Our Other Websites:


Question: What does a fourth nerve palsy look like and what causes it?

Answer: The trochlear nerve (CN4) only controls the superior oblique. This muscle has a funny course, and runs through a pulley at the superior-medial wall of the eye socket. Because of this change in direction, the superior oblique muscle works mainly as an intorter, though it does perform some vertical movement, especially when the eye looks medially.

Patients will often complain of a vertical diplopia, especially when looking away from the lesion. They may develop a head-tilt away from the affected eye. On cross cover testing, you’ll find a vertical hypertropia of the affected eye that worsens when that eye is looking medially toward the nose, especially when reading.

Fourth nerve palsies can occur from DM/HTN ischemia, like all palsies. They can also be:

  • Trauma (that fourth nerve pops off the dorsally and has a long course to traverse)
  • Congenital palsy that decompensates with age
  • Tumor


Hi Tim,
Im confused, I thought a lesion of CNIV would present with diplopia upon a downward gaze such as reading a book or walking downstairs. Do I have the sup. oblique confused with the inf. oblique?
JB Henderson

Comment by JB Henderson — January 14, 2009

You are correct JB. A fourth nerve palsy causes diplopia when looking medialy. We tend to look medially when reading or walking down stairs.

In fact, before I was very comfortable with the eye-muscles, I used the “double vision with reading” mneumonic to help me understand this palsy. When we read, our eyes converge (turn inwards) and a superior oblique palsy will cause a verticle diplopia.

Comment by admin — January 15, 2009

The last optometrist gave me a 2 degree Base-down prism glasses which doesn’t help. I believe my exo phoria is much stronger than hyperphoria!. After less than 2 seconds of focusing my left eye sight starts to deviate to south east direction diagonally when I’m looking straightly or at a right object at most of gazes but not at all gazes my left eye deviates. And when I’m looking at left object the deviation is gradual to north east such as the shape of slash “/”. This is one my head is not moving, but it’s tilting. When I read the sentence by moving my head to follow it I can prevent deviation sometimes. Is this a fourth nerve palsy? What is the treatment for it?

Comment by Jim Jordan — May 30, 2010

I was just yesterday intoduced to the diagnosis of troclear nerve palsy after complaining about double vision progressing over the last year, and after recovering from Uveitis/Iritis of the left eye. I’ve had headaches almost daily for over a year, some being quite bad. Ct scan and MRI last year found nothing and I was told I had a pinched neck nerve. Now, with the palsy in the right eye and the history of headaches plus the recent addition of slighty slurred speach, spells of confusion and dizzyness as well as fatigue, weight gain and a few other things, I’m being tested for autoimmune disorders and will be seeing a nero-ophtamologist on Monday. Does anyone know how often troclear nerve palsy gets diagnosed as having no known source? I’m concerned that all the tests will come back negative and I’ll be stuck with double vision and the other symptoms with no real treatment, leaving me to feel like a hypochondriac. Any one else have this problem, and was it ever resolved? I’m a 37 year old female with a clean health history aside from a few bouts of hypothyroidism.

Comment by Jodi Starr — June 18, 2011

To Jodi Starr…

I’m by no means a medical professional… quite the opposite. Our family is going thru the medical crisis pipeline with “eye” issues too. Have you or your health care providers suggested Myasthenia Gravis? Read up on it.

Comment by Heidi — August 10, 2011

what will be the chin ,face turn, head tilt for superior ,inferior,medial,lateral,rectus palsy?

Comment by claudia — January 17, 2012

I am 54 and have had 4th nerve palsy diagnosis 1 year ago…no known cause. no blunt trauma; mri came back clear…so frustrating. I even had 6months of chiropractor care to get my neck and upper back in check and no improvement. I am ready to try the prism deal in my glasses but wonder if it doesn’t help with keeping one image in focus..why bother? i now am having shoulder joint pain out of the blue so wondering if I do have an autoimmune disease.

Comment by Susan — April 11, 2012

Hi, I have been diagnosed with 4th nerve palsy following a concussion with a blow to the right back of my head. I am getting conflicting advice on whether or not to wear a patch and when wearing it, alternating eyes vs. only patching the affected eye. I have read that for kids with lazy eye, they patch the good eye. Which is recommended and can vision therapy help while waiting months for the nerve to heal? Thanks for any reference you can give me.

