Diplopia For Dummies: What Should You Do About Your Double Vision? | Knock Knock Eye
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- Опубликовано: 17 апр 2024
- This week on Knock Knock Eye, I discuss my tough work day due to some curveballs that came into the office, including a patient with Diplopia. It's a tricky thing to figure out as it could be an eye problem or a brain problem.
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Haha, I was the patient that screwed up everyone's schedule about a year ago. Sudden binocular Diplopia, 35yo, no trauma or other factors, and no visible eye/motion abnormalities. A rural emergency room, then a drive to a city emergency room, a phone consult with an ophthalmologist, head CT and bloodwork, then an in person slot in the next day with the on call ophthalmologist, followed by a referral to neuro and MRI. My favourite part was the ophthalmologist's Jonathan was a huge fan and had a picture of Jonathan on her desk.
...and?? such a tension and you don't tell us the outcome?? all fine? ❤❤❤
@@dorothea_walland I assume all is fine if they managed to churn out a paragraph of text in a comment. Also, maybe they don't want to share too much personal medical info online with total strangers and they were more interested in sharing that they'd seen a Jonathan in real life.
I'm fine. :) the outcome wasn't definitive, so not the best punchline to the story anyways. It only lasted a few weeks.
@@ddavies12345 in that case, tell us more about jonathan 🤩🤩🤩
that story will be GOLD one day when your grandchildren sitting on your lap require it again, holding their breath ☺️🌈 (btw gives you enough time to polish the plot and pimp up the ending. until then you can get xray vision or the ability to shoot invisible yet mildly painful lasers that can remotely pacify any abusive person you focus on. and save their victims without causing any suspicion. omg and all this _just because_ jonathan transfered this power on you through the subtle yet all-transcending nod). ok i totally went wild there. but can't blame me, just thinking of _meeting him_ is so empowering 😁😁 ok i stop now.
and i hope you felt my original comment was all in good brotherly Glauckflock spirit and o didn't wanna prey, just join and spread the joy blessing of jonathans spirit
I had sudden onset binocular diplopia at 17, along with drooping eyelids. I called an ophthalmologist who was very concerned, and he booked me in for the next day. Overnight I developed difficulty swallowing and muscle weakness in my arms and legs. By the time I got to my appointment, I was having a hard time breathing fully. Turns out I have Myasthenia Gravis! The ophthalmologist diagnosed me and called an ambulance, and I spent a week in the ICU on a ventilator because my diaphragm became paralyzed.
That was my first myasthenic crisis. Myasthenia Gravis is no joke y’all, if you’ve got double vision and droopy eyelids, go to a doctor!!
As a neuro-ophthalmologic technician, I love hearing you talk about things I encounter daily and that I see my neuro doctors treat daily. Thank you Dr. G❤️
When I explained my diplopia to my ophthalmologist 6 years ago and told her it was monocular she said, that‘s impossible and sent me away. Time to get checked out again I guess. Very helpful
I'm someone with a bit of strabismus, that was never really treated when I was still a kid (besides instructions like "exorcise the eye muscles"... 🙄). It was a different world back then. Now, especially when I'm tired, I sometimes see things in multiples and my depth perception is less than ideal. But the "cool" thing is, I can switch between normal vision and seeing multiples at will, even when I'm well rested. This video was highly interesting!
I had non-comitant strabismus (wandering left eye). Moms ophthalmologist missed it in 1985. Two optometrists and an ophthalmologist gave me glasses with +3 prisms at bottom of both lenses. Ophthalmologist told me I had a major eye problem but didn’t tell me what it was..
Finally, an optometrist standing in a parking lot at a health fair did the finger to eye test diagnosed it. He sent me to a local optometrist who officially diagnosed it and got me to see an ophthalmologist under my hmo. She waved some popsicle sticks with cartoon characters and praised the guys numbers. Happy she was a pediatric O. After muscle retensioning surgery in 1994, I started having torsional strabismus. Solved that after 10 years by buying a widescreen hdtv and not looking at people.
On my own, i found a paper on the N.i.h website stating the inferior rectus was mucked up by an undiagnosed lower orbital fracture.
What a great optometrist
I love the pediatric angle haha! What a journey, and I sense sarcasm at the end where you talk about torsional strabismus, maybe? Hopefully all is better for you now
As a future EM doc, I’m hanging on every word!
Thank you in advance for the ER work you'll do; and also Thank You currently for the hard work you're undoubtedly doing right now to get there!
