Double vision

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This post is not about the group Foreigner or their hit song of the same name. This double vision thing just started and to be honest, it is kinda scary. Both eyes have it. So, I looked it up and here is the information I found. This information is from www.webmd.com.

One of the things that can cause it is migraines, something I get quite frequently lately. Interestingly, myasthenia gravis is another cause and it is one of those possible overlapping diseases that occur in some people who have autoimmune diseases. Interesting to read. Enjoy!

Double Vision (Diplopia)

Double vision, or diplopia, is a symptom to take seriously. Some causes of diplopia are relatively minor, but others need urgent medical attention. WebMD takes a look at the causes, symptoms, and treatments for double vision.

What Causes Double Vision?

Opening your eyes and seeing a single, clear image is something you probably take for granted. But that seemingly automatic process depends on the orchestration of multiple areas of the vision system. They all need to work together seamlessly:

  • The cornea is the clear window into the eye. It does most of the focusing of incoming light.
  • The lens is behind the pupil. It also helps focus light onto the retina.
  • Muscles of the eye — extraocular muscles — rotate the eye.
  • Nerves carry visual information from the eyes to the brain.
  • The brain is where several areas process visual information from the eyes.

Problems with any part of the vision system can lead to double vision. It makes sense to consider the causes of diplopia according to the part of the visual system that has the problem. Double vision is not normal and should be reported promptly.

Cornea problems. Problems with the cornea often cause double vision in one eye only. Covering the affected eye makes the double vision go away. The damaged surface of the eye distorts incoming light, causing double vision. Damage can happen in several ways:

  • Infections of the cornea, such as herpes zoster, or shingles, can distort the cornea.
  • An uncommon complication of LASIK surgery can leave one cornea altered, creating unequal visual images.

Lens problems. Cataracts are the most common problem with the lens that causes double vision. If cataracts are present in both eyes, images from both eyes will be distorted. Cataracts are often correctable with minor surgery.

Muscle problems. If a muscle in one eye is weak, that eye can’t move smoothly with the healthy eye. Gazing in directions controlled by the weak muscle causes double vision. Muscle problems can result from several causes:

  • Myasthenia gravis is an autoimmune illness that blocks the stimulation of muscles by nerves inside the head. The earliest signs are often double vision and drooping eyelids, or ptosis.
  • Graves’ disease is a thyroid condition that weakens the muscles of the eyes. Graves’ disease commonly causes vertical diplopia. With vertical diplopia, one image is on top of the other.

Nerve problems. Several different conditions can damage the nerves and lead to double vision:

  • Multiple sclerosis can affect nerves anywhere in the brain or spinal cord. If the nerves controlling the eyes are damaged, double vision can result.
  • Guillain-Barre syndrome is a nerve condition that causes progressive weakness. Sometimes, the first symptoms occur in the eyes and cause double vision.
  • Uncontrolled diabetes can lead to nerve damage in one of the eyes, causing eye weakness and double vision.

Brain problems. The nerves controlling the eyes connect directly to the brain. Further visual processing takes place inside the brain. Many different causes for double vision originate in the brain. They include:

  • Strokes
  • Aneurysms
  • Increased pressure inside the brain from trauma, bleeding, or infection
  • Brain tumors
  • Migraine headaches 

What Are the Symptoms of Double Vision?

Double vision can occur by itself with no other symptoms. Depending on the cause, other symptoms may be present with double vision, such as:

  • Misalignment of one or both eyes (a “wandering eye” or “cross-eyed” appearance)
  • Pain with eye movements in one or both eyes
  • Pain around the eyes, such as in the temples or eyebrows
  • Headache
  • Nausea
  • Weakness in the eyes or anywhere else
  • Droopy eyelids

How Is Double Vision Diagnosed?

Double vision that’s new or unexplained needs medical attention right away. With so many potentially serious causes for double vision, it’s important to discover the reason without delay.

