TMS and vision issues, diagnosis that’s a judgement call

Hi, I’ve been working through some TMS stuff for a month and a half or so. Solved some neck pain and hip pain. Think it was related to my TMJ too. For several months I’ve been having what I’m now reading are the symptoms of binocular vision disfunction. Dizziness when looking at my phone, off balance feeling in general, head tilt when working close, etc. I took a screener and spoke to an optometrist who believes it could be BVD. Problem is, this is something that many people have without symptoms. It’s a misalignment of your eyes that causes the brain and muscles to work extra hard to accommodate. It’s making my job nearly impossible, as I get the vertigo / motion sickness feeling after just a couple of minutes on a device. And expensive to fix (to me anyway…I’m relatively broke ). So, I think TMS theory would say get it checked out by a doctor. But in this case that might show I have a misalignment. But how do I know if that’s what’s causing the symptoms? Or if I happen to have a misalignment and TMS is causing the symptoms?

 

You need to be checked out medically by an expert, I'm afraid. Advice to look for inconsistencies in the symptoms (usually a tell-tale indication of TMS) doesn't cut it with binocular dv as there are some eye conditions where the binocular dv would vary and be inconsistent, sometimes present, sometimes not etc.

I have a rare eye condition that causes me binocular dv and leading up to my diagnosis I learned a fair bit about binocular dv.

So, some questions for you in case your answers might help me to point you in the right/possible direction of what might be going on:

1. Does the binocular dv improve with the cold - like when you've come from the heat outdoors and then into an air conditioned room?
2. Does it fluctuate, e.g. sometimes the doubled images will be on top of each other and at other times side by side and/or tilted?
3. Does the binocular dv disappear when you cover (patch) one eye?
4. Do you sometimes have binocular dv and sometimes not?
5. Does the binocular dv get worse when you're tired?
6. Have you noticed either of your upper eyelids drooping at all?
7. Have you been tested for or do you have any thyroid issues?

 

Thank you, that helps, as the inconsistencies or at least variability in severity of symptoms is a part of where I’m struggling.

1. I’ve always been very heat sensitive, and get sick easily in the heat, but haven’t noticed any eye difference. I have more trouble with eye stuff that is near, than far, but admittedly spend a lot more time looking near as well.

2. I don’t have a doubled image where I can actually read the second part, it’s more like a shadow or glare depending on the day / time / source.

3. Yes, symptoms disappear completely (and even some things I didn’t realize were problems, like I suddenly feel more grounded and not lightheaded, but I think I was so used to that sensation that I didn’t realize it wasn’t normal.) if I cover one eye. Once I figured that out, I’m having a hard time not doing it all the time because I feel so much better in general.

4. The overall lightheaded / not grounded sensation is all the time, unless my eyes are closed. The dizziness / vertigo / motion sickness happens usually when I’m doing near work on a phone or computer. Books don’t make me dizzy, but there is a shadow / glare thing around the words quite often. And the only electronic devices causing the worst symptoms is one of the reasons I was questioning it.

5. Definitely worse when tired, and often over the course of the day it gets worse as well.

6. I haven’t noticed any drooping. Upper eyelids are becoming a bit hooded, but my Grandmother who’s face shape I seem to have had that as she got older as well (I’m about to turn 47, so in perimenopause as well which is making me question all kinds of things )

7. I haven’t been tested recently for thyroid issues.

sorry, that’s a lot, but I really appreciate your help!!!

 

With binocular dv the brain is working overtime and in overdrive endeavouring to correct the situation and normalise things for you, so patching an eye gives the brain instant relief from all that (but patching does cause depth perception issues whilst patching, which can become easier to cope with over time). If you decide to patch, alternate the patching rather than patching just your left or just your right eye every time, and spend some time during the day unpatched. That way you won't be training your brain to get too used to the patching while you seek a proper diagnosis (you really do need to do this before assuming it's TMS).

Binocular dv can have quite a number of causes.

As you say, with some people they can have BVD and not know it because their brain compensates for it okay without them noticing. It's not until something happens that it can get exacerbated - like being perimenopausal or menopausal, what with the hormonal changes - and then it may be noticed.

My rare eye condition came on when I hit menopause and had my last period at the age of 50 at the same time as the onset of auto-immune hypothyroidism (hypothyroidism is considered by the medical profession as a 'marker' for my rare eye condition) and hypothyroidism can cause Thyroid Eye Disease (TED) which also causes binocular dv (so I was tested for the latter and cleared for that by having a CT scan). You don't have the same symptoms as me though... e.g. no eyelid drooping, no improvement of the binocular dv with the cold, and no fluctuating of the position of the double images. However, with the menopause things obviously change...

Your binocular dv could be as simple as your eyes being a bit drier than they used to be pre being perimenopausal without you realising it (and computer work dries the eyes out more because the blink rate goes down when staring at a screen) which can be helped, of course, with applying lubricating eye drops and making sure to look away from computer screens on a regular basis (cupping hands and gently placing them over closed eyes for a few minutes I find also helps with my dry eye condition, and also to rest my eye muscles). Dry eye causes irregularities in the tear film and corneal surface, leading to visual distortions such as glare, fluctuating vision, and reduced dynamic visual acuity. Treating dry eye can improve visual comfort and reduce strain on binocular coordination.

I suggest having your blood thyroid levels tested to include TSH, Free T4 plus thyroid antibodies (thyroid issues can cause dry eye too) and to consult an optometrist or orthoptist, someone with expertise in binocular vision to assess your eye alignment and binocular function; they need to do a number of tests to assess and diagnose properly. The average high street optician does not usually perform these tests (leastways they don't where I live, here in the UK). When I was being diagnosed I was referred to a neuro-ophthalmologist by a hospital orthoptist because in my case it was suspected that my binocular dv was neurological in nature... they considered that it might be a nerve palsy at first (which a prism lens would have corrected, you can get stick on ones to put on glasses) but it wasn't, then they considered it might be TED, but it turned out to be of a rare auto-immune/neurological cause. (As I'm a Brit the terms I use for the eye experts might be different to those used in the US or wherever you are in the world.)

If you've got BVD vision therapy can be really helpful. This involves teaching you specific exercises to strengthen your eye muscles. It also helps you learn what you shouldn’t do if you want to help your eye alignment. A friend of mine had a good outcome for their BVD with vision therapy, so if it's suggested to you, then it could well be worth trying.