If you can, please be kind with your eye patients who come in to ER. It's a terrifying thing to suddenly have one's eyes not work.
Over the years, I've had a few "You're about to become very popular" moments in the ER. None of those experiences were as soul-shaking scary as suddenly losing a huge chunk of my vision in a literal blink. ER was pretty chill about the whole thing at intake. A bit of extra empathy and gentleness (even though you already know the life-sustaining organs are probably fine) will give your patients a better experience.
I have monocular polyplopia in both eyes, due to high-level corneal aberrations. I doubt this video will help me, but I'm watching it anyway.
Love your content, Doctor G.
Sama saya juga kena diplopia monocular di kedua mata....sekarang gimana matamu keadaannya
@@hafid_z3106 Same as always.
I am a Neuro-ophth and med school prof. This is the lecture I give to our first year medical students and reinforce when they rotate with me on their clinicals and again as residents; you nailed everything every Dr needs to know and should do to triage diplopia. I joke about the ejector seat button I want for the monoculars who make it to me, not because it is a hassle for me, but because I don’t wish a Neuro-ophth exam on anyone who doesn’t need it. My one ask is to see Dr. Glacomaflecken do Neuro-ophths.
I actually LOVED my neuro-opth exam, because it was ACTUALLY THOROUGH. No gaslighting, actual testing. Sure, the ice pack on the face was weird, but after YEARS of being treated for double vision by a pediatric opth, as a 50+ person, it was GREAT to get a reason!
Quadriplopia ... widely regarded as The Who's best album
I don’t work in healthcare, I don’t have eye issue thankfully, but I still love watching all your content. You get the information across well, so good job. It’s not confusing 🙂
Interesting video. I took my glasses off to see the eclipse with the eclipse glasses and saw 2 suns, which was strange and then when I realized that one of the suns was lower than the other and more shadowy and then I realized it was because I wasn't wearing my glasses and my glasses were correcting for my eyes not working well together. But it's so rare that I am not wearing my glasses that it's extremely rare for me to see that double effect. I did look with one eye at a time to confirm.
Fun fact: Diplopia is how an opthalmologist caught that my shunt had malfunctioned. I have hydrocephalus, and I've had a shunt since I was 4. When I was 7, I had awful headaches and nausea. I don't remember the timeline with the ER, just that when we went in the first time, my ped. neurosurgeon was away doing surgery (He gets called away to other states and countries because he's a stellar surgeon), that when he returned he agreed it was the shunt, and that, most relevant, when I started having double vision, we went to an ophthalmologist who agreed that it was definitely my shunt. I had binocular diplopia, and my medical history obviously pointed that way.
Thank you! Eight ophthalmologist. Just kept changing doctors. And here I have the answer. Have autoimmune condition primarily reflecting as psoriasis, PsA, sometimes red eyes, UTI etc etc. I see multiple moons - vertical, one top of other. And yes this issue is only with far off bright objects. It gets worst at times and then improves also. I have no issues seeing anything during my day to day activities like driving, reading or anything. I think I am getting inflammation due to my autoimmune conditions and the is the reason for my multiple vision problem. I just needed answers. Thank you again doctor!
Very timely…thanks for reading my chart!
At one point I was expecting Neurology to appear..... AHHHH!! SO YOU NEED ME AND MY BRAIN!!!
Great chat and explanations as always!
😂 I read "Diploma" and was wondering how you came up with that topic, till the rest of tge title didn't make sense and clued me in on something going on there!
I was so excited to have a patient with diplopia last night because of this!
You should definitely do the CME. You are a good teacher.
I work for the pharma company with the Thyroid Eye Disease med, so that was exciting to hear you talk about!
One of my friends has POHS and would love to hear about it.
My mom had some issues with diplopia not too long ago, so this was definitely super helpful lol Shout out Dr. G!
Great talk! As a neuro-ophthalmologist, I'll throw another localization out there that shouldn't be missed and that's the neuromuscular junction/ myasthenia. That and to point out that the 3rd is the commonest cranial nerve to be impacted by gca.
Thanks for what you do for education!
Thanks, I'm glad you covered this. I was dx'd with GCA last summer. Now I'll be a bit better informed when I visit my eye Dr. 😽
Hey, I’m an Orthoptist in the UK, a binocular vision allied health professional.
Informative crash course for Diplopia, I loved the initial monocular vs binocular diplopia at the start.
The 3rd innervates the levator not the Müllers and good shout with the gca ix
I wonder what the difference is between binocular diplopia and bilateral strabismus. Because I've always had slight double vision, and I've heard both words be used to describe it.
