[39F] Experiencing intermittent double vision and lazy eye

Patient Description

A 39-year-old female has been experiencing intermittent double vision and a lazy eye, which worsens upon waking and improves on its own. The double vision becomes more pronounced when focusing on distant objects. Alongside these symptoms, the patient reports joint pain, swelling of the legs and ankles, and worsening nearsightedness, but no sudden loss of vision. The patient has been undergoing hormone therapy for invasive ductal adenocarcinoma, diagnosed approximately 1.5 years ago, with treatments including Tamoxifen for 6 months and Zoladex for 1 month. Side effects from these medications include hair loss, high blood pressure, joint pain, and fatigue. The patient has an allergy to Keflex. Additionally, the patient has concerns about a consistently low anion gap from blood tests, despite normal albumin levels and no episodes of vomiting. No other pre-existing conditions, chronic illnesses, or medication allergies were reported.

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Arora's Assessment

What might be happening

Based on the information you've provided, the following possibilities might explain your symptoms:

  • Ocular muscle imbalance or nerve palsy: The symptoms of double vision and a "lazy eye" that come and go could be due to an imbalance in the muscles that control eye movement or a problem with the nerves that control these muscles. This could be related to a variety of conditions, including thyroid eye disease, myasthenia gravis, or a neurological condition.

  • Side effects of cancer treatment: Tamoxifen and Zoladex can cause a variety of side effects, including joint pain and fatigue, which you've reported. High blood pressure can also be a side effect of these medications.

  • Fluid retention or venous insufficiency: Swelling in the legs and ankles could be due to fluid retention, which can be a side effect of certain medications, or due to venous insufficiency, where the veins in the legs have trouble sending blood back to the heart.

  • Low anion gap: A low anion gap is less common and can be caused by a variety of factors, including certain medications, low albumin levels, or the presence of abnormal proteins in the blood. However, your albumin levels are normal and you've mentioned that you're not taking any other medications, so the cause of your low anion gap is not immediately clear.

What you can do

  1. Schedule an appointment with your oncologist to discuss your symptoms and concerns. They can assess whether your symptoms are side effects of your cancer treatment or related to another condition.

  2. Consider seeing an ophthalmologist for your vision issues. They can perform a comprehensive eye exam and potentially identify the cause of your double vision and "lazy eye".

  3. Keep a symptom diary. Note when your symptoms occur, how long they last, and any potential triggers. This can be helpful information for your healthcare providers.

What you should look out for

Seek immediate medical attention if you experience:

  • Sudden worsening of your vision
  • Sudden onset of severe headache
  • Weakness or numbness on one side of your body
  • Difficulty speaking or understanding speech
  • Severe leg swelling or pain

Remember, while I strive to provide accurate information, I'm an AI and not a doctor. Always consult with a healthcare professional for a formal diagnosis and treatment.

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8 mo ago

People Also Ask

What could be causing my intermittent double vision and lazy eye?

Intermittent double vision and a lazy eye can be caused by ocular muscle imbalance or nerve palsy, which might be related to conditions like thyroid eye disease, myasthenia gravis, or neurological issues. It's important to consult an ophthalmologist for a comprehensive evaluation.

Are joint pain and swelling of the legs common side effects of hormone therapy for breast cancer?

Yes, joint pain and swelling can be side effects of hormone therapies like Tamoxifen and Zoladex. These medications can also cause fluid retention, leading to swelling in the legs and ankles. Discuss these symptoms with your oncologist for appropriate management.

What does a low anion gap indicate, and should I be concerned?

A low anion gap is uncommon and can be due to various factors, including certain medications or the presence of abnormal proteins in the blood. Since your albumin levels are normal, it's best to discuss this with your healthcare provider to determine if further investigation is needed.

How can I manage the side effects of Tamoxifen and Zoladex?

Managing side effects of Tamoxifen and Zoladex involves regular monitoring by your healthcare provider, lifestyle modifications, and possibly medications to alleviate symptoms. Keeping a symptom diary and discussing your experiences with your doctor can help tailor your treatment plan.

1 Comments

Janice#97

8 mo ago

Sometimes cancer can cause nerve-muscle junction issues or hormonal issues that can explain your visual problems when waking up. I think you should bring it up with your oncologist and see if they have a satisfactory explanation

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