I have searched for answers to this question and can find none.

I am pretty sure that I have MG. Typical (if there can be such) muscle tiredness and weakness, that gets worse through the day.

But my question is re: Monocular diplopia. This was my first alarm symptom. But Monocular diplopia is, so far as I can discover, unknown of with MG.

This is strange because my DV also worsens dramatically during the day, and recovers overnight. Has anyone else had this with MG? Or does anyone know of any other condition that could cause fatigable DV?

Thanks.

JJ, There has been a bit of discussion on this topic but no real consensus. I'll describe what I think happens to me but I may not have it quite right for you. When my MG flares I can get DV which can go away by closing one eye. For me, the double images are side by side (which means one or both of my eyes are wandering in the left-right direction).

Sometimes I have a problem with DV and it won't go away by closing an eye. In this case, it is usually not so bad and the images are up and down. It also turns out I have astigmatism in both eyes in the up-down direction. I think what happens is that my eyes get tired, have trouble focusing, and make the astigmatism more noticeable. It may even be that my eyelid gets tired, droops a bit and changes the way my eye lens sees.

If I'm right about this, my double eye DV is just 'normal' MG DV. My single eye DV is because I have astigmatism and my eyes can't focus well because they are tired. I talked to my neuro about this and was told the focusing muscles in your eyes aren't affected by MG because they are not voluntary muscles. Many people on this forum would disagree with this statement and I am one of them.

To see if this explanation holds water in your case, you might want to pay attention to lighting conditions when you sense some single eye DV. In bright light, eye defects like astigmatism won't occur because your pupils shrink and diminish the defect. In dim light, the single eye DV gets worse because your pupils open to let more light in.

I don't know if this helps. A few people here have this issue. It's not clear anyone can explain it. I have much more trouble focusing since MG appeared. My neuro can't explain it except to recommend new glasses. I have an explanation but I don't know if it is right.

Something I keep reading here is that it is possible to have two or more "conditions" causing different symptoms. This has really opened my eyes(no pun intended) :-p

It seems that many Doctors stop looking at other possible reasons/disorders after we are "diagnosed."

I have Diplopia and severe Esotropia+Ptosis only around my right eye. I take 180mg/day Pyridostigmine Bromide (Mestinon) and it REALLY helps with both my Diplopia and ESOTROPIA (crossed eye).

Although, by 6-7pm the Mestinon really putters out, so I might need to increase my dose.

May I ask, how long and how much Pyridostigmine Bromide did you take before you realized it did not help with your Diplopia?

Here is some information that really helped me understand how/why my Ocular-neurologist was able to diagnose me:
http://www.aao.org/publications/eyen...11/feature.cfm

Thanks for the suggestions.

But I have Bilateral Monocular Diplopia all the time. It starts the day with what I describe as a 2mm vertically displaced ghost. By the end of the day it can be as bad as 8mm vertically displaced and the ghost can be 90% of the real image.

The eye doctor, took the easy option. Ignored my other MG symptoms, and the fact that my DV worsens during the day, and declared it Astigmatism. When I got my new glasses, they help slightly. But by the end of the day I still have DV even with the glasses.

I have no diagnosis yet, but am experimenting with caffeine. That reduces most of my symptoms, but has least effect on my eyes.

Hi, Juliejayne. Welcome.

I believe these articles will shine some light on the situation.

Monocular DV is NOT caused by MG. There is usually another cause, even if it's "too difficult" for a doctor to figure it out!

A person can have both binocular and monocular DV.

I have astigmatism. It doesn't matter which eye I close, the DV always goes away. A "fuzzy" area around an object is not DV. gr8ful, that is not true, what you said about astigmatism or your eyes being "tired."

I get a little crazy when science is ignored (by doctors). It's lazy doctoring!

I think you need to go see a neuro-ophthalmologist, if you can. They might better determine what is going on for you.

I hope you can get it figured out!

Annie


http://emedicine.medscape.com/article/1189759-overview

http://www.dartmouth.edu/~dons/part_1/chapter_4.html

http://www.aao.org/publications/eyen...11/feature.cfm

http://jnnp.bmj.com/content/75/suppl_4/iv24.full

Thanks Annie.

What I cannot find is any reference to Monocular DV, that is also fatigueable. I.E. it gets worse during the day and improves overnight.

Everything that I can find suggests that my eye problem is a refractive issue, with the Cornea, but I am struggling to find anything or anyone that can tell me IF the cornea can be deformed and recover in a matter of hours.

Because this is a moving target, it means that I cannot get glasses to correct it since the problem that they correct at 9 am will be different at 9 pm.

I think one thing that is overlooked, or can be, is nystagmus. I have an issue with this which could not initally be observed by any of the eye physicians, some considered the best in the world. A VNG discovered my eye issues and mild up beat nystagmus. Do I think it's MG? Could be, but I'm not 100 percent sure. Now my doctors can see this on my exam very slightly after me having issues since last April. I wouldn't describe mine has double vision, but more of a waviness from the images slowly swerving a bit, and my brain trying to concentrate or piece the images together. What I am describing isn't typical MG, but the medical reports say that they are not ruling out MG as a cause of this.

Well, update from the Eye doctors.
1st doctor, 1st diagnosis was astigmatism, so I was sent away to get new glasses. Doctor refused to listen to my complaints that it got worse during the day and recovered overnight.
New glasses, helped, slightly. But the problem remained even with the glasses.
2nd doctor, 2nd diagnosis, cataracts. I insisted that I didn't consider that that fitted with the symptoms that I have. Doctor ummed and ahhed. Checked further, then admitted that there was no appreciable clouding of the lens, so probably not cataracts.
The 2 of them then got their heads together, and dismissed me with, "well we can find nothing in the eye that could be causing the problem. So it must be neurological"

What a waste of effort. Why don't medical people ever want to find answers?
The neurologist has already said that it can't be neurological as it is bilateral (in both eyes). I am hoping that the blood test come back positive for MG, then I can go back to both Neuro and Eye doctors and say... hey guess what... you were wrong.

Hi JulieJayne, I noticed in a previous post that Annie suggested you see a Neuro Opthamologist. Have you done so? You say you've seen two different eye dr's.
with unsatisfactory results. If neither one was a neuro opthamologist, please consider making an appt with one. I searched for 8 years trying to find a dx. Within 10 minutes of an exam by a neuro opthamologist, he suggested that I had MG.
Sometimes we just need to keep searching for doctors that understand MG and know what to look for - not to mention, one that is willing to listen.
Good luck to you
Jan

Thanks, Jan. Ditto on the neuro-ophthalmologist. When the first neurologist I saw dismissed me, I saw one and, after a thorough eye exam, he said that I had MG. They have specialized tests to show double vision (which kind) and why.

I saw ophthalmologists my entire life, as we all do, and not one of them "saw" my ptosis. I've had it since birth or shortly thereafter. I was misdiagnosed at age ten with lazy eye (yes, I've had MG that long).

MG can be beyond an ophthalmologist's realm of knowledge. Which is silly, really, since it's pretty obvious when eyelids are drooping and they do know what the differential is for that!

And an N-O can also figure out the monocular issue.

If you say where you live, maybe someone can refer you to one!

Annie