If I had to venture a guess, I'd say that bilateral strabismus is a type of binocular diplopia.
As a fellow chronic diplopian, I wish you the best of luck and happiness. :)
@@gaysarahk Thank you! ❤️
I have strabismus in both eyes and 4 diopters acuity difference, if corrected I get double vision. I have trained my eyes to work independently without correction and just use reader glasses to drive with one eye and read with the other eye. Cheap and effective.
Informative and entertaining content as always, Dr Glaucomflecken! Thank you! ⚘
I have been looking forward to you getting to this topic! I had a trauma that led to a few eye abnormalities, including diplopia. I’m very interested in learning more about it
This was interesting! I've always assumed that monocular double vision would be the more serious one, but your explanation made sense!
I have strabismus - comitant esotropia worse at a distance - and I've always been curious how it works when there's no nerve palsy found, but it seems like one of those things we just still aren't sure of?
I had surgery for it this past fall and it's been such a relief. I was at 50-ish diopters of eye turn before surgery, with 24 prism diopters crammed into my glasses, so it's really nice to be down to a controllable 6-10 now! Definitely not going to complain about my 6ish diopters of myopia making my glasses thick anymore, haha
For American people: do you need a referral to see an ophthalmologist in the US? You do in Canada, and seems like I see a ton of comments about people casually seeing ophtho for glasses and routine eyecare. Here they are all specialists and you only see them if you have something going on, and none of them do glasses.
Probably confusion between optometrists (who do routine vision exams and prescribe glasses) and ophthalmologists (who are very highly trained specialists and handle all kinds of eye issues).
i learned to always check GCA labs in cranial nerve palsy patients over 60
My mom lost a good chunk of her vision in one eye to GCA recently. Deeply frustrating because her symptoms started over the weekend and her insurance left her with the impression that she couldn’t be seen before Monday. I’m now on a mission to tell people that yes, eye problems do merit an ER trip.
I've had a "baseline" double vision r/t 3rd nerve palsy post head trauma in 1974. I lived with it for years. No problem. Thirty years later, it got worse, much worse. Eye clinic (patient since 1974) blew me off. Primary practice RN ripped them a new one, so they called me right in. They sent me to a neuro-opthomologist (brilliant man, but gigantic effing ego) who dx'd a thyroid and estrogen problem. Problem solved! Still have the baseline double vision, but we've been together most of my life, so we're good.
Gotta love a good theme day! Diplopia doesn’t sound like a fun theme. Big differential!
That was extremely helpful, thank you. I hate double vision in the ED.
Would have loved a shout-out to ocular myasthenia! (Maybe i‘ll get lucky when you get to ptosis). Thanks for another great episode!
I love your videos. Could you talk about eye strain next?
Would love an episode on non psychiatric hallucinations!
I have 4th nerve palsy. Even though I already knew something about diplopia, this was quite interesting to get a more well-rounded understanding of the topic. Mine appears to be permanent even though it came on as an adult. It’s able to be corrected by glasses but it is quite annoying because my vision gets better or worse depending on my tiredness level so glasses don’t always help me see as well as one would like. Bodies are miraculously frustrating machines.
More on preparation for 'Duke Elder' exam please. Thanks.
Interesting topic! I’ve had double vision my whole life, and didn’t know it until my late 30’s. Turns out I’ve had it since birth and thought it was how everyone saw. Ended up seeing a neuro-ophthalmologist and diagnosed with Duane Syndrome (really wish it had a cooler name). I’m lucky it’s mild in my case and I adapted early to function well and fool Doctors that everything was fine for so long! But I’m glad to know why my eyes look like they aren’t pointing in the same direction in photos from the left now!
I have diplopia but mine is entirely related to Idiopathic Intracranial Hypertension. My ophthalmologist as a child tried to "fix" the problem by shortening my eye muscles. It didn't work (because that wasn't the actual problem). Used huge amounts of prism trying to correct it. 30 years of hell, only to find out I had IIH. ONSD/ONSF and a shunt, and I'm mostly okay, but the shortening of my eye muscles as a kid means I'll always have some double vision. Wish my ophthalmologist had been more like you.
I have diplopia caused by hydrocephalus. I've been using prism lenses for I think 8 years now, and although I still see double with these lenses, I'm better able to focus in on just the image I see with my dominant eye. I don't drive because I'm worried that my double vision, along with a few other unrelated health problems, I would be a danger on the road, so I haven't even attempted to get a driver's license (I'm 28), even though none of my doctors have told me I can't.