Comment by Kelly — May 10, 2012

I have left eye 4th nerve palsy and the prisms in my glasses don’t work well when looking at my computer at work. The cause of my diplopia is unknown. I am looking for an opthalmologist that specializes in treating diplopia in the Long Beach or Los Angeles California area. Any referral will be greatly appreciated.

Comment by Bob valentine — August 11, 2012

I had onset of L superior oblique palsy after being hit hard by a tennis ball on the lateral aspect of my left eye in January 2010. It spontaneously resolved in ten months ( not six as predicted) but I am very upset that after ten months or so it has returned. I find it difficult to accept( I am a surgeon)that it is due to micro ischaemia of the trochlear nerve and NOT related to trauma. My MRI is normal.

Comment by christopher rance — August 21, 2012

My son had a head impact, neck twisting injury and consequent left vertebral artery occlusion with small strokes. After years on antipsychotics to counter the dopamine plus affects of reduced cerebral oxygen due to the blocked artery, he experienced spasm in his left neck, was given Procyclidine, which stopped it but interacted with the drug to produce eye slippage. The drugs were withdrawn, the slippage – both eyes stuck at the right corner – stopped, but, after a few days on a new drug, is now happening again when he is relaxing but not when he is moving or focusing. He is also taking Temazepam for insomnia.

An osteopath notes he cannot move the upper part of his neck to the left, and he often experiences neck pain.

Is this 4th cranial nerve palsy, and what should be done ?

Comment by Rosemary — November 8, 2012

Hi all,
I am new to this blog. I had a TB meningitis last year and due to that I got double vision and diagnosed with 4th nerve palsy. My MRI shows 1 scar and dr. said that its a treated tb part in my head. I have been referred to ophthalmologist and they said we can’t give any assurance that after eye surgery double vision problem will be resolved, it might get worse.
I am so confused what to do now. Is it like I need to live with this problem for whole life?

Any one can advise on my situation will be highly appreciated.

Comment by MP — December 3, 2012

have had palsey for 13 years as a result of a head injury in a motorcycle accident . Met a doctor named dr. Buckley at Duke University , and he checked me out and said ,(I THINK I CAN HELP YOU). Oh hell yeah , finally. After 3 surgurys in a out patient program , as of 2 days ago 1-14-13, I seeing one of everything and no head tilt. THANK YOU DR. BUCKLEY . If anyone wants to contact him he is at Duke Eye Center in Durahm N.C. email address buck1002@mc.duck.edu dukemedicine.org phone number 919-684-3957 give em acall. It cant hurt.

Comment by dale thompson — January 16, 2013

I woke up on August 21, 2012 with double vision. At first, I thought I merely had a bit of mucous in my eye, but rubbing it didn’t help. It cleared up after a few minutes, but over the next week or two the frequency of seeing double (vertically) increased. I read all I could on the Internet and actually guessed I had a 4th nerve palsy. This turned out to be correct, as an ophthamologist confirmed. Being a hypochondriac, I thought the worst and assumed he’d refer me to a neuro and I’d have CT scans and/or an MRI, but he didn’t believe it was anything neurologically related. I had no head trauma, but most 4th nerve palsies are idiopathic. So…he told me to come back in a month for a comprehensive visual fields test. If I did well on that, then he would take things from there. I did that and had perfect acuity, so he said no visit to a neurologist was necessary. But…..It was discovered that I had very high blood pressure. We’re talking 190/120! I was one of those people that didn’t have a primary care physician, and hence whenever I had something wrong that didn’t resolve itself, I would just go to Urgent Care and get it fixed. I did this for over 35 years, (I’m 53) and for the past 10-15 years, my BP was always high, but I attributed it to White Coat Syndrome and ignored it. Well, this opthamologist said I needed to get my BP addressed before I keeled over from a stroke, heart attack, or both, so I took him seriously. I made an appointment with my wife’s internist, and not only did I have hypertension, but also Type 2 Diabetes! Cool, huh? Anyway, I assumed that either one or both of these conditions could have caused my 4th nerve palsy. I got on BP meds, but to this day, they have only dropped my BP down to about 140/90 or so, and the internist is still working on that. As for the diabetes, I am managing that very well with no meds or insulin. Here’s what concerns me: It seemed as though my diplopia resolved itself after a couple of months, but then it returned a week or so before Christmas, and my regular optometrist confirmed I still had it in a January exam. It’s no worse than it ever was but I’m wondering why I have it again. The optometrist said that if it didn’t improve, I’d be looking at about 1.5-2 diopters of prism in the affected eye (OS)next time. Granted, it hasn’t quite been 6 months since I initially acquired this condition, but it’s getting close! Is it possible for 4th nerve palsies to seemingly go away and then return a couple of months later?

