Chilbirth/vision MS? Long.

New diagnosis and before diagnosis
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Hi,

First of all I would like to say that I am part of a rare family of MS sufferers - both my Mother and Father have MS which is incredibly bizarre I know also my brother has been diagnosed with MS. I am undergoing investigation and will receieve an MRI in January. I am hoping that it will be clear.

I am 25 and gave birth to my daughter 3 weeks ago - 2 days after childbirth I noticed monocular diplopia (double vision in a single eye when one eye is covered) in BOTH eyes! When I looked at hospital signs i.e a ‘Way Out’ sign of black text on a white background there was also a duplicate image below it even when I covered one eye. The double vision is in both my eyes seperatly.

I have been to my GP, Optition, A&E and eye infermary and all haven’t given me an answer. I am to go back to the eye infermary in 2-3 weeks to have an other eye test to see if I need my lenses changed on my glasses as the DR suggested that my vision could be muscluar although I have researched monocular diplopia and have only found info stating that it is an issue with the actual eye ball and it is rare - so I must be a total odd ball.

Since noticing the initial onset of this double vision it has verly slowly gotten a little better and I seem to notice it more so in the evening around objects that emit light and or objects of contrasting colours i.e white text on a dark background.

I would just like to know if anyone else has experienced this? I am aware that binocular diplopia (double vision affecting both eyes but goes away when one eye is covered) is generally neurological and is a symptom of MS but I don’t think monocular is anything to do with MS but I could be wrong?

Also an hour after birth my mother fell and broke her leg in two places and I had to stay in hospital for 5 days after with no support from my family as my Dad can not drive anymore so I was very stressed - more stressed than I ever have been I suppose and I wonder that maybe I could have had a relapse? That’s if I do indeed have MS.

Does anyone have any advice or input at all?

Thanks so much,

Fiona.

2

Hi Fiona

You might be describing something called ‘ghosting’ which may be different from doublevision. With ghosting, the images are vertically seperate rather than side by side, and the false image(s) are much weaker and therefore most likely to be noticed when they result from a bright object against a dark background e.g. with car headlights at night, you may see a duplicate set above the car, or bright text on a black computer screen may have a ghost image of the text above it. One cause of ghosting results from light scattering as a result of imperfections in the surface or lens of the eye, or contaminants in the vitreous. Another cause is from movement and separation of the vitreous jelly inside the eye which does not necessarily fill the whole space, leaving a bubble and is increasingly likely with age. I seem to remember reading these things but dont quote me as it was some time ago.

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Hi Fiona, welcome to the site and congratulations on the birth of your daughter

I’ve never heard of monocular diplopia before so you have me completed fascinated! (I did my PhD in vision neuroscience.)

I would think that it must have either a systemic (whole body) or neurological origin as I can’t see how something structural would suddenly affect both eyes at once, but I am going to have a wee look in my books and on-line journals and see what I can come up with…

From the journals: only two relevant things. One case study of someone developing bilateral monocular diplopia as a first sign of diabetes (have you been checked?) and a few papers about it happening when some people do “near work”, e.g. reading. This latter thing is described in one paper as being “related to the position of the lids and tear film interaction with the corneal surface” (Ford et al, 1997) - so the way the eyelids are positioned. Is your double vision only when you are looking at things that are a certain distance from you? If not, then we can rule that one out I think.

From the books: nothing :frowning: I guess that’s why I’ve never heard of monocular diplopia before!

From my brain: confusion! I cannot think of a place in the visual system where a single lesion would cause both eyes to have this problem. I wonder if our other resident vision scientist (DoctorGeoff) might know - I will send him a pm…

Could it have something to do with MS? I guess anything is possible with MS, but it would be a very atypical presentation so I would think it’s very unlikely.

I don’t suppose you live anywhere near York btw? I know a scientist who might be interested in scanning you!

Karen x

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My hubby has just asked a very good question: what do you see when you look through both eyes?

Kx

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Hi, thanks for the replies.

Yes - it is ghosting (I think). If I look at black text on white background with both eyes or covering either one eye I see a vertical duplicate under the actual image. I also see doubles of objects - say if I look at the bottom of my mac computer (not the screen the actual computer) there is a kind of halo around it where I can see the bottom of the computer duplicated. Also if I look at the screen of the computer the bottom of the screen is duplicated again. This is all from a distance - anything up close doesn’t duplicate of ghost. An other example is if I’m sat on my sofa and my partner is stood up a few feet infront of me with light behind him and I look at his nose there is a duplicate ghost image of his nose around his nose!

This is all worse in the dark as I can see complete vertical images of say car number plates and traffic lights or car head lights.

I can also get a third ‘ghost image’ that comes from above an image… So I can have the actual image, an other below and an other above. It doesn’t happen with everything though and when I got it in hospital it has gradually got less noticeable.

I did get a new glasses prescription about 2 months ago and I wonder if it is that as I did notice before labour that the muscles in my eyes hurt every so often when I moved my eyes dramtically in certain directions and they still hurt now.

