:
1.  A nerve or muscle problem causes double vision.  A patient sees double, but when you cover the left OR the right eye, the double goes away.  The double vision is only seen when BOTH eyes are working.
2.  An 'optics' problem (or other): A patient sees double, but only out of a single eye.  When the affected eye is covered, the double goes away, then the 'good' eye is covered, the patient stills sees double.

Please clarify so I can help more.

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

QUESTION: I have double vision only in one eye - the left.  When I cover the left eye - I do not have the double vision.

I have acute sinusitis also on left side.  I was told I have a blockage in left sinus and they wanted me to have surgery.  I have not been able to schedule yet due to money.  Have you ever seen severe sinusitis cause double vision?

So when you cover the right eye, you still have double vision?
If that's the cause, then this is not a movement / alignment issue with a nerve or muscle.  Monocular diplopia should be investigated thoroughly, though.  Sometimes this is an issue with how the light is going into the eye (a problem with the cornea or lens), but rarely it could be the sign of something more serious.
I would get a second opinion and a full work up to rule out more serious disease.  
If it's truly monocular diplopia, as you have described, it would be unlikely (but possible) that sinus disease could cause it.
Good Luck!

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John M. Dovie, OD, FAAO


As a residency-trained Fellow of the American Academy of Optometry I am able to answer most questions regarding eye and vision health. Anything is welcome, ranging from dry or allergy eyes, bifocal contact lenses, or thoughts on LASIK surgery. As I am not a surgeon, detail-oriented surgical-related questions may be better answered by an ophthalmologist.


Selected to participate in the PCO residency program in Philadelphia at The Eye Institute, where I worked OD and MD specialists gaining invaluable experience in various clinics including glaucoma, cornea and cataract, oculo-plastics, retinal disease, neuro-ophthalmic disease, primary care, emergency medicine, and special populations. Have practiced and trained in numerous settings including hospital, academic, retail and private practice. I earned my Fellowship in the American Academy of Optometry (FAAO). There are currently only about 3000 active fellows worldwide, and there are only about 70 Fellows in the state of Virginia. I currently own and operate my own optometric practice/clinic.

American Academy of Optometry, American Optometric Association (Contact Lens/Cornea Section member since 2001), Southwest Virginia Optometric Association, Virginia Tech Alumni Association

“Nyctalopia as the Presenting Sign of Vitamin A Deficiency: A Late Complication of Gastric Bypass Surgery.” Clinical Case Study Poster presented at The American Academy of Optometry Denver, Colorado, December 2006, co-authored with Bradley Lane, OD.
“The Importance of Considering Paranasal Sinus Mucocele as a Differential Diagnosis in Diplopia.” Clinical Case Study Poster presented at The American Academy of Optometry San Diego, California, December 2005, co-authored with Kelly Malloy, OD, FAAO and Cherie Farkash, OD.
“Acute Onset of Halos and Glare: Bilateral Keratitis—An Atypical Presentation of Amiodarone Keratopathy.” Clinical Case Study Poster presented at The American Academy of Optometry Tampa, Florida December 2004. Also Presented to New Jersey Academy of Optometry, Neptune, New Jersey March 2005.
“The Opportunity for an Optometrist to Save a Life.” Clinical Case Study and Grand Rounds Presentation presented at The Pennsylvania College of Optometry, Philadelphia, Pennsylvania, September 2004.
“Corneal whorls cause wonder.” Clinical Challenges Quiz, co-authored with Andrew Gurwood, OD, FAAO, Review of Optometry. Published 10/15/2006.
“Acute onset of halos and glare: bilateral corneal epithelial edema with cystic eruptions--atypical presentation of amiodarone keratopathy.” Co-authored with Andrew Gurwood, OD, FAAO. Published February, 2006, Optometry.
“Pondering the posterior polka-dots.” Clinical Challenges Quiz, co-authored with Andrew Gurwood, OD, FAAO, Review of Optometry. Published 5/15/2005.
Professional Involvement:
“AION: Amiodarone-Induced or Anterior Ischemic Optic Neuropathy?” Participated as a peer-review referee for Expert Review of Ophthalmology (London, UK); refereed 10/2006.

Bachelor of Science, Cum Laude, Virginia Tech. Bachelor of Science, Pennsylvania College of Optometry. Doctorate (OD), Pennsylvania College of Optometry Residency, Pennsylvania College of Optometry Fellow of the American Academy of Optometry

Awards and Honors
Winner, First Place, "Best Beside Manner" by Our Health Magazine: 2012, 2013, 2014 Winner, First Place, "Best Eye Doctor" by The Roanoke Times: 2013, 2014 Recognized as a Fellow of the American Academy of Optometry, December, 2006 Recipient of the Onofrey G. Rybachok Memorial Scholarship, 2000-2001 Member: The Golden Key International Honor Society Member: The National Biological Honor Society Member: The National Honor Society Eagle Scout awarded 1994

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