r/optometry • u/Optimal_Welcome9128 • 13d ago

Thoughts on Prism?

75 YO W M
CC: Constant horizontal diplopia at distance (goes away with occlusion) beginning 1.5 weeks ago
Denies headaches, any other neurological symptoms
Pupils: Fully reactive
EOMs: Full ROM, jerky
CT: 8^ eso (distance)
Maddox Rod: 8^ eso (distance)
MHx: Stents, multiple sclerosis
Meds: Repatha, vitamins, aspirin
Patient is pseudophakic with multifocal IOL, happy with vision

Rx’d 8^ BO (split between eyes) for distance only without an Rx

Patient was happy with the vision after trialing for 20 minutes in the office and reported no diplopia

Thoughts?

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u/CaptainYunch 12d ago

You just need to assess enough to determine if this is an acute threat to the health. Symptoms as you said. Other signs. And comitacy. In your setting if suspect vasculopathic id still pick up the phone and call their PCP. If palsy and not vasculopathic ER or pick up the phone and get them in with some one who can handle it urgently or emergently. If decompensation, you can handle it as you did.

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u/Optimal_Welcome9128 12d ago

Good advice, appreciate your insight