Had Blurry Vision. Diagnosed Early Contracts. Refraction Reduced To 3.5. Done With MRI. Do I Have Chronic Sinusitis?

Posted on Mon, 29 Jul 2013

Question: The vision in my right eye went very blurry one morning (had been walking in the local hills the day before) I wear contacts. Age 60. Female. Saw doctor - ruled out TIA - referred to ophthalmologist who said I had very early cataracts and just needed new glasses. Saw optometrist and over the next week my refraction went from a stable 1.75 to 5 - since then it has reduced down to 3.5 but is not stable - sometimes little problem, sometimes lots. Optometrist and Ophthalmologist unable to identify cause. Had MRI last week (waiting results and am assured if there was anything sinister it would have been flagged quickly). Have had 5 days without contacts - no real improvement. When lying down, seems less of a problem. Do have chronic sinusitis (continual nasal drain) - should I go back to GP or just wait for next appointment with Opth - really getting frustrated. Driving difficult (although legal) computer work an issue - reading an issue. Any ideas about next step?

Blood pressure good (average 125:85) - cholesterol in March 2013 was LDL 4.4 HDL 1.5 Triglycerides 1 - ratio 4.6. All other blood checks normal (this was part of a check re arrhythmia) heart strong - pulse good - medication doing its job (quoting cardiologist). Height 6 foot. weight around 13 stone to 13 stone 4 lbs.

Answered by Dr. N K Mishra (2 hours later)

My Dear,
Thanks for sending your query to us.

There are a lot of reasons for such diminution of vision. To get to those reasons we have to have a retinal examination, including optic nerve assessment. I think this will be the next step.
Top of the list being retinal swelling and optic nerve swelling.

Get an eye examination done and get back to me if needed.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. N K Mishra (26 minutes later)

Those options have been discounted (two OCT scans by ophthalmologist) and the other tests undertaken by an optometrist using drops etc. No sign of an odema of the macular - no indication of anything on the optic nerve. Am attending optometrist weekly to get a stable reading (unsuccessful so far) and will go again tomorrow - they're not hopeful of finding anything new.
Could it be sinus related?

Answered by Dr. N K Mishra (4 hours later)

My Dear,
Thanks for getting back to us.

A sinus involvement will lead to infllamation,either of optic nerve or retina,which will be seen on OCT,so sinus being responsible for this is unlikely.

One possibility is Retrobulbar neuritis,this should be looked into as it does not a tell tale sign and can be seen on MRI.

Please do get back to me if needed.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. N K Mishra (23 hours later)

MRI scan shows nothing (just heard) everyone completely flummoxed. Increased refraction prescription now stable for about 3 weeks at 3.75 (from original 1.5 to 1.75).
Am guessing there's not much more that you can suggest either?

Answered by Dr. N K Mishra (9 hours later)

Dear,

Does change of power improves vision to normal level?
If not, then optic neuritis (retrobulber) should be suspected.

Myopes are always suspected for Intraoccular pressure rise and retina / choroid defects - they have to be thoroughly investigated.

Consult a neurologist for nerve dysfunction.

Do get back to me for queries in this regard.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. N K Mishra (3 hours later)

Yes, the increased power does improve my vision to normal levels. Am seeing ophthalmologist again at end of month.

Answered by Dr. N K Mishra (5 hours later)

My Dear,
This problem falls in the category of refractive error.
Change glasses and you are fine.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. N K Mishra (38 minutes later)

But why would it have happened so quickly - literally overnight and within a week from 1.75 to 5 refraction (and a worsening of a mild astigmatism to a problem)? I don't see that is normal and would love to know what caused it.

Answered by Dr. N K Mishra (9 minutes later)

My Dear,
Thanks for getting back to us.
This is not supposed to happen overnight. That is the reason you are to be put through so many tests and investigations.
We presume that this can happen in unilateral cases, as you are working with the other eye and did not notice the worsening of vision in non dominant eye.
As the vision is fine continue with glasses and have regular follow up and you will be fine.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. N K Mishra (3 hours later)

Sadly that's not the case either - the eye that went is my dominant eye - probably why I noticed it so quickly. I will have to wait and see if it settles and monitor the macular with the Amsler grid. Thanks for trying

Answered by Dr. N K Mishra (37 minutes later)

My Dear,
why wait for amslar grid,download it from ne and at best print it and have a look at it with one eye closed and see if you see all the squares regularly.All this while focusing on the central fixation point.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. N K Mishra (50 minutes later)

Sorry you misunderstand me - I have the grid but have been recommended to check daily because some concern that now everything else has been eliminated that the macular may be weak and may leak - hasn't yet. If answer comes up I will let you know for future queries

Answered by Dr. N K Mishra (4 minutes later)

My Dear,

For early macular defects we will rely mainly on OCT,instead of amslar grid,as the grid can at best give you an early inkling.Since you have base line OCT done any followup will be informative.

Regards,

Above answer was peer-reviewed by : Dr. Raju A.T