I think low blood sugar and low blood pressure can independently of each other cause double vision. If you have BOTH at the same time
the effects may be increased. Also increased blood viscosity may be a culprit?

I'd check your blood pressure at home with a cuff when you have this effect, and see if there is a correlation.

I also get vision changes from MSG.

I think if you journal your episodes during the day, you might correlate to food (hunger), or low pressure.

Blurred vision also comes from anticholinergic drugs. OTC things like Benadryl and Imodium, and RX things too. I don't recall on your list however, that you sent me, an anticholinergic drug.

I don't have a means to check blood sugar at home, but can certainly check BP and will do so.

I also hadn't considered MSG. I don't eat many processed foods...very little actually, but I will pay attention and journal to see if there is a connection.

No anticholinergics for me with the Sjogren's...they cause dryness, which I have plenty. I was given atropine once during a chemical stress echo...thought I would die afterward. I couldn't talk or swallow at all...literally. It was actually quite scary.

Thanks for all the suggestions. I will note when it occurs for patterns, BP, food, etc.

You can roughly correlate to blood sugar. Since you take those heart meds... beta blockers typically block sweating etc so that sign is not there for you to use.

But if you get the vision things, when you get hungry, or just before a meal is due...or first thing in the morning before breakfast, etc, it might be low blood sugar. If it gets better with food, then comes back, that would implicate blood sugar IMO.

The tiny muscles in the eye that change the lens shape, are very sensitive to metabolic changes. Low oxygen, low electrolytes, low sugar, low pressure (results in slow blood flow).

I am thinking the beta blocker. This drug tends to make cold extremities, and constricts the bronchioles of the lungs. The beta blocker might be causing vision issues. If you look up
"beta blockers vision" on Google you will see vision changes listed as a side effect. I was on atenolol for about 13 yrs and all of sudden it started to make me wheeze. Even though I did well otherwise, my doctor took me off and will not let me have it again...I ask each time! So side effects can come much later in therapy and not be paid attention to.

The double vision has already occurred today (and I had already eaten) so I'm doubting blood sugar.

But the beta-blocker...I had no idea side effects can cause problems long after taking it...like years. I assumed once you tolerate a medicine and don't have side-effects, that you won't have them later. I have taken a beta-blocker for many years, so automatically discounted it being the cause.

I will have to discuss it with the cardiologist. Gosh, that would be horrible if it's the beta-blocker. Don't know what I would do without it. I have tapered off once about 1.5 years ago and had numerous problems and had to start again...but it is a lower dose. Pacemaker recorded 76 cardiac events in only a couple months when I was off the beta-blocker. I have severe sick sinus syndrome and already had one EP study and double ablation to help. There are not many other options. I really hope it's not the beta-blocker, but you may be right.

If it is the beta-blocker effecting (constricting) blood vessels to the eye, would they be able to detect this with MRI? That way we would know for sure.

Well the thyroid question was asked by an eye specialist I saw if I had it checked because it can cause eye issues. I don't know about double vision but just a thought. The blood sugar just came to mind because I thought diabetics often have eye problems but again these are not facts I have just thoughts.
Have you been on sjogrens support forum to see if others there have double vision?

Yes, I asked on the Sjogren's forum, and a few (very few) had double vision, but it was unexplained. Dry eyes can cause problems with vision, but more blurry vision vs double.

There seems to be a big difference in double vision and blurry vision and what cause each to occur. From what I've read double vision is usually a muscular dysfunction caused by a neurological problem...whereas blurry vision has a wide variety of causes.

Have you thought of seeing a neuropthamologist? Sorry if you mentioned you did. I am not sure about the mri detecting what you are asking. For me I think they were looking for something pressing or a growth etc on the brain.
At least you are seeing a neurologist at Hopkins and I am thinking they could refer you to someone if the neurologist does not have answers.
On a side note you have sinus issues? From one eye doctor I was given nose spray because they thought and again a guess which starts happening when they can't figure out things. They said maybe the sinus was actually causing the eye pain but it did not and nose spray makes me so much worse.
Anyhow I will stop with my guessing for you. I hope you can find the true reason behind all this. Try to stay in the day which I know is hard. I remember when my eyes started I went from A to Z with so many fears but did the same with my legs and everything else. Ugh!
Sending warm thoughts