Question

Dear Doctor,
my wife has the double vision, it symtom of MS(Multiple Sclerose) or Strabismus. She is 18 yhr. She see double vision when: work with computer, at car, looking at objects in side window of car by movement, and by hard reading in the dark time. So in the time when she feeling it, I can see, thah her eyes looking in some different direction. When she fast look at other object , then this effect go, come again when she look for long time. So this is temporary. This come when she watch most unstabile objects (Monitor,in a car to side, TV). And in this moment, I see that eyes loking some different directions. We was by 3 ophtalmologs. First told us,that hard work with computer(my wife never worked with computer,and now work). The Doctor tests the vision and found assigmatismus.Not big.But in this she di dnt sow double vision, because she has to real long look at computer(1 hour). 2,3 Doctors didnt found this, because she has been also no in the dark time and in computer work free time. We spend a lot of many, and no expanation get. So we have variant MS or Strabismus. Please tell You us more about this. Best regards,

(Armen Vard)

Answer:

Dear Armen,
Thank you for sharing your experience with us. The symptoms you describe would fit well to an exophoria or an esophoria, i.e. a latent strabismus that occasionally becomes manifest, you see the eyes of your wife pointing inward or outward (what do they do when she squints ? point inward or outward ?) and she sees double. You would expect such a patient to get complaints in the circumstances described by you: working at the computer for long periods, reading in the dark, shifting gaze, etcetera. Have your wife examined by an ophthalmologist that does a lot of strabismus surgery and have him decide whether her double vision could be alleviated by prism glasses or by surgery. Why do you mention multiple sclerosis ? Are there other symptoms that point towards that diagnosis like a palsy, sensory deficits or incontinence ? Without additional symptoms, attributing the double vision to multiple sclerosis would seem farfetched, although indeed MS of the brainstem may cause difficulty in moving either eye towards the nose, especially when moving rapidly. Maybe you can give us some more details.

Yours truly,

(Herb Simonsz, MD, PhD)

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