Dr. Anand Yattinamani
Ophthalmology (Eye Care)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 23-year-old female. Can you please explain to me the clinical presentation of decompensated phoria? I have had diplopia for over two years now, binocular, horizontal, and worse on distant gaze. I have had an MRI as well, but no lesions were found in my brain stem or other areas. Only a few white spots punctate, in both hemispheres. They say, it is not cranial nerve palsy, so I wondered if it could be some kind of muscle misalignment caused by decompensated phoria. I also have astigmatism, and myopia (left eye -3.75 and right eye -4.25). I am very anxious about this diplopia being a sign of MS. (I have severe health anxiety). I have no other symptoms, no headache, and taking no medicines.
Hi,
Welcome to icliniq.com.
Diplopia for distance vision is more common in neurological conditions. If you do not have any neurological problems (ruled out by MRI), other problems can be considered. In your case, as you have high myopia, it can be due to decompensated tropia (phoria). In myopia, there is a loss of accommodation since childhood. This will lead to losing or decreasing fusion (focus on an object). This may lead to intermittent diplopia. This can be improved to some extent by fusion exercises like holding a pen in hand and looking at the tip of the pen, bringing it slowly near to your nose. Repeat this exercise daily for 5 to 10 minutes morning and evening. You can send pictures of your eyes for better evaluation and treatment. You can also call for any queries.
Patient's Query
Hi doctor,
Thank you so much for your fast reply.
I also have a little diplopia on near distant. The squint is not visible in pictures. There is no cranial nerve palsy, my doctor says. For a couple of months ago, I had three prisms in my eye-glasses, which seems to resolve the squint a little, not completely though. Also, I wear contact lenses, for a year too strong in the left eye. Could that have a saying? As a child I had a little squint I think. And I should mention the diplopia is constant.
Hi,
Welcome back to icliniq.com.
Contact lens wear has nothing to do with your problem. You can continue to use contact lenses with all the precautions and hygiene. As you mentioned, a squint in childhood suggests more accommodation weakness which may lead to decompensated tropia (phoria). Yes, prisms will definitely help to some extent. Along with that, you try eye exercises, as I mentioned above, that will definitely strengthen your eye muscles and improve diplopia. This exercise will help you both with distance and near vision.
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Ophthalmology (Eye Care)
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