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Thread: Sudden permanent double vision - adult.

  1. #1
    Craftsman PJdB's Avatar
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    Sudden permanent double vision - adult.

    My Mum suddenly found that had double vision a week ago, - left it a day thinking it would subside, but it did not.

    It's been a week now.. and it's got slightly worse (as the glasses she ordered to temporarily correct the issue, were out of focus 5 days later when she went to pick them up).

    She is seeing the nurse about her blood test results later today, she was told over the phone that all tests bar one were negative, the exception was borderline (but she can't remember what test it was for!!).

    I have made the cardinal sin of googling the problem, and most of the reasons aren't trivial. So I'm very worried. My Mum is 69.

    Just wondering if anyone here had any experience of this condition at all? Is it a high probability that this could be life changing?




    https://www.nhs.uk/Conditions/Double...es/Causes.aspx

    In adults, if double vision develops suddenly and isn't caused by a childhood squint, it may be a sign of another condition affecting the free movement of the eye, or the muscles, nerves, or brain. Conditions may include:

    a thyroid condition affecting the external eye muscles – your thyroid gland is found in your neck and produces the hormone thyroxine

    a condition affecting the blood vessels supplying blood to the brain, or to the nerves controlling the eye muscles (for example, a stroke or a transient ischaemic attack)

    diabetes – which can damage the blood vessels supplying blood to the nerves of the eye muscles

    myasthenia gravis – which causes the body's muscles to become weak, including the eye muscles

    multiple sclerosis – which affects the central nervous system, including the nerves of the eye muscles

    an aneurysm – a bulge in a blood vessel caused by a weakness in the blood vessel wall, which can press on a nerve of the eye muscle

    a brain tumour or cancer behind the eye that prevents free movement or damages the nerves to the eye muscles

    a head injury damaging the brain or the nerves that move the eye muscles, or damages the eye socket and restricts the movement of the eye muscles

  2. #2
    Don't mess about with stuff like this. Get her to an optician/GP straight away who will refer her to hospital eye clinic.

  3. #3
    Master
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    Her GP needs to get her in to see the orthoptists and Ophthalmology asap. Its probably nothing, it's not that uncommon, but there are some underlying causes that need attention. There shouldn't be any issue with doing this, a quick call to the local eye dept and they will fit her in.
    They will use a stick on (Fresnel) prism to correct it and this can be changed if the amount needed changes. If there is any residual, stable diplopia at the end this can be built into spectacle lenses. It does usual resolve in time and the prims will keep her vision single.
    Hopefully all will be well.
    David

  4. #4
    Master Arcam's Avatar
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    Quote Originally Posted by Kingstepper View Post
    Don't mess about with stuff like this. Get her to an optician/GP straight away who will refer her to hospital eye clinic.
    +1

    Sent from my SM-N910F using Tapatalk

  5. #5
    Master unclealec's Avatar
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    My wife had an acute and serious eye problem that as it turned out needed urgent surgery. She was being seen at 6-monthly intervals by the local opthalmic dept of our nearby general hospital.
    When she consulted tham about the synptoms they advised her to go to an optician. We were surprised, but followed the advice and went to Specsavers (which maybe I should have done before marrying her).
    Oh! boy did she get fast-tracked (still within the NHS) to a contracted-in specialist, where she received prompt treatment.
    So my advice is to go down the optician route rather than the GP route.

  6. #6
    Craftsman PJdB's Avatar
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    Many thanks for replies so far. Just a quick reply to say that she has been referred to the hospital, but will probably have to wait a month or so for an appointment. Is it worth going private? Is speed of the essence?

  7. #7
    Don't know who referred her but if thought a genuine emergency she'd be seen right away.

  8. #8
    Master
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    Not good enough. I'd want a patient in far sooner than that.
    At the very least the eye dept need to know and then they can make up their mind.
    I'll contact The Surrey LOC and see who does what where. Which bit of Surrey are you/she in?
    David

  9. #9
    Craftsman PJdB's Avatar
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    Quote Originally Posted by DavidL View Post
    Not good enough. I'd want a patient in far sooner than that.
    At the very least the eye dept need to know and then they can make up their mind.
    I'll contact The Surrey LOC and see who does what where. Which bit of Surrey are you/she in?
    David
    David, - my Mum is actually based in Essex - Witham

  10. #10
    Quote Originally Posted by PJdB View Post
    David, - my Mum is actually based in Essex - Witham
    Broomfield then - spent many hours waiting in their eye clinic.

  11. #11
    Craftsman PJdB's Avatar
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    Quote Originally Posted by DavidL View Post
    Not good enough. I'd want a patient in far sooner than that.
    At the very least the eye dept need to know and then they can make up their mind.
    I'll contact The Surrey LOC and see who does what where. Which bit of Surrey are you/she in?
    David
    Been on the Essex LOC website, - I cannot see a phone number, however I could email them http://essex-loc.org/contact-us/

  12. #12
    Master
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    Quote Originally Posted by PJdB View Post
    David, - my Mum is actually based in Essex - Witham
    ok there is a MECS scheme (minor eyecare) in NE essex
    http://primary-eyecare.co.uk/enhance...p#NEE_CCG_MECS

    Doesn't seemt to far away. If she could see one of these then they will sort it out. Failing that if that's all her GP can do an explanation to her optom should illicit a phone call to the eye dept who will decide.
    David

  13. #13
    Craftsman PJdB's Avatar
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    MANY thanks everyone, - this is all really helpful - your time and help and hugely appreciated.

