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01/23/2012 12:39 PM

Trouble with eyes focusing

Nymph
NymphPosts: 231
Member

Does anyone have trouble keeping your eyes focused? When I'm doing something that requires sustained visual concentration, e.g. driving, my eyes will go out of focus and I have to deliberately rein them in. It's like an effort of willpower. And this can happen on 10 hours of sleep, so I know it's not sleep deprivation, although that makes it worse. It happens any time of day. Blink
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01/23/2012 01:55 PM
DukeNLucy
DukeNLucyPosts: 200
Member

Yes, I have the same problem. I lost my L eye 20 yrs ago with the tumor removal from the cavernous sinus area, so my R eye has to double-work. However, the blurrs started last year, especially in the outside peripheral edge. Without thinking of it I turn my head to compensate for the blur when I look in that direction. I can also be looking at anything, get a blur, and then have to try hard to get back in focus. I also started using Tri-focals last year, but now find them a pain in the butt - I have to nod my head up and down to see some things clearly. Now I just whip them off and use all-short-focus glasses when I'm at the computer or reading a book or doing my nails.

When the pituitary stalk is compressed, or there is stalk and pit gland compression, there is usually optic nerve compression as well. Unless there are other ophthamalogic reasons to account for peripheral blurs, pit problems can be the reason for the blur symptoms. My recent MRI didn't show any pit problems, and the Ophthamologist doesn't see a cause either. So.. who knows what the cause of mine could be. Maybe just old age.

Have you had a MRI? Have you seen an Ophthamolagist?


01/23/2012 02:21 PM
Footprints11
Footprints11Posts: 397
Member

I've been thinking about this a lot lately. I've been surprised by how many people here have mentioned visual problems. I had them as an initial symptom, but rarely have I found others (at all the other health-related sites I've visited, trying to understand myself) who have experienced the same or similar. This further makes me think it may all be related. Or not. There are many different kinds of visual problems and sources/causes.

So....I would like to put on my neuroscientist/lab rat hat on (but I'm NOT a doctor...), and share some knowledge and observations, in case it can help others pin down their own problems. However, I do NOT understand blurring.....my understanding is limited to nerves/neurons, and working or not working transmission.

If you have vision problems, it could be due to inability to control eye muscles because of damage to cranial nerves. In this case, your eyes won't go in a certain direction (depending on the cranial nerve affected, and whether it's only one or both, because they're in pairs), or the movement is slowed. A neurologist can test this by having you watch a finger move slowly side to side, and then up and down. (I was symptomatic for cn 3,4, and 6 dysfunction to various degrees over time; 6th nerve severely). If one or both eyes are not moving as planned, you will probably have double vision (and it is also relevant how the double vision appears-ie parallel/next to each other or is one image higher than the other, etc). *what I find possibly of interest to us SAI folks!* IF there is inflammation around the pituitary (or some other problem in that area), it sounds like it could also manifest with symptoms of cranial nerve 3,4, and/or 6 dysfunction

for example, see http://en.wikipedia.org/wiki/Cavernous_sinus (What I stumbled upon last week, the idea of lymphocytic hypophysitis, it's an interesting relationship, so I think it's worth considering and investigating) If you scroll down at this site, you can see a cartoon from the front, showing how the pituitary, optic chiasm (see below for relevance), and cranial nerves are all in the same "plane":

http://endocrinetoday.com/view.aspx?rid=60740

If you have loss of vision, then that would suggest the nerves from the eye to the back of your brain are affected somewhere along the way (and figuring out where exactly is complex). A neuroopthalmologist can test doing that lightdot in the box thing (where it jumps around and you press a button when you see it). Also, my neurologist had me undergo a "visual evoked potential" test where I watched black checks move-one of the few tests I failed gloriously. Here's a good diagram for seeing how an image is carried from the visual field back to the occipital lobe. http://en.wikipedia.org/wiki/File:Gray722.png If you imagine the blue part of the retina is "seeing" the lateral visual fields (outside), and then trace it to the middle where they cross, that's called the optic chiasm, and is right over the anterior pituitary (but in front of the "stalk", or connection from the hypothalamus to the pituitary)!

http://www.gwc.maricopa.edu/class/bio202/EndoHemoTutorial/ pit/pituitary.htm

(so this MAY be relevant if there is something going on around the pituitary-ie SAI cases-that may impact on the optic chiasm and result in vision problems......tumors or inflammation, etc.....and therefore maybe loss of lateral vision).

