Ghosting in Vision (MGD or Something Else?)

[feldfan]

My story
9 months ago, I noticed a sudden change in the quality of my vision — specifically, ghosting around the edges of everything (most noticeable in high-contrast situations). My optometrist didn't find anything unusual, but a second opinion (an opthamologist) suggested that I have MGD. He pressed on my eyelids and noticed that the secretions were not flowing as he'd expect and followed-up with a Schirmer test (which showed dryness). I know now that a TBUT would have been a better test.

My treatment
For nine months, I've been applying daily compresses using Dr. Latkany's technique and taking flax/fish oil supplements. Three weeks ago, I updated my glasses prescription.

The result so far:
Aside from my treatment, the ghosting in my vision has not changed, and it doesn't even change immediately after the compresses. The new glasses (which account for my astigmatism), have not helped either.

The point is:
Even though MGD has been suggested, my symptoms don't quite correspond to the stories I'm reading on this forum. Reading through the list of symptoms, I don't see much correlation. If it weren't for the ghosted vision, I would think that my eyes were normal (outside of dryness after wearing contacts).

My questions:

1. Are there any other MGD patients who have ghosted vision — with or without any of the other classic symptoms?
2. If so, does the ghosting subside after a warm compress?

[Rebecca Petris]

I think that usually if some kind of dry eye incl. MGD is affecting vision significantly, (1) there is also visible dryness on the eye surface, and (2) it fluctuates, and (3) it responds to treatment, i.e. if the doctor sees improvement on the surface the vision is probably improving. In addition, dry eye bad enough to affect vision significantly usually really hurts (though not if you've had a lot of loss of sensitivity - which paradoxically also happens with dry eye). So it's certainly possible to see poorly from dry eye without having any of the symptoms on my list - just as some people get only one symptom, say extreme light sensitivity, without having any other symptoms. It's just not common.

If the ghosting is really really consistent, and were happening to me, personally whether there were MGD or not (and MGD is very common) I'd suspect some uncorrected astigmatism.

Just out of curiosity, when you recently updated your prescription... What was the refraction like? (the 'better 1, or better 2?' test). Did you ever get to a point where you saw the chart without any ghosting?

[feldfan]

Thanks for the information, Rebecca!

Whether or not MGD is involved, I don't believe my new glasses have the correct prescription, since they're actually exacerbating the problem. Regrettably, I didn't pay attention to the ghosting during the initial test.

I'm going in for a re-test soon, so I'll report back with my findings.

[feldfan]

After visiting the optometrist for a follow-up exam, and I'm no further along in figuring out where the ghosting is coming from. The doctor confirmed that my new prescription is accurate (a -1.00 astigmatism in both eyes). I paid close attention during the exam this time, and the ghosting was persistent. My corrected vision is 20/15, in spite of my symptoms.

We talked about the ghosting (knowing now that they're not due to the astigmatism), but the doctor didn't have any specific ideas on the cause. I'll pay a visit to the opthamologist early 2010 and see what he has to say.

I'm looking for any recommended doctors in Nebraska or western Iowa.

[coxblox]

I suffer from ghosting too that I'm 100% sure is not due to astigmatism (unless this can suddenly increase by a couple of diopters in about 48hrs). Also, I do have the every odd day (every 2 months or so) when the ghosting almost completely disappears. I now know it is a tear film or cornea problem but not sure which it is since the eye docs so far have been of no help.

Still trying to figure this one out but if I ever do I'll be sure to post and let everyone know as this ghosting is without doubt the most annoying thing I;ve ever experienced!

[feldfan]

I suffer from ghosting too that I'm 100% sure is not due to astigmatism

It sounds like you and I have similar symptoms, many of which aren't common dry-eye symptoms (floaters, ghosted vision, after-images)… Any idea what might have precipitated yours (prescription, trauma, etc.)?

I'm beginning to suspect that my symptoms are due to the fluid inside my eye, rather than outside.

[coxblox]

Immediately before onset I would say I was going through a period of prolonged stress though nothing I haven't been able to handle before. Also I can't remember which came 1st (floaters or ghosted vision) but they did occur at almost exactly the same time so maybe it may be linked somehow?

About 5 months prior to the ghosted vision I do recall getting a 'foreign body sensation' in my eye that is typical to dry eyes. For several weeks I actually thought the eyelash on my lower lid was growing inwards and rubbing against the inner corner of my eye! I tweezed some of them out but the feeling still consistently remained. Again I don't know if this linked.

I'm convinced it isn't the vitreous even though I did notice a sudden and continuing onset of floaters since I do notice almost clear vision on some days and I also get some days where it would appear that each and every blink I make controls the severity and positioning of the ghosting. On top of that I get the very odd day when one corner of my eye will be red (lots of broken vessels) with a red fringe on the outer edge of one side of my cornea. This clears up though in a few days. Lastly, I took a painkiller twice now before I went to bed because of a bad headace. Each time I noticed less ghosting the following day.

