How can double vision be treated?

Prisms added to or incorporated into spectacles can realign the images and allow single in straight ahead gaze.

Because the degree of the misalignment varies in different gaze positions, prism cor- rection does not always eliminate Contact numbers double vision in every gaze position. Orthoptist: The power of prism can be reduced as the palsy improves. Patching one eye St Richard’s eliminates double vision, however, this treatment must be carefully monitored in 01243 831499 children to avoid the development of . Southlands 01273 446077 Can long-term third nerve palsy be fixed?

After observation (usually 12 months), surgery may be performed to reduce Orthoptic Department double vision or to improve the appearance We are committed to making our publications of the eyes. as accessible as possible. If you need this Information Sheet document in an alternative format, for example, Progress will be monitored by the large print, Braille or a language other than Orthoptist and Ophthalmologist and any English, please contact the Communications Third (III) Nerve Palsy treatment will be discussed and carried out Office by email: [email protected] when and if appropriate. or speak to a member of the orthoptic team. St Richard’s Hospital Spitalfield Lane Chichester www.westernsussexhospitals.nhs.uk West Sussex PO19 6SE Department: Orthoptics

Issue date: March 2018 Southlands Hospital Review date: March 2020 Upper Shoreham Road Leaflet Ref ORT24 Shoreham-by-Sea West Sussex BN43 6TQ This leaflet is intended to answer some of What are the symptoms? The types of tests you will need to have the questions of patients or carers of done will depend on your age, general patients, diagnosed with Third Nerve Palsy The affected eye may appear to be out of health and any pre-existing medical under the care of Western Sussex Hospitals alignment. Commonly this is seen as the eye conditions you may have. NHS Foundation Trust. turning outwards (away from the nose) and downwards. Your orthoptist will repeat the What is third (III) nerve palsy (also know measurements at regular intervals to as palsy)? Double vision () may be noticed. This monitor any changes. Should your could be sudden in onset or gradually occurring condition change dramatically between This is weakness of the III (third) cranial depending on the cause. It may be present all appointments you are advised to telephone nerve which is responsible for moving four of the time or only in certain positions of gaze. the Orthoptic department. of the six eye muscles which control . The upper may droop, this could be mild Does third nerve palsy improve with or complete so that the eye appears fully time? A weakness of this nerve results in the closed. affected eye being out of alignment with the Yes, in many cases. The amount of other. This nerve also supplies the upper You may notice the may also have improvement depends upon the cause. eyelid and the muscles that control pupil changed in size. This can cause blurred vision. Most third nerve palsies caused by vascular size. This means lid droop () may be conditions such as recover noticed and the pupil may also be affected Symptoms of double vision may be masked if completely. where the pupil becomes enlarged and the eyelid is drooping initially, but this may blurred vision may be a problem. become more problematic when the lid muscle Some patients may experience begins to recover or if the lid closure is not improvement but not complete recovery and What is the cause? complete. may be left a residual muscle weakness. The orthoptist and ophthalmologist can This weakness can be there from birth How is it diagnosed? advice you on the long-term management (congenital) or acquired through the result options available to you. of damage to the nerve. The orthoptist will examine the eye movements and position of the eyes taking various Maximum improvement usually occurs The most common causes in adults are measurements. You may be asked to have during the first six months after onset, but diabetes or other vascular conditions. blood tests or in some cases a CT or MRI scan. may occur up to 18 months after the start of There are also other rarer causes such as If the doctor knows you are diabetic, have had a symptoms. trauma, , , or stroke or have other general health risk factors tumour which may require further then often no further investigations are Congenital third nerve palsy is unlikely to investigations. necessary, providing the III nerve palsy shows resolve spontaneously. signs of recovery.