What to do for sudden vision disturbance in lazy eye?

Question

Hi doctor,

I have a congenital left lazy eye, which wanders outwards and upwards. This is managed by prism glasses, currently 7 base vertically and 2 horizontally. I am managing my eye strain and daily life well in general. I do however have occasional episodes, which are not manageable. Sometimes, months apart and sometimes every other day, I have a very short (around 1/2 second), but very violent twist in my vision. There is no warning for this. I have experienced it while sitting, driving and standing. Afterwards, I feel very unbalanced for a few minutes and then fine. The only other symptom is my head feels like it has been pulled on the top and I have ringing in my ears afterwards. I have had three MRI scans in the last 18 months, because the diplopia onset was quite sudden and experienced a lot of pain in my head and face. These have all been clear. I do not seem to have any warning when these episodes occur and they are so sporadic at times. It is difficult to tell what exactly it is. I am also unsure, because it is too fast, whether it is just my left eye or both. Any opinions would be greatly appreciated. Apart from eye strain, which does happen occasionally, I do not have any other symptoms. I regularly do convergence disorder exercises to stop straining and it works. Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

Lazy eye is not congenital. It is acquired due to the presence of anisometropia (difference in the refractive status of both eyes) or due to squint or due to congenital cataract or ptosis, etc. Sometimes, lazy eye tends to move out to lead to squint and for that prism or surgery is required depending on the amount of squint. In your case, squint is very small and so it is managed by prisms. Intermittent diplopia as you reported might be due to decompensated squint and this suggests that your binocular status is good. Pain and visual disturbances are not related to squint or lazy eye, but anyway you can ask your squint specialist to check your convergence and accommodation. Get your refractive status checked by cycloplegic refraction. Also, get your squint checked by prism bar cover test. If all these are normal, then your symptoms are not related to lazy eye or squint. The causes of all these problems could be migraine, stress and dry eyes. You can also use some lubricating eye drop. If possible please send me your medical records as it will help me to understand your problem better. I hope I have addressed your concerns. Feel free to reach out if you have any further questions. Thank you.