Comment by Patrick — February 7, 2013

Carbon Monoxide poisoning leads to head trauma and neurological disorders, and can create a “strabismus” effect in the eyes. It also can cause a mild stroke.
If your sleeping and waking up with a turned eye-possibly the inhaling of toxic fumes cut off circulation to the brain or damaged nerves. Remember Carbon Monoxide is odorless and colorless.

Comment by Craiger — March 1, 2013

It’s not Co2, unless you count 38 years of smoking…..Since I last posted, my BP is now under control at about 120-130/70, but I still have the palsy. It’s now most bothersome when I try to read throgh my bifocals, and at my last optometrist visit, he said I definitely have one eye that’s higher than the other. I’m straining my memory here, but the more I think about this, I’ve been squinting my left eye to “see better” for quite some time, long before the diplopia was obvious, so I’m wondering if I always had the imbalance and now that I’m in my 50s, I’ve simply lost the ability to compensate. While I’ve had to wear glasses since I was 7 years old, it’s possible that all those eye doctors overlooked it……..Another possibility is as follows: I didn’t mention this above, but I was also recently diagnosed with severe sleep apnea and have started using a CPAP machine prescribed by a neurologist. His nurse suggested that maybe all those years I stopped breathing multiple times during sleep caused a depletion of oxygen to the part of the brain that conrtols my trochlear nerve. Interesting theory…….Has anyone ever heard of that?

Comment by Patrick — March 4, 2013

Any opinions on my recent history of fourth nerve palsy (started 11 months ago, cured itself by 6 months ago)?

I had a routine eye test in which dilating drops were used these coming from a common bottle and applied by dropper (contrary to best practice which has acknowledged for years that eye drop bottles should not be shared among patients due to risk of cross-infection eg if an earlier patient blinks and the dropper makes contact with the edge of the upper or lower eyelid).

Four days later I suffered from double vision on looking sharp right. This was in the nature of separate images from each eye one displaced horizontally and vertically in relation to the other.

Within a week a consultant diagnosed fourth nerve palsy in the left eye. For ten days just before and for a week after the diagnosis I had severe single point pain in the upper right quadrant of the eye socket (as viewed by me in a mirror). This was similar to shingles but much worse than the normal pain of shingles which I have suffered around the trunk or in the thighs at long intervals since childhood chicken pox. There was only one point of pain which can be explained by the fact that the fourth nerve is a single line starting at the spine and travelling through the skull to the relevant neuromotor in the eye. It does not branch out like other nerves which when infected by shingles (herpes zoster) exhibit a rash where branches come to the surface.

There are various theories about what causes shingles (the random reactivation of the herpes zoster virus which lurks in the spine for ever after chickpen pox). One theory is that herpes zoster will be reactivated by contact with chicken pox viral particles.

Could the dropper on the bottle used for my eyedrops have previously come in contact with the soft moist tissue of a previous chicken pox infected patient’s eyelids and transferred chicken pox viral particles to the remaining content of the bottle so as to reactivate the herpes zoster which I harbour in my spine?

I should just add that there was absolutely not evidence of cardiovascular incident or injury to my skull.

Comment by Bill — March 20, 2013

Can MS cause “4th nerve palsy?

Comment by Gary — April 13, 2013

Hey I have a question to JODI STARR! Your answer to my question will be helpful to me. Is your problem with the fourth cranial nerve has been resolved? I have a friend who has the same problem, a history of hypothyroidism and age of 36 years! His MRI and CT scans did not show anything. Please describe the something more about your problem, you do not know how helpful it will be. Thank you in advance

Comment by Pavel Oc — June 9, 2013

can anyone tell me if fourth nerve palsy can be linked to Parkinson’s disease?

Comment by Joy — June 13, 2013

Can MS cause 4th nerve palsy?