    Just another quick thing I think I forgot to mention, the doctor said that he believes the problem is because the muscle controlling the focus is not working.

  14. #14
    after seeing the eye specialists go and see and endocrinologist too

    my boss's daughter got double vision all of a sudden one day - it was her thyroid, when underactive or even overactive, inflammation can happen behind the eyes due to many reasons but mainly immune system response

    "a thyroid condition affecting the external eye muscles – your thyroid gland is found in your neck and produces the hormone thyroxine "

  15. #15
    Master
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    Quote Originally Posted by PJdB View Post
    MANY thanks everyone, - this is all really helpful - your time and help and hugely appreciated.

    Just another quick thing I think I forgot to mention, the doctor said that he believes the problem is because the muscle controlling the focus is not working.
    Ultimately it has to be this, the question is why? There are 6 muscles that control where each eye points (not the focusing, that's different), obviously there is a large degree of coordination between the 2 eyes to prevent double vision. This has now broken down. It can be neural, muscular or cortical.
    But the orthoptists will thrash this out and help as best they can.
    Having double vision is really unpleasant so waiting a month is just mean - an eye patch may be required in the meantime.

  16. #16
    Craftsman PJdB's Avatar
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    I am presuming David that are a GP or healthcare professional.

    Again - really appreciate all the comments here, - I have shared them all with Mum. She got back from the opticians an hour ago, they said that her eyesight has deteriorated twice as much from when she was seen a week ago.

    She then rang Bloomfield hospital who weren't very helpful, so, so save hassle and waiting any further, she has booked herself in for a private appointment for next Tuesday.

    Thanks again everyone.

  17. #17
    Sorry to worry you but don't be palmed off

    I agree this need relatively urgent attention, and needs urgent investigation especially if assoc with headache

    If you are seeing an ophthalmologist and they cannot determine an obvious reason for double vision i.e. thyroid eye disease, then an MRI scan of the brain with a vascular series would be advised, and sooner rather than later

    Its probably microvascular disease of one of the extraocular nerves, common in the elderly and often assoc with diabetes, but the causes are numerous, and you need to be sure

  18. #18
    Master
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    Quote Originally Posted by PJdB View Post
    I am presuming David that are a GP or healthcare professional.

    Again - really appreciate all the comments here, - I have shared them all with Mum. She got back from the opticians an hour ago, they said that her eyesight has deteriorated twice as much from when she was seen a week ago.

    She then rang Bloomfield hospital who weren't very helpful, so, so save hassle and waiting any further, she has booked herself in for a private appointment for next Tuesday.

    Thanks again everyone.
    I'm an optometrist.
    What did her optom say? Are they not doing a referral or at least allowing Ophthalmology to decide.
    From your description there may be another explanation. It is perfectly feasible to have good vision in each eye but to then see double using both. This is true diplopia and needs attention.
    But lots of patients arrive saying they can see double (often in each eye!) when the issue is that one is much worse than a: the other or b: it was.
    Blurred images are larger than sharp ones so you see a good image with a big fuzzy shadow around it. People descibe this as double but clinically it isnt, it's blurred which tallies better with the statement her vision is twice as bad a week ago. A patient or clinician wouldn't really describe sudden onset dipolpia this way/ in these terms.
    So then the issue is what's changed and why. In the absence of obvious signs then a more routine referral would make more sense which then tallies with what seems to be happening.
    How old is Mum?

    David

  19. #19
    Master
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    As above, a key thing is whether this is blurred or double vision. I ask my patients whether they see two distinct objects with both eyes open (true double vision) whether they see two distinct objects only with one eye open (monocular double vision-rarely has a serious underlying cause) or whether they see one object with another superimposed on top or one object which has indistinct edges (most likely blurred vision).

    If an optician has measured her vision (which I assume to have been good previously) as twice as bad now as compared to one week ago, there may be a sinister underlying cause and it is worth getting this further investigated in an expediant manner. People can have both blurring and double vision at the same time but if both acute onset and significant, this is of particular concern.

    As I work locally, the local emergency (NHS) eye services in the Essex area are Broomfield (not sure what hours/how referrals are treated there), Southend (same), Queens Romford (M-F 9-5 only), Addenbrookes in Cambridge (on site M-F and possibly Sat/Sun) and Moorfields in Old Street (24/7 Mon-Sun). I generally direct people to the latter unless they are a shorter travel time from Cambridge in which case go there. This might be prudent to rule out anything which needs treatment within hours and ensure that the appt on Tues is with the correct person to further manage any identified problem.

  20. #20
    Master
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    My father-in-law (who happens to be an optometrist) had sudden double vision on holiday. His problem turned out to be due to a mini stroke.

