All paid DoctorBase customers will be migrated to Kareo Marketing on December 15, 2016. Read how to get your practice ready for the transition.
×

4 Reasons Why Ask DoctorBase™ is the Most Efficient Way to SEO and Establish Your Brand Online

  1. Ask DoctorBase™ is a free service for patients on the DoctorBase platform - currently servicing over 6 million American patients of record.
  2. All answers submitted by healthcare professionals (you) are for entertainment purposes only and do not constitute doctor-patient relationships. All patients must agree to this before using Ask DoctorBase™.
  3. Our software and our Marketing Engineering staff review each answer and optimize your answers for keywords valuable to your specialty. It is a well kept secret that doctors (you) - not SEO consultants - are the ones who have the most valuable content prized by search engines. Ask DoctorBase™ "unlocks and optimizes" your content in the most efficient manner possible with today's technology.
  4. Finally, the doctor who provides the most popular answer - "the Featured Answer," gets an added benefit by allowing patients to write rave reviews about your expertise - reviews that are submitted to both Google and Google Local through our Preferred Data Provider relationship.

Ask Dr. Molly if you have questions or want a personal session on how to best use Ask DoctorBase™ for maximum marketing impact.

...

Molly Maloof, MD

Director of Clinical Content
@DoctorBase

Large deviation and squint

Hi, my daughter, currently 14 have been diagnosed with strabismus, esotropia accompanied with double vision, early this year. She is currently wearing temporary 3M stick on prism on her glasses. With 25 diopters on her right and 15 diopters on the left. She has a new onset of headache, but other than that no other symptoms. The doctor has scheduled her for an MRI should we go ahead with it? What could be the illness?

++

She has binocular double vision, and has myopia 75 on the left and 200
Poster
  • Female | 45 years old
  • Complaint duration: 90 days
May 25, 09:30 AM

Find low drug prices at local & online pharmacies

Featured Answer

3 UpVoted this answer
Yes MRI IMMEDIATELY. Other than space occupying lesions,hemorrhagic or embolic strokes can occur at any age. If this is an isolated finding, set of symptoms, intervention can be focused on the visual system. Full neurological workup is manditory in this case
Douglas Smith
Douglas Smith, OD
Optometrist in Medford, OR
Level: Contributor (8)
Website: Bison Vision Center
May 26, 03:51 AM
Call Email
3 UpVoted this answer
Recent onset double vision is always a concern, and a thorough history and neuro/ophthalmic testing is crucial for a correct diagnosis to be made. Conjecture as to diagnosis on our part, without full knowledge of findings, is to be discouraged.

An absence of neurological signs (yes?), and presence of good fusion response with prism correction (yes?), does seem to be a good predictor of an ABSENCE of intracranial pathology. However, careful motility (eye muscle) examination, and fundus examination (optic nerve) for papilledema and optic atrophy is essential.

As the other doctors have pointed out, an MRI (if done correctly/thoroughly) should rule out space-occupying lesions, but some doctors feel that without any other neurologic symptoms, neuroimaging is not indicated.

Me? I'd get the MRI (can't be to safe), if it comes back negative (probable), I may then recommend bilateral medial rectus recession. Hope this is all helpful information, and everything turns out well.
Kevin Kukla
Kevin Kukla, OD
Optometrist in Waukegan, IL
Level: Candidate (1)
May 26, 03:02 AM
Call Email
3 UpVoted this answer
Immediately get an MRI. It can determine the cause of the cause of the double vision and headaches. It would be best if the mri was ordered by ophthmologist who specializes in ocular motilty. There are different ways that orbital mri's can be done and such a specialist will make sure that images optimally shuw areas of concern. High on the differential diagnosis are various tumors of the orbit and brain, as well as such systemic diseases as thyroid and various neurological and muscular dystrophies. Prism treats the symptom but not the disease.
John W. Elman
John W. Elman, OD
Optometrist in Santa Monica, CA
Level: Contributor (17)
Website: Dr John W Elman Optometrist
May 25, 11:25 PM
Call Email
3 UpVoted this answer
New onset double vision and headache in a teen is concerning! If the prisms helped this is true Diplopia and not pseudo Diplopia which is normally astigmatism.

Whomever gave you the stick on prism must have been concerned. Did they refer you to another specialist? Was this an OD or an MD?

The list of possible reasons is daunting and you certainly avoid conjecture and Internet diagnosis. Though this forum seems universal in its vote for imaging I would hope you have a neuro ophthalmologist or neurologist that is guilding this process. Which scan and what tissues we are interested in seeing are critical and will help avoid further studies and get at the root cause sooner.

If you live in a metropolitan area you should seek out guidance and not just have her scanned.

For instance an orbital scan will miss the motor parts of the brain. A brain scan could miss sinus structures and a CT scan may best elucidate some pathology.

I assume that someone with knowledge of your daughter has ordered this scan. If not get under the care of someone that has a clue what they are looking for!

Best of luck and it is sad to not have follow up on these opinion forums for the benefit of these for profit companies.
Richard B. Foulkes
Richard B. Foulkes, MD
LASIK Surgeon in Lombard, IL
Level: Contributor (7)
Website: Foulkes Vision Institute
May 25, 08:44 PM
Call Email
3 UpVoted this answer
Definitely do the MRI. Get a complete physical with blood work also. Keep asking questions and continue until you get to the bottom of this. Don't be afraid to get a second opinion if you are not getting any answers.
Kevin Wells
Kevin Wells, OD, FAAO, Diplomate American Board of Optometry
Optometrist in Destin, FL
Level: Master Contributor (53)
Website: Wells Vision and Laser Eye Center
May 25, 04:34 PM
Call Email
3 UpVoted this answer
Yes, by all means have the MRI and any other tests involving the brain and the eyes. It is important to see if there are issues such as trauma to the head or eyes that is causing the symptoms. The sooner the better.
Randall Bernstein
Randall Bernstein, OD
Optometrist in Indianapolis, IN
Level: Contributor (13)
May 25, 11:16 AM
Call
2 UpVoted this answer
Sounds like a progressing condition. MRI and other tests are necessary to rule out a space occupying lesion that may cause the strabismus and headaches. If headaches seem to be caused by double vision only (for example, waking up in the morning without headaches), she may want to try "uni"-vision glasses (one lens frosted, blurred) or monovision glasses (one lens for Far, the other for near) to allow the use of only one eye, for temporarily relief, while waiting for the MRI results. She needs to see an optometrist for such eyeglasses.
Johan Tran
Johan Tran, PhD, OD, Board Certified
Optometrist in Huntington Beach, CA
Level: Contributor (14)
Website: Healthy Eye Center Family Optometry
May 25, 06:07 PM
Call Email
2 UpVoted this answer
Yes and have the imaging done as soon as possible.
Eric Knight
Eric Knight, OD
Optometrist in West Allis, WI
Level: Contributor (13)
Website: http://www.knightvisions.net
May 25, 06:03 PM
Call Email
2 UpVoted this answer
Well , I see no harm in getting an MRI done , so go ahead with it - it might be just to exclude any intra cranial lesion and most probably it may come out to be normal
Deepak Khosla
Deepak Khosla, MD
Ophthalmologist in Calgary, AB
Level: Contributor (6)
May 25, 04:55 PM
Call Email
2 UpVoted this answer
I recommend an MRI as well. Better to be safe.
Tracy Swartz
Tracy Swartz, OD MS
Optometrist in Madison, AL
Level: Candidate (1)
May 25, 02:19 PM
Call Email