Comment by Martin — June 21, 2013

I woke up one morning in January with dizziness and double vision, originally diagnosed as trochlear nerve palsy. I was told it is common not to find any specific cause for it. MRI was normal. Now almost 6 months later, the double vision has gotten better but not resolved. I can focus looking straight ahead, but still have double vision looking down or to the side. It usually seems a little worse at the end of the day. I can function without an eye patch now, but it is still very annoying. I have been seeing a neuro-opthalmologist, and last week he said that my vision problem no longer looks exactly like a fourth nerve palsy and is going to test for the possibility of ocular myasthenia.

Comment by Stacey — July 6, 2013

I’m happy to report that 99% of my diplopia has now been gone for about 4 months. The only “leftover” experience I have from my trochlear nerve palsy is a slight torsional doubling when I look in the mirror to shave, and that’s only if I turn my eyes far to the right side. I may very well have this for the rest of my life, but I can live with that. After all is said and done, while the doctors cannot determine with certainty what initially caused this, I would bet that it was my extremely high blood pressure that was untreated for years. Now I’m on Lisonopril and Amlopidine with a BP of 124/77 and maintaining an A1C of 5.8 with diet and exercise. This was a wakeup call, to say the least……

Comment by Patrick — August 12, 2013

Stacey, for what it’s worth, while textbooks and websites will say most of these palsies resolve in 3-6 months, some can take up to a year, so hang in there. Mine took about 8-9 months.

Comment by Patrick — August 12, 2013

In answer to Gary and Martin (Can MS cause 4th nerve palsy?)


Comment by Patrick — August 12, 2013

I have fourth nerve palsy which came on July 28, 2013 upon waking from sleep. My Rheumatologist says it was caused by RA.My Opthomologist has not said which eye to use an eye patch. My right eye is affected. Which eye should I cover, the good eye or the affected eye? Thank you.

Comment by Patricia Cattermoul — August 24, 2013

Hi Patricia. I had surgery for 4th nerve palsy (double vision) September 2006 of my left eye.
They placed a plastic prism on the inside of my left glasses lens. So, my answer would be that the prism should be placed on the affected eye to correct its vision to what it should be. Mine was apparently the worst they had seen. The bottom right side quarter of my “double” image (fake) was occupying the top left quarter of the real image, i.e. the fake image was slightly above and to the left of the genuine object and overlapping. Hope this helps and good luck with things. I sympathize with you 100% but it will all work out for you in the end!

Comment by Declan — September 4, 2013

Stacey, my IV nerve palsy occurred last October, lasted 3 months, almost 90 days almost on the nose. Mine was idiopathic; my MRI was clean and there was no evidence of disease. It didn’t suddenly clear one day however. The improvement each day was gradual. In my 4-7th month after onset, I still had some issues when looking downward (e.g. gardening) or moving my eyes about too quickly. Its very, very scary world living “under the patch”, something only someone else that has experienced it can understand. I wish you a textbook spontaneous recovery.

Comment by cinny — September 20, 2013

I’d like to hear “hope” and recovery stories.
I am 62, have always been very healthy, take no maintenance meds, have good blood pressure and cholesterol levels. Woke up one month ago with double vision. No known cause whatsoever. Opthamologist diagnosed right fourth nerve palsy. Have prisms. Have patches. Adjusting but it is so difficult and annoying. Do not know anyone personally that has had this. People who haven’t don’t understand. Anyone want to share some hope and cheer? Cinny, thank you for posting your experience. you seem like you might be much younger though. My age worries me for recovery.

Comment by Marie — October 12, 2013

My double-vision started at the beginning of June 2013 and it was very gradual but by the end of the month it was full blown. Optometrist confirmed eyes were ok, my GP took me off my BP meds to see if that was causing it but of course that was not it, Brain MRI showed normal for 61 year old, had my sinuses CT scanned, same result (did find out I have a slight deviated septum), finally went to a neuro-ophthalmologist and was diagnosed with CN4 palsy (I do have the head tilt). Got glasses with prisms to drive and another pair for reading a computer screen (I’m a QA tech in I.I.), still wear a patch for close reading. If you use progressive bi-focal glasses you’ll have to go to single lenses glasses. The last 2 weeks I’ve had some improvement, I can see normally only if I keep my head at a certain level and look up BUT that is a major improvement because now I can raise my phone at eye level and read it. Had some eye muscle discomfort doing this but that has gotten better. From all the DR. Google searches I’ve done it seems I’m right on schedule for the recovery in 6 to 12 months. The main thing that concerns me is that this can occur again, at least I’ll have glasses handy in case it does (lol). Hang in there if this has just happened to you.