All this makes me believe there is some sort of inflammation taking place on the surface of my eye that is causing this ghosting. The cause of the possible inflammation is where I am baffled since nothing looks blatantly obvious.


How did your ghosting come about and can you draw any possible parallels from my description?

[feldfan]

How did your ghosting come about and can you draw any possible parallels from my description?

I apologize that I've been absent for so long. But, I have some special bonuses to make up for it.

Potential Causes
These are the only things that are eventful enough to come to mind. My eyes have been especially dry since my vision changes, but they aren't painful or significant.

• I do have slightly-high blood pressure, and I consider myself a mildly anxious guy — which my vision changes have not helped.
• 6 weeks before, I was in a car accident (although without any head injuries).
• I had been a Propecia user for 18 months (and stopped shortly afterward). It's the only medication I've ever taken, and I haven't taken it (or any other medication) for the last 12 months.

Parallels
The only parallel I can draw to you is pretty simple: stress. The car accident was certainly stressful, despite my lack of serious injury. My changes in vision (and my concern that they may be related to an elective medication) have also been worrisome. I've been exercising regularly for months now and working at de-stressing my life. I'm hoping that if I can reduce my general level of anxiety, my blood pressure and vision may eventually clear up.

Visual Aids!
I created these images in Photoshop to show my doctor, but I thought they may be helpful here. To re-cap, my primary symptoms are floaters, ghosted vision, after-images, with some dry eye. These images illustrate the times when my symptoms are most noticeable: in high-contrast or in situations with large solid colors (like blue skys and white snow). My symptoms are barely noticeable at night, but during the day they, I'm aware of them quite often.

It should be noted that these are exaggerated to illustrate the point, but only barely.

[feldfan]

A quick update…

I went in for an annual exam (with the same opthamologist), recounting the same information that I've written here. He says — despite the findings on this forum — that ghosting is a direct result of MGD.

He was so convinced that he couldn't suggest an alternate cause. My eyes are otherwise completely healthy, and I have 20/15 vision.

[vman]

ghosting/mgd

ignore this message

[coxblox]

A quick update…

I went in for an annual exam (with the same opthamologist), recounting the same information that I've written here. He says — despite the findings on this forum — that ghosting is a direct result of MGD.

He was so convinced that he couldn't suggest an alternate cause. My eyes are otherwise completely healthy, and I have 20/15 vision.

This could very well be likely. I am now 100% sure though it is not the vitreous degenerating (even though I'm now seeing more floaters than when I first posted in this thread).

The opthalmologist I've been seeing is pretty useless in identifiying what could be possibly wrong simply stating that I may have always been nearsighted and that I may not have noticed it before. Believe me though, ghosted vision that seemlingly happens overnight is not something that you may have overlooked in the past!!

Anyway, what I have discovered very recently after my last checkup is that if I shine a light on my eye I can see a thin (almost membrane like) clear film that seems attached to my upper eyelid that covers the upper 1/5 of my eyeball and moves with each blink. This film is also visible close to the periphery and lower part of my eyeball but doesn't cover my cornea or inner eyeball so it almost looks like this sheath has been torn/ripped. I looked at my other eye that isn't ghosting and its not there so surely this can't be normal?

I suspect this could be a part of the problem as sometimes (as I stated before) it seems each blink I make changes the severity of ghosting and on rare occasions a blink can give me perfect vision until I blink back again!

I tried some topical antibiotics and that didn't really do anything. I'm also on lubricants but they don't seem to do offer any longterm solution. I'm very tempted to give Azasite or Restasis a go but getting hold of them in the UK is next to impossible.

Anyway, in the meantime, I will go see an optpometrist and find out what this membrane like film is and if it is the cause of my woes. Hopefully I get conclusive answers...

[littlemermaid]

Shop around in the NHS

The opthalmologist I've been seeing is pretty useless in identifiying what could be possibly wrong ...

Time to seek other opinions. Try regional teaching hospital eye clinic for the best clinicians and equipment - say to triage nurse the magic words 'eye inflammation, ghosted vision, worried I have erosion or damage on cornea' to find out what this material is on the surface of your eye. Dear God, they should know. Also need to be on their lists, get some records in place, for chronic dry eye inflammation, follow up at least. If they discharge you and you want to go back, say 'I am Mr ...'s patient' as long as you have attended his clinic (maybe seen his staff), and ignore the fact you've been discharged (they don't mess with the consultant).

Watch the optometrists too - huge variation in skills according to when they trained and further qualifications on disease: maybe try 'health check' at modern young optometrist where they flog LASIK - actually have some experience in dry eye treatment.

My daughter's orthodontist (very skilled professional guy) said his local eye clinic couldn't even find his contact lens under upper lid. It is OK to shop around.

Please post how you are getting on!

[coxblox]

I definitely will search for someone more competent in that area. I think it would probably be easiest for me to see a lasik dry eye specialist as you suggested since they can do things such as corneal topography's (which my doctor has never even suggested).

[feldfan]

Please keep us updated on your findings. I'm curious to hear how things go for you.

[littlemermaid]

Yes, please. What is this film, coxblox?