Visions and Revisions (eye trouble)

[elinora]

My considerable eye troubles are complicated by the fact that I do have Myasthenia gravis, which causes ptosis (eye droop) and plain old binocular diplopia. Lately, my medication has taken care of the eye droop, but my vision remains double. Actually, it's more like I see ghost images, sometimes more than one, and this problem is monocular. It can vary a lot throughout the course of the day, so that sometimes my vision is just a smear of images, and putting on my glasses doesn't help. I am wondering how prevalent this type of visual disturbance is. Thanks for sharing experiences.

[MSer102]

I know that people with MS have "visual disturbances" but monocular diplopia isn't caused by MS so I don't know if anyone here can tell you how "prevalent" the type of visual symptom you are having is. Your eye doctor is a good person to ask. What did your eye doctor say is causing your vision trouble?

Do you want to know "statistically" how prevalent monocular diplopia is or do you just want to share experiences? I've had several episodes of optic neuritis and two episodes of binocular diplopia but I've never had the monocular ghosting you are having or vision that varies so much during the day. I'm visually impaired because of my optic neuritis but between episodes my vision is pretty stable. To have vision change so much during the day sounds awful! Did your eye doctor have any suggestions about what might help?

[22cyclist]

One of the hallmarks of MG is that it changes throughout the day, symptom wise. Especially the eyes. It is no wonder your eye symptoms change throughout the day in response to the disease. In MS, there is not that much of a change. A lesion causes a certain symptom, IE: double vision upon looking left, and it stays that way for weeks if untreated. It does not change from moment to moment or hour to hour, it stays the same. If treated with IVSM it may get somewhat better. Otherwise it goes away in time. We do not have monocular diplopia unless there is a problem with the eye itself and the prescription for that eye. For the most part, we do not get ptosis either except for the rare case of a 3rd or 6th nerve palsy and it is there for a few weeks too, and also due to a lesion in the brainstem.

No matter, the symptoms of double vision between the two diseases MS and MG are fairly easy for an ophthalmologist to spot with history and examination. The muscles behave differently.

Take care
Lisa
Moderation Team

[MSer102]

elinora, just to clarify what I said before, monocular diplopia isn't caused by MG either. MG affects motor nerves and monocular diplopia isn't caused by an eye movement problem.

Is it possible that what you are having isn't really monocular diplopia? The way my ophthalmologist explained it, doctors don't really consider ghost images to be diplopia. He said that a smear of images like you are seeing might be caused by an eye or eyes not holding steady. That sounds like it could be a motor nerve problem caused by MG that could change during the day. MS doesn't usually act that way.

What did your eye doctor say about it?

[elinora]

I need to remember to choose the instant email. It took me a while to see replies.

I am very familiar with the binocular diplopia I get with MG and its ptosis, both of which respond to a drug called Mestinon. This new visual disturbance is definitively not a result of MG, and it is not true diplopia. Rather I see ghost images, sometimes many, sometimes a smear. I asked my neuro's nurse about this, believing it strange for a disturbance to come and go. Wouldn't an eyeball problem be consistent? My eyes are not dry. It is such a red herring in the mix, and it does get worse when I tire. The nurse said the optic nerve could be slow, causing the brain to hang onto the image beyond its time. I am having an MRI of spine tomorrow (not related but I am) and seeing a neuro opthamogist soon. Most of the symptoms making me sickest currently are not MG, as if MG weren't bad enough.

My doctor also checked for Sjogren's, though he seemed to consider it a checkbox.

[22cyclist]

The neuro ophthalmologist will be able to tell you more about what is happening with your monocular vision troubles. They don't sound like ON to set your mind at ease. They could be related to your ptosis. For sure your neuro-ophtho will be able to sort it out so you are on your way to finding out what is going on.

I am glad they are pushing on with this. Good luck at your appointment, and hang in there. Let us know how it goes, OK?

Lisa
Moderation Team

[elinora]

Thanks

It is a really big mess with at least 2 things going on; I am in the hands of my neuro now, so it is a good thing I trust his capabilities. It will probably not be a short journey. I went from being an endurance athlete to finding it difficult to sit up in my chair and finally to finding it difficult to stay awake! Sleep study determined MG related apnea or high CO2 not the problem. I appreciate others opinions and xperiences.