  21. #21
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    quickest way to see an ophthalmic Doctor is by presenting to A&E, they do not know eyes so she will be seen by the on call eye doc, works very well here.

  22. #22
    Master
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    Quote Originally Posted by Pardalis View Post
    quickest way to see an ophthalmic Doctor is by presenting to A&E, they do not know eyes so she will be seen by the on call eye doc, works very well here.
    Bit of a risky strategy that. Lots of hospitals don’t have eye departments, those that do will not necessarily have any doctors outside of 9-5 either available or on site. Even those that do might not have the capacity to see walk in patients the same day.

  23. #23
    Quote Originally Posted by mmgg1988 View Post
    Bit of a risky strategy that. Lots of hospitals don’t have eye departments, those that do will not necessarily have any doctors outside of 9-5 either available or on site. Even those that do might not have the capacity to see walk in patients the same day.
    An eye department will always have doctors on call, eye injuries don't just happen 9-5.

    If there's no eye department pretty sure patient will be directed to one that does.

  24. #24
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    Quote Originally Posted by Kingstepper View Post
    An eye department will always have doctors on call, eye injuries don't just happen 9-5.

    If there's no eye department pretty sure patient will be directed to one that does.
    Erm, I work in an eye department that just has doctors on call 9-5....

    Yes, the latter is true however I would suggest not waiting potentially several hours to be told that, I would ensure that they have someone available on site before going unless we are talking about a 999 style emergency. I have lost count of the number of understandibly fustrated people who have waited 4 hours to be told actually they should go/have gone to an alternative hospital. What I was trying to suggest is rather turn up at your local A+E with an eye problem, ensure that you can have that problem treated there first. Many smaller local hospitals will not have an on call eye specialist either at all or on site so it is best to travel slightly further in the first instance if urgent treatment is needed.

    A slightly extreme example from yesterday is a patient who was nearly sent from Dorset to Southampton for treatment which could not be performed there so they would have to send them on to London. A good way to mess up your day...

  25. #25
    Quote Originally Posted by mmgg1988 View Post
    Erm, I work in an eye department that just has doctors on call 9-5....

    Yes, the latter is true however I would suggest not waiting potentially several hours to be told that, I would ensure that they have someone available on site before going unless we are talking about a 999 style emergency. I have lost count of the number of understandibly fustrated people who have waited 4 hours to be told actually they should go/have gone to an alternative hospital. What I was trying to suggest is rather turn up at your local A+E with an eye problem, ensure that you can have that problem treated there first. Many smaller local hospitals will not have an on call eye specialist either at all or on site so it is best to travel slightly further in the first instance if urgent treatment is needed.

    A slightly extreme example from yesterday is a patient who was nearly sent from Dorset to Southampton for treatment which could not be performed there so they would have to send them on to London. A good way to mess up your day...
    Ok, fair enough! Guess we're 'spoilt' at our local hospital.

    In my experience, difficult to bypass going to local A+E though without referral from GP etc.

  26. #26
    Master
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    How is Mum OP?

  27. #27
    Craftsman PJdB's Avatar
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    Hi David - thanks for asking. And thanks again everyone.

    She decided to pay £100 to see an Orthoptist privately. She said that it appears that one of the muscles which controls her eye movement is not working. She told her that she needs further tests, an MRI, and, to see an Ophthalmic consultant who should do further tests. She said that it might just suddenly correct itself as quick as it came.

    My Mum went back to her GP and relayed what the Orthoptist has said. He laughed when she mentioned an MRI. He said that MRIs are so expensive she will never get one. He said there is nothing we can do for your condition, it's very common and it will probably just correct itself.

    Mum has finally got some corrective glasses so she can see in a straight line... - she went down the town earlier this week and unfortunately fell down some concrete steps. She was taken to hospital in an ambulance, - she's fractured her ankle, but not too badly. But for the moment, she is bed ridden.

    Talking to Mum and trying to get her to push for treatment is difficult, - she has little fight in her, and she does not like to make a fuss. Even finding out information about what has been happening is hard work.

    Anyway, - the Orthoptist sent a letter to her GP stating that she needs to see a Ophthalmic Consultant on the 24th Oct. I rang them yesterday and they have not received this letter, - they said that that cannot refer her to anyone unless they get this letter. (The receptionist I spoke to, incidentally, was surprised that she hadn't had an MRI.) My Mum's sister is going to drop a copy of the Orthoptist's letter to the surgery on Monday, and then we'll have to wait for an appointment.

    I have relayed all the information here to my Mum, - the common response is "oh, I'll do it in my own time". Actually the Orhtoptist hinted subtley that the best way might be to rock up at A&E. Again - Mum is too much of a scaredy cat do to this.

    Thanks everyone again for all your help here.

  28. #28
    Craftsman PJdB's Avatar
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    Mum finally decided to visit Moorfields!

    They were excellent, - she said by just walking in, she was seen quicker than many people who had an appointment.

    Anyway, they diagnosed it as Eye Palsy (sixth nerve). Told her to wait 6 - 9 months as it might correct itself, - if it doesn't, they can operate.

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