I focused on visual issues that may impact SAI folks with things going on around the pituitary. There are other parts of the brain, obviously, that can be affected when there is visual loss, or cranial nerve dysfunction. MS can cause lesions anywhere along the way, resulting in symptoms (and an MRI can rule out lesions). Helping to figure out as specifically as you can what you mean by "vision problems" can help (obviously, a doc could do that easily, but when you're sitting at home worrying, you understandably want feedback asap! Smile

Like I said, high dose steroids helped (mostly) resolve my serious cranial nerve dysfunction; and trying to wean off cortef, I started having weakness in my eye control (ie, some mild double vision). Also, right before I was diagnosed with AI (after the initial resolution courtesy of steroids), I have a note that an optometrist said my "extraocular movements are not as strong as they should be" and my eyes were occasionally crossing, and frank cranial nerve problems came and went prior to starting the cortef. Interestingly, a month after starting cortef, the neuro report says my cn function is normal except some very mild remaining nystagmus (ie almost all better!) Why the relationship? I can only hypothesize......!

Another possibility

blurred vision (or loss of vision) and/or altered color vision:

http://en.wikipedia.org/wiki/Optic_neuritis

As an aside.....I have experienced brief episodes of blurry vision, on the side I'd fallen asleep on (when watching tv, only to get up an hour or two later.....like a "smooshed" feeling). Transient and would go away, but strange nonetheless. Maybe a pressure thing? It's noted in my file after a period of intense stress (PhD defense!), if that matters.

Post edited by: Footprints11, at: 01/23/2012 04:03 PM


01/23/2012 03:24 PM
Nymph
NymphPosts: 231
Member

Well, my vision is not exactly blurry so much as my brain and my eyes seem disconnected from each other. It's like staring into space and not seeing anything, only it happens when I am supposed to be seeing things. If something appeared in front of me, I would see it, but I would have to then focus on it. I have had an MRI about 7-8 years ago. I have not seen an opthamologist, just an optometrist for glasses.

Footprints?


01/23/2012 05:03 PM
DukeNLucy
DukeNLucyPosts: 200
Member

Footprints,

You reinforce my reluctance to wean off the Pred. It seems to have reduced a number of my AI symptoms, including the cranial nerve dysfunction I have remaining from the tumor removal long ago. For example, I have no touch sensation to my L forehead down to my L upper cheek (totally numb), but I used to get a lot of tingling sensations and sharp pain in those same areas. I can raise my L eyebrow some on that side, and grin just fine. But the L eyelid droops and I cannot raise it. The L eye muscles move differently than the R: they are not coordinated, and I have no vision on the L. I also have no eye sensation on the L and a decreased tear production. I used to get eye infections easily because I had no blinking reflex to keep out dust, etc because I never felt them. So I have several different types of sensory and motor dysfunctions.

Nymph, I also have nerve dysfunctuion on the L side of my leg. The neurologist said I don't have a good connection from my brain to the muscles there. Signals may fire saying to be strong and move, but the neuroreceptors don't recognize or receive them well. They don't speak the same language. Parts of the L side of my leg are numb, but I used to get a lot of tingling sensation there as well. It sounds to me like what you're describing is similar to some of the neuro problems that I have; your eyes don't take in an image as they should. Please go get evaluated by an opthamologist. And if you haven't had an MRI recently, ask for one. With GAD.

