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Seeing double images when viewing on the right side, with head straight. Upper eye lid of the right eye has dropped. Suggest the treatment?

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Ophthalmologist
Practicing since : 2000
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About a month back, the patient complained that he sees double images when viewing on the right side, with head straight. About a week later, the upper eye lid of the right eye dropped, basically came down and the right eye looked smaller than the left eye. Now, almost after a month, he complains of the same issue (double images) at different angles, especially when viewing downwards (towards the feet). We are worried if it is simply muscular or something to do with nervous system (optical nerves or otherwise). The right eye also seems to be a little inside in the eye socket compared to the left eye.
Posted Sun, 15 Sep 2013 in Vision and Eye Disorders
 
 
Answered by Dr. Mihir Shah 32 minutes later
Brief Answer:
It seems to be neurological. Further investigation required.

Detailed Answer:
Dear XXXXXXX

Thanks for the query.

Based on the history and reports sent by you, it looks like a case of ocular myasthenia, a neurological disorder caused by autoimmune process. I would order a neostigmine test to confirm this possibility. The patient can visit a nearest neurologist and get this test done. The test can be performed at the doctor's clinic without hospitalization.

An alternative diagnosis will be partial occulomotor nerve palsy or a abducens nerve palsy. A MRI scan of the brain is also necessary at this stage.

In brief, a neurological disorder is my inference based on your history and reports. Further investigations are going to be necessary to confirm the condition and to start appropriate treatment. Please urge this patient to see a neurologist at the earliest.

Hope this helps. Let me know if you need clarifications.

Best regards,
Dr. Mihir Shah
Above answer was peer-reviewed by
 
Follow-up: Seeing double images when viewing on the right side, with head straight. Upper eye lid of the right eye has dropped. Suggest the treatment? 25 hours later
Thanks much doctor for the clear reply and 2 possible diagnosis. We'll follow it up.
 
 
Answered by Dr. Mihir Shah 42 minutes later
Brief Answer:
You are welcome

Detailed Answer:
Dear XXXXXXX

Always glad to help.

Do get back to me if you have any furthur queries.

Best regards,
Dr.Mihir Shah
Above answer was peer-reviewed by
 
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