| Googly Eye |
| ||
|
Anyone have this condition? I'm a guy in his mid-twenties who's been diagnosed with a unilateral case of this ocular motility disorder. I always suspected that I had some sort of strabismus, but I consistently passed rigorous vision exams and the CN IV amazingly went unnoticed my entire life. I have a phoria of 14 diopters but retain fusion in primary gaze, which is probably why it was only discovered incidentally. Not sure if it's contributory, but an MRI revealed a 1.3 cm pineal gland cyst in my brain. Aside from the health implications, this all seems like a convenient excuse for sucking at sports other than running. Are there any people out there who have experience with a similar situation, or--now this might be a stretch--any neuro-ophthalmologists who want to weigh in? Thanks, LetsRun: you're my number one source for group therapy and medical advice. |
| Prism Bound? |
| ||
|
I'm a 54 year old female with 4th Cranial Nerve Palsy. I believe in my case it is congenital because I remember at a very young age closing one eye at a time and seeing objects move up and down as I changed eyes. It was never an issue until my early 30s, when I was taking a programming class and found myself having to close an eye so as not to see double when changing back and forth from reading text in a book to reading data on the screen. I too had regular eye exams and my vision was always 20/20 or better. When I explained to my optometrist what I experienced in the programming class he tested for and discovered my double vision problem. He did not call it 4th Cranial Nerve Palsy and never indicated that surgery could correct the problem. One of my eyes focuses 17 degrees from the other. I was prescribed glasses which have a prism in them, the left lens to bring my sight line down and the right to bring it up. I always wear them at work, I am a programmer, and I wear them half of the time at home. When I get tired or if I have a glass of wine it's more difficult for me to compensate for the difference so I must wear my glasses to avoid double vision. I have recently had some bad headaches and went to a neurologist yesterday, 06/09/2009. She is the one that put a name to the problem and said I was a textbook case. She has scheduled me for an MRI to be sure I do not have a tumor but believes my headaches are probably due to spinal degeneration in my neck. This is because another way people compensate for this problem is by tilting their head which helps align their vision. The neurologist could not believe I had not seen an opthamologist or neurologist for this condition and seems to believe it is easily correctable by surgery. I will see her again once I have the MRI at which time I will get a recommendation for an opthamologist. This must sound pretty negative to you but most people don't even know I have it. My husband who seems very aware of other people's eyes not tracking properly says he doesn't even notice it. Hope this helped! |
| humble servant |
| ||
|
Is the condition new or longstanding? Do you have an associated head tilt? Look at old photographs to see if a tilt or turn is present. Are you experiencing diplopia (double vision)? Is it correctable with prism? Are you experiencing any symptoms at all? You report fusion in primary gaze, how about in the paretic field? Is the deviation comitant (equal)or non-comitant in various fields of gaze? Are you having visual fatigue, eyestrain, headache? Is the deviation cosmetically displeasing? From your post, I'm not detecting a complaint beyond "sucking at sports". I'm not sure how rigorous the eye exams you have received were: a simple cover test, performed correctly, should have elicited a strabismus if present. Bottom line: recent onset is much more worrisome than a longstanding or congenital one. Before you undergo a surgery, you should be tested by a competent optometrist or ophthalmologist to make sure that surgery would not disrupt your retinal correspondence; you don't want to induce a diplopia that isn't there. best of health to you, seek further care if this is new or bothering you. |
| Bluestreak |
| ||
|
I too have recently been diagnosed with 4th nerve palsy, at age 31. The moment my head tilts to the right to the smallest degree, my vision goes double. MRI shows a weak right superior oblique muscle and I was told my right eye is a small bit higher than my left. But, I have 20/15 vision in both eyes. My neuro opthamologist said it is possible I was born with it and it is manifesting itself now. When I run, it gets bad; i can't see straight at all. A few cocktails and it's bad too, and what is strange is when I smoke too. Next step is to see if glasses can help. Googly Eye, perhaps you should see a neurologist or neuro-optho for next steps. |
| Googly Eye |
| ||
|
Thanks everyone for the comments. When I didn't see any responses after the first few days, I thought my thread would be buried. My right fourth nerve palsy was incidentally discovered by a neurologist after I received a concussion. At first he thought it was traumatic in nature, but we connected the dots and determined that it was probably long-standing. I do have a contralateral (left) head tilt, which was noticed by the ophthalmologists, and in hindsight is evident in some photos such as on my driver license. Because of the prolonged head positioning, I also have a 6% facial asymmetry, but am not aware of any neck problems. As for eyestrain or any sort of pain, I might get a little from time to time, usually fatigue-related. I do not have diplopia in primary gaze, unless fatigue or alcohol cause me to relax the superior oblique muscle. Like a previous poster, no one had ever noticed it prior to the diagnosis. I can remember maybe half a dozen comments over the course of my entire life that even