Q. Can my diplopia be a sign of MS?

Answered by
Dr. Anand
and medically reviewed by iCliniq medical review team.
Published on Apr 28, 2018

Hello doctor,

I am 23 years 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, worse on distant gaze. I have had an MRI as well, but no lesions 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, 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.

Dr. Anand

Ophthalmology (Eye Care)
#

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 loss or decrease of 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, bring it slowly near to your nose. Repeat this exercise daily 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.

For more information consult an eye care ophthalmologist online --> https://www.icliniq.com/ask-a-doctor-online/eye-care-ophthalmologist

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.

Dr. Anand

Ophthalmology (Eye Care)
#

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 squint in childhood suggest more towards 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 for distance and near vision.

For more information consult an eye care ophthalmologist online --> https://www.icliniq.com/ask-a-doctor-online/eye-care-ophthalmologist

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