I am seeing double in my left eye. I had Bell’s palsy on the same side of my face. Is this a form of stroke which has damaged the optic nerve or could it be that the palsy has affected the six as well as the seventh cranial nerve? My MRI was negative and clear.

Sudden onset double vision can occur in people with diabetes. It is usually thought of as one of the forms of neuropathy that people with diabetes are susceptible to. Generally, the paralysis of the ocular muscles innervated by the sixth cranial nerve (cranial nerve III is the most common) is short-lived and improves over weeks to months. Supportive care is important while the muscle is paralyzed.

It is important to differentiate this temporary paralysis from a form of stroke where there is a greater chance of long-term paralysis. Sometimes they can’t be separated early after presentation. Other supportive evidence is helpful, such as MRI, other neurologic involvement, and pupillary responses. Pupils remain active to light with diabetes involvement of the third cranial nerve. Other causes of cranial nerve palsy can include aneurysms of the ophthalmic artery, hypertension, and trauma. Follow-up with your diabetes-care provider and ophthalmologist is very important in order to receive appropriate supportive treatment and the correct diagnosis.

JTL
Additional comments from Dr. Tessa Lebinger:

I don’t know how common Lyme disease is in Arizona or if you have travelled to any area that has Lyme disease, but this should also be considered with new onset double vision. Lyme disease is unrelated to diabetes. Also, overactive thyroid is more common in people with diabetes and can also cause double vision. It is very important that you have a thorough ophthalmological/neurological evaluation to try and determine the cause of this double vision and not just assume it is a complication of diabetes (though it may be).

TGL