hinted at my "googly eye." I repeatedly passed rigorous military exams, which included binocular and cover tests. It was discovered when the neurologist did the old "follow the finger" thing. Ironically, at least two other doctors failed to notice this when they were looking ocular motility problems after my concussion. Perhaps if it's done too rapidly, my eyes don't have time to fully uncouple before the object of regard sweeps back across the field. The doctors do not recommend strabismus surgery for the reasons you indicated: I can maintain fusion in primary gaze, and the procedure would risk making things worse. As for glasses, I see one poster has experiences with those. Do they distort the image excessively, or is the effect more like standard prescription eye wear? I don't think I'd be comfortable looking through prisms if they're anything like the ones the ophthalmologists have used to measure my deviations. It seems that most congenital cases diagnosed during adulthood are discovered when the compensatory mechanisms begin to fail. What's everyone's experiences in that regard? My case was discovered incidentally, but I have to wonder when I'll completely lose fusion in primary gaze. Though I'd already had CT scans for the concussion, an ophthalmologist requested an MRI to rule out a tumor affecting CN IV innervation. That's how the 1.3 cm pineal gland cyst was discovered. I have follow-up imaging in a few months to determine if there's any growth. My neuro-ophthalmologist said its placement could be pressuring the CN IV nucleus, and it's also possible that it has been the root cause of the palsy for my entire life. Obviously further monitoring and a neurosurgeon's opinion will be required. Hopefully it's benign. Here are my phoria numbers in diopters (Field: Right Hyperdeviation, Exophoria): Right tilt: 25, 10 Left tilt: 9 , 10 Up: 14, 14 Right: 8, 10 Primary: 18, 10 Left: 30, 10 Down: 14, 10 Thanks everyone. |
| humble servant |
| ||
|
I would recommend giving the glasses a shot, base down prism over the hyper eye, and base up over the fellow eye. Many patients have benefitted from prismatic correction, which can also alleviate compensating neck problems if present. Seek out a practitioner experienced in optical correction and see if you benefit. Most of my patients who exhibit "decompensation" of a longstanding palsy or strabismus are usually a little older (>60) but a case like yours is not terribly uncommon. I am not qualified to comment on your neuro presentation, but obviously you should continue with close monitoring as you stated. best of luck to you |
| Prism Bound? |
| ||
|
I regret my choice for a name here because I am VERY thankful for my glasses with prisms. They got me through a fast paced programming class in my early thirties and through the last twenty years. The test for this condition is very confusing. The image never looks perfectly in focus. The new test where you try to align two white arrows on a blackground is even more confusing than the old test of aligning two black squares on a whiteground. The test is not representative of how your vision will be with prisms. My experience is, after wearing them for an hour or so my eyes adjust and then I'm back to normal binocular vision. I'm definately a fan. I can even watch 3D movies with little distortion if I put the 3D glasses on top of my glasses. It's interesting that none of us had issues until our early thirties. I'm still waiting on my MRI. |
| eyec12many |
| ||
|
Hi Googly Eye, I'm a 49 year old male who's been dealing with CN IV palsy since childhood. I was diagnosed at age 16. I have severe double vision that is inoperable do to the intermittent nature of my situation. The double vision has lasted as little as a few minutes and as much as 18 months. The current episode has lasted almost 4 months. I have been tested for everything imaginable, but all tests always come back negative. In short I was told to live with it. I am currently looking at the possibility of vision therapy. If you have any questions for me, would like more details or would like to share your experiences, please feel free. eyec12many |
| eyec12many |
| ||
|
Hi Prism Bound?, I'm a 49 year old male who's been dealing with CN IV palsy since childhood. I was diagnosed at age 16. I have severe double vision that is inoperable do to the intermittent nature of my situation. The double vision has lasted as little as a few minutes and as much as 18 months. The current episode has lasted almost 4 months. I have been tested for everything imaginable, but all tests always come back negative. In short I was told to live with it. I am currently looking at the possibility of vision therapy. If you have any questions for me, would like more details or would like to share your experiences, please feel free. eyec12many |
| ckck |
| ||
|
I'm a 57 year old woman who developed 4th nerve palsy suddenly 1 year ago. Other than having been under a great deal of stress, I had no other known contributing factors, such as trama. Examination of old photos may indicate some head tilt--which went unnoticed. I wear prism glasses now for both distance and close up---and find these do help. My double vision seemed to resolve some over the past 12 months----but recently seems to have worsened, especially at night or when fatigued or under stress--or if I have a glass of wine. I have had various tests including MRi and CAT scan, as well as blood work looking for causes such as MG. All negative. I find playing sports, such as squash or running very difficult--and wear the prism glasses which help some. I have been seen by 3 neuro-optomologists who all concur with 4th nerve. I am strongly considering surgery---can anyone weigh in as to how effective a surgical approach might be with my age and history? |