Your doctor will most likely use multiple methods to diagnose the cause for double vision. Blood tests, a physical exam, and possibly imaging studies like computed tomography (CT) or magnetic resonance imaging (MRI) are frequently used.

One of the most effective tools in diagnosing diplopia, though, is the information you can provide. You can make the diagnosis for double vision more accurate by answering several questions beforehand.

  • When did the double vision start?
  • Have you hit your head, fallen, or been unconscious?
  • Were you in a car accident?
  • Is the double vision worse at the end of the day or when you’re tired?
  • Have you had any other symptoms besides double vision?
  • Do you tend to tilt your head to one side? Look at old pictures, or ask family — you may not even be aware of the habit.

Now, focus on something unmoving in your field of vision — a window or a tree.

  • Are the two objects side by side, or is one on top of the other? Or are they slightly diagonal? Which one is higher or lower?
  • Are both images clear but simply unaligned with each other? Or is one image blurry and the other clear?
  • Cover one eye, then uncover it and cover the other. Does covering either eye make the double vision go away?
  • Pretend your field of vision is a clock face. Move your eyes around the clock, from noon to six and up to 12 again. Is your double vision worse at any clock position? Does any position make your double vision improve?
  • Tilt your head to the right, then to the left. Do any of these positions improve the double vision, or make it worse?

How Is Double Vision Treated?

With double vision, the most important step is to identify and treat the underlying cause. In some cases, double vision can be improved by managing or correcting its cause.

  • If weak eye muscles are the cause, or if a muscle has been pinched as a result of injury, surgery may help.
  • Myasthenia gravis can be treated with medications.
  • Graves’ disease is often curable with surgery or medical therapy.
  • Blood sugar in diabetes can be controlled with medicines and/or insulin.

If double vision can’t be reversed, treatments can help people live with double vision. Sometimes, this requires wearing an eye patch or special contact lens to minimize the effect of double vision.

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Myasthenia Gravis facts

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Once again, here is another of the autoimmune family of diseases. This one is Myasthenia gravis. The information I have here is from the website, www.myasthenia.org. If you would liek more information, please consult their web page and your doctor. Please read and learn. Thanks! This is another one that can overlap with lupus as well.

Myasthenia Gravis comes from the Greek and Latin words meaning “grave muscular weakness.” The most common form of MG is a chronic autoimmune neuromuscular disorder that is characterized by fluctuating weakness of the voluntary muscle groups. The prevalence of MG in the United States is estimated to be about 20/100,000 population. However, MG is probably under diagnosed and the prevalence may be higher. Myasthenia Gravis occurs in all races, both genders, and at any age. MG is not thought to be directly inherited nor is it contagious. It does occasionally occur in more than one member of the same family.

The voluntary muscles of the entire body are controlled by nerve impulses that arise in the brain. These nerve impulses travel down the nerves to the place where the nerves meet the muscle fibers. Nerve fibers do not actually connect with muscle fibers. There is a space between the nerve ending and muscle fiber; this space is called the neuromuscular junction.

When the nerve impulse originating in the brain arrives at the nerve ending, it releases a chemical called acetylcholine. Acetylcholine travels across the space to the muscle fiber side of the neuromuscular junction where it attaches to many receptor sites. The muscle contracts when enough of the receptor sites have been activated by the acetylcholine. In MG, there is as much as an 80% reduction in the number of these receptor sites. The reduction in the number of receptor sites is caused by an antibody that destroys or blocks the receptor site.

Antibodies are proteins that play an important role in the immune system. They are normally directed at foreign proteins called antigens that attack the body. Such foreign proteins include bacteria and viruses. Antibodies help the body to protect itself from these foreign proteins. For reasons not well understood, the immune system of the person with MG makes antibodies against the receptor sites of the neuromuscular junction. Abnormal antibodies can be measured in the blood of many people with MG. The antibodies destroy the receptor sites more rapidly than the body can replace them. Muscle weakness occurs when acetylcholine cannot activate enough receptor sites at the neuromuscular junction.