Comment by Bob — October 14, 2013

Bob, Thanks for the post. Please keep me updated on your progress. Mine occurred September 14th so I’m 3 months after you. Idiopathic. Sudden. I guess I need to be patient and settle in for the slow recovery. I’ve done all the searches as well. Yes, I have progressive bi-focal lenses. No one has mentioned about single lenses. Why did you have to do that? They put stick-on vinyl prisms on my left lens. Had to do two prisms due to bi-focal; cut the vinyl–top half and bottom half are different. Helps. Not perfect. I am also on the computer all day, responsible for a $75MM budget. No one has mentioned anything different for the computer. ?? Have not read about occurring again. I can’t go there. You sound like you have a pretty good outlook. I am too bummed and having a difficult time being my usual self. I won’t drive except to and from work and then I wear a patch. Please keep posting your progress.

Comment by Marie — October 19, 2013

Marie, I’m just 4 years younger than you. Never even heard of IV nerve palsy til I had it. Last week I found a journal I had written at onset. Pretty scary time, not knowing how long until, or even if my vision would ever resume. I kept a calendar that I’d write a big “X” on each day as i crept toward the 90 day mark. I was very determined, if not stubborn, about willing my recovery. As I neared 90 days, I found the tilt was less, although still such that I couldn’t drive. The day I finally went patch free was one of the happiest days of my life. Not to get too spiritual about it, it has awakened me to appreciating what we so easily take for granted – normal sight. Waking in the morning and not needing a patch to get out of bed. If we must experience this dizzying world, we have to get something out of it. If not, it was just a bad time in our lives. I wish for you, and everyone else that’s still on the dark side of the patch, to be strong and positive. Best to you, Marie.

Comment by Cinny — October 19, 2013

Marie, initially I had the prism sticker but it wasn’t strong enough and I didn’t like it. I have a bunch of old frames so I brought in a couple pairs to the optometrist and worked with him to get one set for driving and another for the computer. Since my vision started getting a little better I held off on a 3rd pair for reading. Since I drive 35 miles to work one way and work on a computer all day I didn’t want to go through the hassle of trying to get one pair of glasses to work. Both my optometrist and ophthalmologist had said it was easier to setup single lenses for prisms then bi-focals. And the lenses weren’t really that expensive,about $70 per pair. I like driving and enjoy trail bike riding and there was no way that I was going to limit both (lol). This has also allowed me to act like a pirate when I wear a patch (lol). Hang in there, this is one of those character building events that life throws us (lol).

Comment by Bob — October 20, 2013

Bob & Cinny, Thank you so much for sharing. It’s like there is an immediate bond and it really helps to not feel so alone with this strange phenomena. Spiritual is good- only after asking my entire church family to pray, I expected the miracle to happen. Forgot it’s not about my timetable. And I mistakenly thought that at my age, my character building was finished. Again, this has proven me wrong. I have plenty of frames. I’m going to ask about the single lens at my next check on Nov 5th. I paid about the same for the split prisms. I also found some occluders online. One style is a clip-on (like clip-on sunglasses only singular to clip over one lens). Another style is a non-adhesive stick-on vinyl (like colorforms stickers for little kids). Both were very inexpensive and easy to use to basically patch one eye while driving (better than the pirate style elastic to mess up the hair). Also allows me a little peripheral vision. At first I tried the bandage style(hospital quality eye patch), but the adhesive irritated my skin and by the end of the day it was very itchy. Someone above asked about which eye to patch. My doc said it didn’t matter, either one. My vinyl occluders came in 8 different colors so I can match my mood or my outfit. LOL I believe I will recover and when I do, I will try to remember to check this site for anyone needing to hear the voice of experience for encouragement.

Comment by Marie — October 21, 2013

I am 50 year old, an ophthalmologist.I self diagnosed my 4th nerve palsy just today.I am well controlled diabetic and hypertensive.I read about the condition in my text books but never got to see a case of 4th nerve palsy.I knew about prism use.I tried the lenses from my trial lens set.I could not help a smile on my face at the results.Now I have difficult job to get it fixed in my glasses.Just now i am holding the prism with my hand and typing with one hand.As was encouraged to do it from other peoples story I felt duty bound to write it down just now.

