Double vision calls for prompt attention

Dear Dr. Donohue: I am 67 and wear glasses. I woke up three weeks ago with double vision. I can see with either eye only if the other eye is covered. My eye doctor said a muscle wasn't working, and that usually the double vision self-corrects, but it may take a few months. She sent me for an MRI and blood work. I don't have a brain tumor or an aneurysm. Right now, a prism has been put in one of my glasses' lenses so I can function. Does my doctor's prognosis seem sound? — B.F.

Reply: Your doctor has told you the truth. Our two eyes view things from a different point of reference. If the eyes are not properly aligned, the brain gets two confusing images that it cannot merge into a single image. You have binocular diplopia (double vision); when both eyes are opened, your brain receives two pictures.

Diabetes, high blood pressure, an overactive thyroid gland, injury to the brain, myasthenia gravis (a nerve condition), a stroke and a ruptured brain aneurysm (an artery bulge) are some of the causes of binocular double vision. You have no other signs of those illnesses.

Your tests were normal. Your two eyes are not working together, perhaps from a temporary glitch in blood supply to one of the eye muscles. This sort of double vision almost always resolves in a couple of months.

You acted wisely. You saw your eye doctor immediately. The more dangerous causes of double vision have been ruled out.

Dear Dr. Donohue: I visited my doctor three times in one month because of what I thought were hemorrhoids. My doctor gave me Anusol suppositories for it. Yesterday, I saw the doctor again. He suspects I have an anal fissure, not hemorrhoids. When he asked if I was bleeding, I said there are signs of blood on the tissue, but I don't appear to be bleeding like when you cut yourself. He recommends I take Metamucil and continue with the suppositories. Is there something else I can do? — B.

Reply: An anal fissure is a tear in the lining of the anal canal. Such a tear makes elimination of stool painful, and the pain can remain for some time after a bowel movement. Frequently it produces bright-red bleeding. Constipation is the leading cause for an anal fissure.

Sitz baths help healing. Fill a tub with about 5 inches of warm water, enough to cover the buttocks and hips. Squat in the water for 10 or 15 minutes and do this two or three times a day.

Ointments applied to the torn anal lining help. Nitroglycerin ointment is one such preparation, the same medicine used for the chest pain of angina. Diltiazem ointment is another that produces good results with fewer side effects than nitroglycerin does. If the fissure hasn't healed in another month, you might need surgery.

Dear Dr. Donohue: I have been having a lot of headaches and wonder if it could be due to cataracts. — B.

Reply: The lens of the eye is a clear, oval-shaped structure behind the pupil. It focuses incoming light on the retina to produce a visual image.

A cataract is a clouding of the lens like a smudge on a window. The smudge interferes with vision. Central vision becomes fuzzy. Night vision is poor. The smudge is a clumping of proteins inside the lens and comes about from aging.

Headaches from cataracts? Anything is possible, but cataracts don't usually cause them or eye pain.

Your doctor has to look for other causes for your headaches.