The most common cause of double vision in people over the age of 50 is caused by Microvascular Cranial Nerve Palsy (MCNP) is when blood flow to certain nerves in your head (called cranial nerves) is blocked. As a result, you may not be able to move your eye a certain way. Also, you will have double vision. Double vision is when you see two of a single image—either side by side, or one above the other.
Your brain sends signals to your eye muscles through 3 nerves. If blood flow to one of these nerves is reduced, certain muscles cannot move the eye.
Doctors do not know for sure why the tiny blood vessels that go to your cranial nerves get blocked. MCNP is very common in older adults. It is more likely to happen to those who have diabetes and high blood pressure. People that develop MCNP are at a much greater risk of having a stroke in the next 6 months.MCNP may get better on its own in about 6–12 weeks and your vision may return to normal.
At Joseph Eye & Laser Center, we guide you through your options and help you determine the treatment that is customized for your specific needs. Dr. Christopher Joseph, DO, FACS is an expert in the diagnosis and treatment of Cranial Nerve Palsy, Double Vision, as well as Cataracts, and Glaucoma Surgery. He completed an extra year of training by completing a fellowship in Pittsburgh, PA, which specialized in Laser Cataract Surgery, and Minimally Invasive Glaucoma Surgery (MIGS). Dr. Joseph is also one of the few Ophthalmologists in the United States recognized for his excellence by the America College of Surgeons (ACS). In 2018, the ACS nominated Dr. Joseph as a Fellow of the American College of Surgeons (FACS).
The most common MCNP symptoms are problems moving your eyes, blurry vision and double vision. You may find that it takes longer than usual to move your eyes. Or you may not be able to move your eyes at all in one or more directions.
Drooping eyelid
In some cases, you may have vertical double vision. This is where you see two of the same image, one above the other. Tilting your head toward one of your shoulders may reduce or get rid of this double vision. You may also have both up and down (vertical) and side by side double vision.
You may have a droopy eyelid. You could also have pain in, or around, your eye. This may happen just before you notice the double vision. Rarely, your pupil (the black dot in the center of your eye) gets larger. If this happens, it is an emergency.
Your ophthalmologist will do a complete medical eye exam. He or she will want to learn more about the type of double vision you are having. That can help show which nerves are affected.
Sometimes, you will have tests to provide detailed images of your eye, such as a CT scan, MRI, or angiogram.Your ophthalmologist may also refer you to a neurologist.
MCNP and stroke
Risk factors for MCNP include high blood pressure, diabetes, and smoking. These same risk factors increase your chances of having a stroke. People that develop MCNP are at a much greater risk of having a stroke in the next 6 months. We work closely with your primary care doctor to reduce or treat these risk factors.
MCNP may go away on its own. There is no way to shorten the amount of time it takes to recover from it. In the meantime, there are ways to help cope with your double vision. For instance, you can wear a patch on one of your eyes. This often helps reduce the symptoms of double vision. You can also try wearing prism glasses. Your ophthalmologist can explain how they help with double vision and prescribe them for you.
If you have pain from MCNP, you might take an anti-inflammatory medicine such as ibuprofen (Advil® or Motrin®). It is also important to make sure that your blood pressure and blood sugar levels are well controlled.
If your eye muscles do not recover fully on their own, your ophthalmologist may suggest you have eye muscle surgery. It is very important to tell your doctor if your double vision does not go away or if you get new double vision symptoms.
Only your eye surgeon, can assess whether your Double Vision is caused by an MCNP, Cataracts, or Glaucoma and determine the necessary treatments or surgeries, for these diseases. These procedures are extremely safe and have a high success rate, however, the use of cutting-edge technology can be difficult to master, so picking the right surgeon is critical. Dr. Joseph is Fellowship trained in minimally invasive glaucoma surgery (MIGS) and laser glaucoma surgery (SLT). As well as, LASER cataract surgery, dropless cataract surgery, and high-tech lens implants (IOLs). If you would like to further learn about any of our Dry Eye Disease evaluations, Cataract or MIGS procedures, contact the trusted experts at Joseph Eye & Laser Center today. (330) 619-3155