Comment by Subhash Lazarus — October 23, 2013

SL-welcome to this site! Whoever created it-THANKS! Interesting that you never got to see a case until now. I asked my ophthalmologist how often he sees this and his reply was “Maybe 3 or 4 a year, but usually in people much older than myself”. Since he has a full blown practice and does nothing else but eyes, I found his answer to be surprisingly rare. I’ve not really been able to locate any statistics on the rate of occurrence either. I’m in Ohio and have yet to meet someone who has had this or who has even known anyone who has had it. The good news is that my doc says my eyes are “healthy”. Keep posting. Very interested to hear your progress and perspectives.

Comment by Marie — October 23, 2013

Additional comments I am working in a remote village in India.Do not not have literature handy,but I would like to know does any one was using alcohol or nutritional supplements. In my case I was using about 60ml of alcohol daily and nutritional supplement tablets from a multinational brand of a very popular company.I read in an article in a news paper that alcohol intolerance is because of toxins in the body.

Comment by Subhash Lazarus — October 31, 2013

Subhash, Odd you should ask. I had 2 glasses of wine the night before. It was leftover wine and tasted quite strong. I don’t usually drink anything. At first I thought I woke up with a hangover and that vision was blurred. I was very careful to eat healthy and sleep early the next evening. I became more troubled when it was still there the second day and that’s when I discovered that my vision was not blurred but double. That first morning I also remember getting a cramp in the back of my neck and it took some rubbing to make it feel better. I shared all this with the emergency room doctor and again later with my ophthalmologist and both said there was no correlation. Not taking nutritional supplements except that I am on a diet program well known here and the company’s food could very well be loaded with unknown supplements.

Comment by Marie — October 31, 2013

I have a followup appointment with my opthamologist in late December, he wanted to “wait and see” if there were any changes in my vision. No treatments or causes were discussed yet but he did hint at getting an MRI since I had no head trauma. He has diagnosed a fourth nerve palsy and it has me worried for my driving since it seems to be getting worse. I commute daily on a motorcycle and do some trail riding as well. Has anyone been restricted from driving due to this condition?

Comment by Mark — November 4, 2013

Mark, see my entries on:
Comment by Bob — October 14, 2013
Comment by Bob — October 20, 2013

If you do decide to get glasses with prisms you might want to hold off on the motorcycle and drive a car until the double vision clears up. The prism glasses are good for car driving but I noticed if I moved my head too fast I have some issues with my eyes adjusting to the lenses. The adjusting is quick but on a bike I think you might not want to take the chance. Remember you’re on a bike and are always looking out for the driver that doesn’t see you. I use to do a slow swerve in my lane so the guy behind me would know I’m there.

Comment by Bob — November 4, 2013

Back from the ophthalmologist. Not getting any better. Not getting any worse. Next check-up December 17th. Here’s what he said. It’s as frustrating for them as it is for me. Sometimes he sees someone who he thinks isn’t going to get better and the next time they come in, the double vision is all gone. He said he does not see reoccurrences. The nerve goes from the back of the brain to the eye. The length of time to recover is related to where the damage to the nerve occurred. Closer to the eye, the nerve can grow back quicker. The further away, the longer it could take. Getting used to tilting my head to compensate. Mark, I’d give up the motorcycle. What Bob said is so true. I can function, but I know my reaction time is not good. Sudden movements of the head or eyes create a vision nightmare. And looking over my shoulder to try to backup is not clear at all. I tell myself to live very carefully right now. No car accidents, No falls. I can’t do anything but wait out the nerve palsy to heal and pray that it does. However, there’s a lot I can do to avoid a secondary incident. It’s been a life changing event, but it’s not the end of my life altogether unless…..just saying….

Comment by Marie — November 5, 2013

I am 5 weeks post op from a craniotomy for a meningioma resection. When I awoke from surgery I had vertical double vision. It is very frustrating. My neurosurgeon sent me to an opthalmologist this week who diagnosed me with cranial nerve IV palsy. I also have cranial nerve 5 palsy from the surgery causing facial numbness. The opthalmologist has referred me to a strabismus specialist in his office and I see this physician in the morning. I’ve been wearing an eye patch and also got a pair of clear lense glasses and put scotch tape inside per suggestion from the first opthalmologist. I need to get this diplopia resolved so that I can drive, be able to carpool my kids and return to work. I’m so worried that this won’t resolve on its own although I’ve heard it usually will in 3 – 6 months. Had anyone ever tried the spot patch on the lens if the affected eye? I’m curious if that would allow me to be able to drive or if I’d need prism lenses. I actually had LASIK surgery 3 years ago so my vision is 20/20 otherwise.

