Hard to explain visual problem

[Noah091]

Hi guys,

Just a quick refresh on my situation. I went to ER for diplopia in my right eye which developed over the course of 5-10 days. The diplopia was caused by a VI nerve palsy on my right eye. Given steroids and sx completely went away and I felt good.

Since then I have had constant muscle twitching all over my body, which I attribute to the stress of a potential MS dx. They dont hurt, or affect my life any way, but they are literally all over. Arms, legs, eye, buttocks, thighs, face. They usually happen when im resting and visible (you can see them under the skin). They dont last very long and occur maybe 3-6 times a day in random spots. I am honestly not too concerned about these, but just throwing it out there.

The last few weeks I had a couple problems that may or not be related to any of this, but here goes. First problem is with my right eye again. It doesn't hurt and its not diplopia... I wouldn't even say its out of ordinary blurry, but something is off and I cannot put my finger on it. I went to the eye doctor who has been helping from day 1. He dilated my eyes and checked them out and said he saw no signs of any kind of optic neuritis. He recommended I use lid scrubbers and eye drops to thoroughly cleanse my eye. This was about 2 weeks ago, yet the problem still persists.

Has anyone had anything like this? Can anyone offer possibilities for how I may accurately describe whats going on with the eye? I've never had so much confusion trying to explain something lol.

[22cyclist]

I can offer to you that the muscle twitching all over is a symptom of withdrawal from the steroids. I think that your eye doctor is blaming your blurry eye on dry eye. It is hard to know what is wrong since it is so hard to describe it. It may be left over from the VIth nerve palsy. Steroids can shorten an attack, but they do nothing to "fix" the damage that has been caused by the attack that caused the palsy.

Did you have an MRI? What did it show?

Best of luck
Lisa
Moderation Team

[Alicious]

Two thoughts--

1. Optic neuritis doesn't have to hurt. It usually does, but I've had it at least twice, and there was never any pain.

2. 2/3 of your optic nerve is behind the eye and cannot be seen on an examination of the eyeball itself. A neuro-ophthalmologist told me that even MRI doesn't always pick it up, and if it does, it will only reliably do so in the first two weeks after onset.

None of this means that you have optic neuritis, of course, but from what I understand it can't be ruled out based on what you've said here, either. Maybe another visit to the ophthalmologist is in order? A recheck and a quiz of the doc to ask why they think it's not ON might be a good idea. It may very well not be ON and the doctor may have very good reasons to think it is something else, but it's important that you as the patient have all of the information you need to understand.

Good luck!

[newbie but goodie]

From what little I know of optic neuritis (from personal experience) the opth should have done an OCT to get a look at the nerve and optic disc. Can you maybe get a 2nd opinion or go to a neuro-opthalmologist? ON isn't always painful and can be a little vague.

[MSer102]

Most cases of optic neuritis happen behind the eye so if the doctor can't see a problem with the optic nerve by looking at the inside of the eye an OCT wouldn't pick it up either. There's no point in doing a test that isn't going to show anything because it can't see deep enough into the eye. I've had an OCT a few times and my ophthalmologist said its to document the damage later not to diagnose an active case of ON.

Seeing a neuro-ophthalmologist is a good idea. If its already been 2 weeks the doctor probably isn't going to do anything for it but might be able to do some more tests to tell you if it really is ON or not. That could make a difference in your diagnosis or treatment so its a good idea to go to one if you can.

[acaverly]

I have had problems with my right eye for almost two years. My symptoms have never gone away. I am seeing a nuero opthamologist and he has done all kinds of testing. My right eye does not move to the left and when I try to look left I get double vision. It is some type of opthalmoplegia and they are still trying to figure out the cause.

[MSer102]

acaverly, in internuclear ophthalmoplegia (aka INO) one eye can't turn all the way toward the nose. It goes halfway and then stops. It happens in MS sometimes. Does your right eye always stay all the way to the right or does it go half way left (straight ahead) before it stops? If it can go half way then maybe it could be INO but then it seems like your ophthalmologist would know that and know it happens in MS.

My doctor checked me for it when I had double vision but it wasn't what I had and mine got better. I'm sorry that your still having trouble after such a long time.

[22cyclist]

Aclavery: You can also get an INO from a 6th nerve palsy like the OP that started this thread. 6th nerve palsy is when you cannot move your eye all the way to the left or right on command or otherwise. It comes with nystagmus at end point in affected eye. INO can occur depending on where the lesion is. It is usually in the MLF (brain stem) and is sometimes hard to see on MRI. Yours could be at a junction since it started with 6th nerve palsy.

Although 6th nerve palsies are rare in MS, they do happen and depending on where they are on the sixth nerve they can cause INO. It should be self limiting (3-4 weeks).

Take care
Lisa
Moderation Team

[acaverly]

It stops right in the middle. They also thought I had 6th nerve palsy and did an mra to check for that. It seems that they have ruled everything else out. I saw a nuerologist first and she said I did not have ms and referred me to the nuero opthamologist who I am seeing right now.