When I went to the ER with double vision after having the worst headache I’d ever had for a week. It turned out to be meningitis! I was in the hospital for several days…
Aha! Thanks to Dr. Glaucomflecken, I now know that it was 4th nerve problem.
I have binocular double vision, which I have had since birth. The muscles on the outside of my right eye are weaker. When I get really tired, I can see the right eye track out and out of focus. When that happens, I sometimes see double--other times my brain just ignores my right eye and uses the image from my left eye. At that point, I lose some of my depth perception and have to be more careful.
I did have a brief spell of monocular double vision in one eye. It was not a ghost image, it was due to changes in the vitreous body. My eye doctor saw me that day to make sure the retina was not beginning to tear. 😊
I will remember double vision can be from one eye--then mostly likely dry eye--or both eyes. If both it could be from trauma, something displacing the eye, something preventing the muscles from working properly, or from nerve palsy.
8i almost spat out my drink when you said dry eye cause i literally just had an emergent eye appointment for eye pain, that was dry eye.
I developed esotropia due to Heavy Eye Syndrome. Surgery on the medial rectus corrected it 2 years ago, but it's creeping back. Probably gonna have more surgery eventually.
27:45 not confusing, reminds reminds me of A&P 223 and 224 study videos. Except I don’t have to take notes because I’ve already passed those tests 😉
More information on how neurological issues cause ophthalmic issues would be great. My late mother had loss of vision due to minor strokes, but was positive there was something wrong with her eyes. There wasn't, but because she couldn't see, she kept trying to see the ophthalmologist.
In my experience, the "ghost" thing happens when I'm tired and _can't quite_ properly focus my eyes.
Sometimes I get double vision as a result of my medication along with dizziness. This happened once while driving. Thankfully, I was close to my destination.
Just had bilateral lateral rectus resection, so getting rid of prism lens glasses again
I'm currently experiencing horizontal gaze nastigmus, now I'm fairly certain it has something to do with my BAC, but if it doesn't resolve after a nights sleep, ill be seeing you well sort of, ill kinda be able to see you...oh never mind
29:20 I just imagined the Neurologist standing behind you with his usual look of disapproval as you were trying to remember the nerves.
EDIT: He's probably beat me to death with a reflex hammer with my lack of knowledge, but I'm also only educated to an EMT level.
I had binaucular a few years ago. It was due to a really high intracranial pressure. I got rushed into emergency and had to be monitored for weeks. Having two eyes open was nauseating as everything was doubled, as a passenger in a car, i could see uncoming traffic but also an identical car right in front about to hit us.
I have diplopia for a few minutes when I wake up and whenever I look straight up. I had to have a drain placed after the combination of glaucoma and opthalmic zoster and steroids all conspired to earn me a drain last fall.
And now I'm getting a cataract in that eye thanks to all that! And I had 20/15 vision beforehand.
Why does it have to be eyeball stuff? After all these years as an anesthesiologist, only eyeball surgery grosses me out!
I get diplopia only at Philadelphia Union soccer games and/or the Sons of Ben tailgates before the games. It lasts for 2.5 hours and I have zero other symptoms with it. fun.
I just got prism glasses last year, I have a horizontal split so I've had double vision my whole life and did not realize it until I saw through prism lenses
I could pass eye tests, but I couldn't drive
Had an onset of double vision and bad headache for a few days and a gritty feeling in my eye. Optician said I needed new glasses but I insisted on a hospital referral which they grudgingly did. By the time I got to hospital my vision was very poor. Staff freaked as my pressure was 58 and I ended up on IV mannitol ( allergic to neomycin.) Got sent for a chest x-ray and tested for TB, HIV and every other infection known to man. Felt better after a month of steroids but still didn’t get a diagnosis. Would love to know what it was.
I am fairly sure I have monocular diplopia. I keep telling my optometrist about the double vision that comes and goes. I thought for a while it was from my astigmatism but what you described sound like what I have. Plus i have medications that cause eye dryness. My optometrist never explained anything just kept saying my eyes were fine and to not worry about it.
optometrist here, dry eye, uncorrected astigmatism, and some forms of cataracts are the 3 main causes of monocular diplopia.
Thoughts on ageing with a congenital Horner's? I don't know how to say this without the neurologist appearing at my door with a reflex hammer, but nothing of note on brain imaging.