Since all my AI problems started last fall and I begam Pred, I've been able to cut back on Neurontin dosage, which used to keep the face/forehead/leg tingling/pain under control. Neurontin also has a sedative effect, so reducing that helped slightly reduce my chronic fatigue.

Opthoneurology is quite complex, and the doctors at a Washington DC hospital used to use me as a complex example to interns and residents. Most of what I have in the L eye/face is related to damage to the III, V, VI, and VII cranial nerves, and leg damage due to the tumor that had pressed on the spinal cord. How the cranial nerve dysfunction could, or couldn't, be related to the pituitary damage I had from the tumor is unknown.

I don't trust neuroradiologists. I get copies of my MRIs on CD and give them to my Endos and Neurologists. If they have questions, they could talk "doctor talk" to one another to discuss possibilities. They may not have full radiology training, but they should be familiar with scans related to their own field of expertise. The more eyes that view a scan, the better.

For a person with diagnosed AI or suspect AI having symptoms related to eye focus or blurring, I'd get an opthamologist, neurologist, and an Endo to view scans, discuss symptoms, and decide then what to do next. Vision is not something to play around with.


01/23/2012 05:23 PM
Nymph
NymphPosts: 231
Member

Hmmm... Well, I have had all those vision tests and always do fine. I'm just a bit short-sighted w/astigmatism. And I have had those things checked out by a neurologist (my dad), and the field-of-vision stuff is normal. Sometimes it seems like it might just be my sinusitis making my eyes tired, because that's what it's like, tired eyes that zone out when they shouldn't be tired. It's more like what you described, Footprints, as weakness of visual control. Anyway, I will keep it in mind and bring it up at my upcoming appointments.

It could be that the treatments I am having for AF (DHEA and pregnenalone and 5-HTP) aren't enough, but I'd rather give it more time to see if my HPA function is improving before going the Pred route. (I have only been under treatment for a week!) It turns out that my mother's cortisol is quite low, too, and I have little doubt that my grandmother's was. So I think what we have here is a case of HPA suppression handed down through the generations, not bad enough to kill us but just enough to drive us batty! Wink


01/23/2012 06:12 PM
DukeNLucy
DukeNLucyPosts: 200
Member

Sounds like you've taken some positive steps, and have a sense of patience and humor. And that's great that you have a family neurologist! I bet you don't have to wait 4 months to get an appointment! Thanks for starting an interesting post. Let's see what others have to say about vision problems.

01/23/2012 10:34 PM
ITeach91
ITeach91  
Posts: 1872
VIP Member

Hi,

Yes I get blurry vision - extreme floaters - and problems focusing with double vision kind of symptoms. Opthamalogist did a field of vision test - I'm wondering if that's the same as the visual evoked potential you talked about - but the test I had was a box with lights in different spots - I had to push a button to indicate when I saw a light. The dr. said he thought the blurry vision and floaters were from hypoglycemia. He tested me on two different days and got two completely different results as far as my eyeglass prescription goes and he asked me what I had eaten - the day I did worse I had not eaten before I went to the appt.

Deb


01/24/2012 04:32 AM
Nymph
NymphPosts: 231
Member

Hmmm... Deb, your floaters sound kind of like my mom's. She has black spots that she can see against the sky. Now I'm wondering if hers is low cortisol-related. I'm trying to talk her into seeing someone with expertise in the area. This might be good ammo, since I know the vision changes were a bit scary for her.

As for me, I've wondered about hypoglycemia but there doesn't seem to be a connection. I am not sure, though, as I think a lot of symptoms that I was putting down to low BP might in fact be that instead.

No, I don't have to wait four months for an appointment, but I do have to convince him that I'm not a hypochondriac. He is my dad, after all, therefore nothing could possibly be wrong with me!


01/25/2012 11:19 AM
EnglishRose119
Posts: 170
Member

i have a lot of eye issues, had extensive tests around 19 and they couldn't see the cause. I have 40% vision in my right eye, weak eye muscles, optical migraines. it's hard to explain whe you can't focus but you can, it's just super super hard
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