Common symptoms can include:

  • A drooping eyelid
  • Blurred or double vision
  • Slurred speech
  • Difficulty chewing and swallowing
  • Weakness in the arms and legs
  • Chronic muscle fatigue
  • Difficulty breathing

Myasthenia Gravis: Tests and Diagnostic Methods

  In addition to a complete medical and neurological evaluation, a number of tests may be used to establish a diagnosis of MG.A diagnosis can be confirmed in several ways, including the following:

  • Acetylcholine Receptor Antibody — A blood test for the abnormal antibodies can be performed to see if they are present. Acetylcholine Receptor Antibody testing – Approximately 85% of MG patients have this antibody and, when detected, is a guaranteed diagnosis. 
  • Anti-MuSK Antibody testing – a blood test for the remaining 15% of seronegative (SN) MG patients, those who have tested negative for the acetylcholine antibody, 40-70% test positive for the anti-MuSK antibody. The remaining patients have an unidentified antibody causing their MG. 
  • Tensilon® test, The edrophonium chloride (Tensilon®) test is performed by injecting this chemical into a vein. Improvement of strength immediately after the injection provides strong support for the diagnosis of MG. 
  • Electromyography — (EMG) studies can provide support for the diagnosis of MG when characteristic patterns are present. Repetitive Nerve Stimulation to check for a post-synaptic defect, Single Fiber EMG, or a muscle biopsy to look for antibodies may also be used. 
  • Single Fiber EMG — studies can provide support for the diagnosis of MG when characteristic patterns are present.

Sometimes all of these tests are negative or equivocal in someone whose story and examination still seem to point to a diagnosis of MG. The positive clinical findings should probably take precedence over negative confirmatory tests.

 

Treatments for Myasthenia Gravis (MG)

  There is no known cure for MG, but there are effective treatments that allow many-but not all-people with MG to lead full lives. Common treatments include medications, thymectomy and plasmapheresis. Spontaneous improvement and even remission may occur without specific therapy.Medications are most frequently used in treatment. Anticholinesterase agents (e.g., Mestinon®) allow acetylcholine to remain at the neuromuscular junction longer than usual so that more receptor sites can be activated. Corticosteroids (e.g., prednisone) and immunosuppressant agents (e.g., Imuran®) may be used to suppress the abnormal action of the immune system that occurs in MG. Intravenous immunoglobulins (IVIg) are sometimes used to affect the function or production of the abnormal antibodies also.Thymectomy (surgical removal of the thymus gland) is another treatment used in some patients. The thymus gland lies behind the breastbone and is an important part of the immune system. When there is a tumor of the thymus gland (in 10-15% of patients with MG), it is always removed because of the risk of malignancy. Thymectomy frequently lessens the severity of the MG weakness after some months. In some people, the weakness may completely disappear. This is called a remission. The degree to which the thymectomy helps varies with each patient.Plasmapheresis, or plasma exchange, may be useful in the treatment of MG also. This procedure removes the abnormal antibodies from the plasma of the blood. The improvement in muscle strength may be striking, but is usually short-lived, since production of the abnormal antibodies continues. When plasmapheresis is used, it may require repeated exchanges. Plasma exchange may be especially useful during severe MG weakness or prior to surgery.Treatment decisions are based on knowledge of the natural history of MG in each patient and the predicted response to a specific form of therapy. Treatment goals are individualized according to the severity of the MG weakness, the patient’s age and sex, and the degree of impairment.

What is the prognosis for those with MG?

The current treatments for MG are sufficiently effective that the outlook for most patients is bright. Although the treatments will not cure MG, most patients will have significant improvement in their muscle weakness. In some cases, MG may go into remission for a time, during which no treatment is necessary. There is much that can be done, but still much to understand. New drugs to improve treatments are needed. Research plays an important role in finding new answers and treatments for MG.Click here for a Clinical Overview of MG.