I have an arachnoid cyst in my left lateral cavernous sinus and Mikels cave. I’ve had sudden onset pain in my left eye towards the back of it that has been there everyday for almost 3 years after a fall. Binocular diplopia started last year along with vertigo. It’s frustrating trying to get answers. I had to retire because of this.
Just outta curiosity what does it mean if you have a rainbow floater that can only be seen in one eye that stays for 6+ hours before a massive stroke? I've been told it was my brain warning me and that it was just an weird eye thing that happened. Not sure if ya know what it is or not but just curious if you know
I learned how much I’ll need the expertise from an ophthalmologist should anything like this happen:) I’ll remember the third nerve palsy, and hope I don’t get it.
I've had binocular diplopia my entire life. I was a teenager before I realised not everyone can see their hand AND behind their hand at the same time 😂
thought . . . you said "If I had this, I'd get an MRI right away," what happens for a patient who can't get an MRI. I have metal implants in my feet and I've been told that I can't get MRI's, but I've wondered, if it was say the eyes at issue, could I go in and keep my feet out of the machine?
I'm not a doctor, so obviously, not the last word on this, but I have plates and pins in one ankle and an artificial ankle in the other ankle and I've had quite a few MRIs. I don't think it matters, because they have different options on how much of you they scan.
No, if the metal isn't MRI safe the strength of the magnetic field could heat up the metal so it burns through the tissue in your feet or move and cause damage. That is why we are so cautious about MRI checklists. Modern implants..put in since 1990s are mostly safe but usually need proof of exactly what is in there for them to agree. There are many other ways neurologists can diagnose problems in those we can't get scans on
How do they/you create an eye from an eyetooth?
Ahhhh so that's why I have that ghosting/monocular double vision!
My tear ducts are uhh.. completely buggered is probably the polite way to put it XD
So my eyes are basically always in various stages of dryness.
Speaking of btw.. So.. I have eye drops for this but I've noticed that if I use them for too long without taking several days or so off, my eyes start to struggle more than without the drops.. Any idea why that might be?
Optometrist here, can I get 1 hour of COPE CE credit for this?
I had bell's palsy and ever since my left eye still fell weak although I see fine unless I am tired and make left eye see down and right eye up the image almost like 2 projectirs.
I developed monocular diplopia, progressively? or I was born with it?... I just can't remember not having it... I got my eyes checked this year by 4 different ophthalmologists, and they all said my eyes seem to be fine (except for mild hyperopia and annoying accommodative/ciliary spasms) ... I thought seeing double was normal, till for some reason I mentioned it to a friend a year ago... I'm almost 38, how did it take me so long to even suspect this wasn't normal!!!??? 😂 ... the dry eye is a probable thing, I'm on a treatment for "obstructed glands"? We'll see ....
Gimana sekarang matamamu
I had a sleep mask that put a little pressure on my eyes, it ended up giving me double vision for a little while.
What diseases have dry eyes as a symptom? NOT eye diseases, but others that affect the body in a more general way? Can very dry eyes be the first indication of some diseases?
Is that a map of Victoria on your t-shirt?
I have double vision in both my eyes.
@dglaucomflecken My Doctor suspects that I have either BVD or Nystagmus. Can my regular optometrist diagnose these or should I see an ophthalmologist?
Bvd isn’t really a diagnosis, it’s a catch all term for what could encompass a whole range of binocular vision issues.
nystagmus has a whole range of presentations and some require further investigation. I can’t comment on you specifically but an ophthalmologist would be suited to investigate further
@@Goudaisgouda ok I will make an appointment with an ophthalmologist.
I have a 6 nerve palsy! Had Ct w/wo contrtast. It happened very shortly after I got H1N1 vaccine! It has never improved... doggone it! I see a neuro ophthalmologist .
Congenital 4th nerve palsy here, how often are cranial nerve palsies congenital versus acquired? Lost my compensation abilities with age
About 50% are congenital, followed by trauma and vascular issues being 3rd and 4th cause. Many congenital 4ths go undetected
I’m saving this video for the next time I have insomnia 👍. It’s well done but once you start talking cranial nerve palsies dream land inevitably starts beckoning.
Quite strange to hear absolutely no mention of strabismus whatsoever in a video about double vision.
I did not know that the cute girl is his wife.
Makes sense.
She's a petite warrior! Saved his life a couple years ago when he had sudden and unexpected cardiac arrest while sleeping. She did 10 minutes of chest compressions until EMS arrived and took over.
she's not a 'girl'