![]() ![]() Taub putting the tape on the right lens, it was now clearly down the center of the left lens. When asked where the glasses were, she pointed to the table. Upon entering the room, we observed the patient without her glasses, squinting her right eye shut. A Bump in the Road to RecoveryĪ few days later, the patient showed up again on our patient list at the rehabilitation hospital. The patient was instructed to follow up with us upon release from the rehabilitation center. So, eye stretches help to keep the system as mobile and adaptable as possible. This makes recovery harder should the affected muscle begin to come back to life. When an eye shifts to a new location in the head for too long, the muscle that is dominating can actually shorten in length. We want to get the eyes moving in all directions as far as possible. In addition to educating the patient’s therapists on this simple therapy, we also instructed them on eye stretches to keep all of the muscles from suffering contracture. ![]() Shown here is the patient with tape placed in a variation of the initial proper position, with the tape placed on the right half of the right lens. For this patient, simply putting a strip of tape down the center of the right lens eliminated her double vision as long as she turned her face toward objects she was trying to view. For example, we have used binasal occlusion, spot occlusion and monocular full lens occlusion in the past. With our next option, occlusion, we sought to implement an important overarching concept: use the least amount of occlusion possible to reduce or eliminate the double vision. Achieving Fusion: Keep it SimpleĪlthough we typically start with prism to attempt fusion, this patient’s variable double vision made finding the right power and direction of prism impossible. The anterior and posterior segment evaluation revealed no issues. Eye movements showed the patient’s left eye was restricted to the right and her right eye restricted in upgaze movement was of poor quality with numerous fixation losses. Cover test showed a constant right exo/hypotropia in the patient’s right eye. Confrontation fields were full-to-finger count. Because the patient was tilting her head while lying in bed during the exam, we surmised she was looking through the incorrect portion of the PAL. She was wearing a progressive bifocal.ĭistance visual acuities were taken at six feet-standard for a visit at a rehabilitation center due to the patient’s prone positioning-and measured 20/20 OD and 20/50 OS. She had been self-patching to eliminate the double vision. She reported double vision that was horizontal, vertical or both, and variable. At the time of our examination, she was undergoing rehabilitation to improve activities of daily living. Case ExampleĪ 71-year-old African American female presented to a local emergency room with complaints of double vision. Luckily, far superior options are available. Although patching treatment does the trick to eliminate double vision, it inhibits the brain’s ability restore the visual system to fusion. Before we made diplopia a priority at our rehabilitation facilities, it was common to find patients doing rehab therapies while still wearing the dreaded black patch. Considering improvement immediately following a stroke is essential to the patient’s long-term overall life outcome, eliminating the diplopia is a vital first step. Not only is it disorienting for the patient, it also interferes with the rehabilitation process. O ne of the most common ocular findings following an acquired brain injury, such as stroke, is diplopia. ![]()
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