Question:
Dear Dr.Simonsz,
Thank you for responding to my question. I was diagnosed with an intercranial aneurysm
of my left carotid artery in May of this year. It is the size of a quarter and is located near
my optical nerve.At the time I was first diagnosed, my eyes saw double but were
symmetrical and appeared normal. The angiogram I originally had showed that it had
thrombosed. Since May, my condition has slowly deteriorated. My left eye started seeing
at a slant. My neurosurgeon ordered a cat scan with angiogram and said my left eye had
some kind of contorsion. Since that cat scan, my left eye has started "wandering" on its
own and now crosses in towards my nose and down. People are now very aware of my
problem. This last week my left eye has started seeing things vibrating. Everything I see
with my left eye vibrates back and forth from left to right. I have difficulty balancing and
have fallen a couple of times. My doctor is hoping that the aneurysm shrinks over time
and that the damage that has been done will undo itself. He explained that the surgery
would be very dangerous. My problem is that I am having trouble finding more
information. I cannot drive a car. I have difficulty reading. If I were to wear an eye patch
over my left eye, would I cause more damage to it? My doctor explained this is not
muscle damage but nerve damage. I want to be able to be as normal as I can. My double
vision is not side by side but overlapping. Things around me are visually confusing. I am
trying to get some kind of occupational help. (Having trouble finding that also as I am not
considered blind.) I am in constant pain and hope this just all goes away but I want to be
realistic and prepare myself. Can I help my vision in any way with patches, therapy,
anything? I appreciate any help you can give me. Even leading me in the right direction,
both figuratively and literally. Thanks so much for your time. Wishing you the best and
so happy to have someone like you on the web. Michelle
(Michelle)
Answer:
Dear Michelle,
Seeing at a slant means most likely means you have a trochlear nerve palsy that may well
be caused by the aneurysm. I don't have an explanation for the horizontal vibration of the
image of the left eye, are you sure only it is only the image of the left eye and not of
both eyes ?
In your case I would be reluctant to do strabismus surgery, as the angle of strabismus is
still changing and the chance to obtain single vision in all directions of gaze is mall.
Better use glasses with an occluder for the left eye, these can be made such that people
see almost nothing special but the patient sees blurred with that eye and is no longer
disturbed by the double images.
Yours truly,
(Herb Simonsz, MD, PhD)
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