This could be one of so many things it really is getting me down. I feel like I am totally obsessing over it and it is coming between mine and my daughters bond. I just wish it would go away.

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Thank you for pointing this one out to me, Karen, this is a really interesting one.

Fiona, I have to start somewhere, so “Just what is diplopia?”

Crudely it is double vision, and I prefer the term “Second Image” as it makes it easier to explain.
Classical binocular diplopia is when the eye muscles focus the light coming into the eye onto a different place on each retina (that’s the sensory surface at the back of each eyeball). It can be detected by an optometrist (the person in an opticians who measures your eyes) and it is fairly easy to find out which eye is causing the problem. The fix is a prism lens. This can be a stick-on Fresnel lens - typically on the reading part of a bifocal - or by making the whole lens act as a slight prism. I have the latter, and my wife has the former as a tool to determine just what strength the prism has to be for reading. What you get is a second image (not quite so strong) when you look at something with a clearly defined shape, and/or against a high contrast background.

Monocular diplopia is rare - yes, it really is - and the effect is just what you have described. Since it is not just one eye - as evidenced by the fact that it occurs with either of the eyes covered or closed - it is obvious that the problem is not in the eyes themselves but somewhere behind the eyes. It could be in some of the nerves that control the eye muscles, but more likely (and this is rare in itself) is a lesion in a specific part of the visual cortex.

This is where I have a problem. If I say which part of the cortex, and you start asking for this to be checked, you could come across as the sort of patient that no-one wants. What I will say is that you need an MRI scan of the whole visual cortex (at least) and how you get this becomes your problem. My gut feeling is that a neurologist should be involved as soon as possible, because yes, it could be a symptom of MS. If, as you say, you actually get a third image, then now you see why I prefer to talk of images. You should give the people at the eye hospital a clear description of what you “see” as in your posts above - the primary image, a second image below it, and a third image above it - with either eye. This should tell the specialist that this is not something that can be sorted out with just a prism lens. Once you have got to that point, an MRI should be easier.

At this point, I would not demand an MRI, but I would say something like “Gosh, does this mean that I will have to see a neurologist?”.

If you get an MRI, you can feed the results to Karen (our resident MRI person), and I can tell her where a lesion might be to cause the second/third image. That way, you do not present with “knowing all the answers”, but we can see if we can help. Note that a neurologist may spot other symptoms that will help with a diagnosis.

Hope this helps

Geoff

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What is your opinion on the fact that it is not as bad as it was 3 weeks ago?

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Also, I am due an MRI scan in January as I am under investigation for MS would an MRI for MS show this type of lesion you are talking about?

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Hi Fiona

Taking the second question first …
If you are already booked for an MRI, that suggests that you already have a Neurologist on your case. The scan you get is the one that the Neuro requested. Did he/she know about the vision problem before the scan was booked? If not, then there is no reason why a scan of any particular area should have been requested (like: if a set of physical/sensory tests suggested a spinal problem, then the request would be for the spine to be scanned - not any part of the brain. It might be an idea to contact the Neuro’s secretary and ask what scan was requested.

It does look like you have too many professionals involved - since they can often be not so good at sharing information with each other. If you are back to the eye hospital before the MRI scan is due, you might be able to get a specialist to commit themselves in such a way that you can make sure that the parts of the brain related to vision are scanned.

As for a slight recovery … you have to accept that there may be more than one cause. Karen has mentioned diabetes. If you are marginal for this, it could be that a tiny change in blood sugar levels is influencing your vision. If (and I do mean IF) this is affecting your vision, this is really for your GP to deal with - diabetes in itself needs to be checked out and dealt with fast. You must also consider that childbirth does cause some chemical changes to your body. The multiple images showed up just after you gave birth, and are improving slightly with time. Probably, your GP or Practice Nurse is the easiest person to get to fast, and whay you have to do is to get the possible problems checked out and eliminated one at a time.

Geoff

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Fiona and Dr Geoff, how I hope you both are still on this site. My experience is almost identical to you Fiona, but it happened to me 21 years ago. Over the years I had two incidents of left sides weakness, memory issues, and consistently getting double vision and tremor when overheating. I have seen numerous neuros but have always had perfectly clean mris and spinal taps. So my diagnosis has remained “possible/probable ms.” My latest vision loss in one eye (third time around) led me to an oct that showed optical nerve damage in that eye and sent me back to the Neuro. My MRI showed some “patchy” white matter that my Neuro felt was unremarkable. Since then my double vision is 24/7 and is bilateral monocular diplopia. New bifold also did not help and I still see 2-3 images always, ghosting just as you said. My Neuro has offered me steroid treatment now if I choose and medication for ms but it’s my choice. The hange from occasional double vision to constant scares me it has been weeks and isn’t going away.

Should I see an Optho-neurologist? An ms specialist (again)? Or sit back and hope for the best for another twenty years or so? Gwen