Comment by Tara — November 7, 2013

I would suggest going to an optometrist and have that person exam you for a prism stick on for the clear glasses instead of blanking it out. See the following entries, they might help you decide if you want to try that:
Comment by Marie — October 19, 2013
Comment by Bob — October 20, 2013

Comment by Bob — November 7, 2013

Thanks for the reply Bob. The strabismus specialist prescribed prism lenses so I am waiting for those to be made. He didn’t mention the stick on prisms. I think my eyes are requiring a strong prism so the stick on lenses might not be strong enough. I asked the doc about needing different prescriptions for reading or computer viewing and he said no so I hope these glasses work.

Comment by Tara — November 11, 2013

Another update here, and some thoughts:

It’s now been 15 months since I first acquired my 4th nerve palsy. Since most of these are ideopathic or have an obvious cause, like mine with very high blood pressure that was untreated for at least 10 years, I’m surprised that so many people here had to undergo CT scans and/or MRIs. My opthamologist gave me a basic neurological test by having me stick out my tongue, squeeze his hand, balance on one foot, etc, and asked me a few questions. I was fine on all counts, and then he had me do a visual fields test a month later, and since I passed that with flying colors, he stated that an MRI with a neuro-ophlamologist would be a waste of time and money.

With that said, I’ve just learned something that I think is important to realize here, and it is this: Practically every textbook description of this condition will say that if the palsy was caused by a mini-stroke like I apparently had, it will spontaneously heal in 3-6 months, but I’m here to tell you this isn’t necessarily true. Mine did disappear after about 3-4 months, but every once in a while, I get a relapse for a few days, and I still have some mild residual diplopia, and likely will for the rest of my life. I now have one eye (OS) that’s about a millimeter higher than the other, so I’ll probably get about 1.5 to 2 diopters of base down prism put into my left lens in one pair of glasses and wear another pair without the prism during times I’m seeing okay.

Comment by patrick — November 11, 2013

As I read it occurs to me that while we all have a common diagnosis, we are also all unique individuals with varying circumstances. In other words, one size may not fit all. Tara awoke from surgery with double vision. I would think that her doctor(s)are going to over-prescribe treatments if for no other reason than the medical liability involved. Not sure it has so much to do with the strength of the prism. My Optometrist said my stick-on prisms were a 6 but that the highest that they could do the ground in prisms was a 3 so let’s hope my eyes improve. As for all the tests, Patrick, when my double vision occurred I was out of my home state on vacation. I wound up in the emergency room scared that it could be a symptom of something much worse. The tests may have gone overboard, but again, I suspect it had more to do with the medical liability involved. I believe if I had been home, one trip to my Ophthalmologist would have been all that was necessary for the diagnosis. As for your reoccurrence episodes, you mentioned in earlier posts about your high blood pressure and being on BP meds. I have met one person who had double vision as a result of a medication and when they switched the medication, it cleared. Something to keep a close watch on.

As for me, after 8 weeks now, I have no change in vision yet, but have greatly improved my ability to cope. I’ve resigned myself to on-line shopping for Christmas this year as I really don’t have panoramic span of vision for stores or malls. Mostly I’m okay working on the computer and driving under 45 mph. The body is not made to last forever. At some point it begins to deteriorate. My peers have had knee surgeries, shoulder surgeries, back surgeries, hip surgeries, open heart surgeries. I have had nothing so I count my blessings that it’s only a 4th nerve palsy and it is manageable. Now to go work out on my elliptical.

Comment by Marie — November 11, 2013

I had a headache that wouldn’t go away and was told that I had a sinus infection. 2 weeks after the start of the headache I woke up with double vision. I was diagnosed with 4th nerve palsy still waiting for the MRI in 2 weeks. Very frustrating to read and do my job at work on the computer. My optholmologist told me it can be caused from Hight blood pressure and diabetes both of which I dont’ have. Very frustrating.

Comment by Sarah Hodges — November 14, 2013

I didn’t have any headaches but I did have a feeling like my sinuses were going to start bothering me (I’ve had what I thought were sinus issues all my adult life but now I think it was just my eyes trying to adapt to the CN4 palsy).
As of today I can read my computer and type without wearing my prism glasses or a patch (I still have to wear a patch to read a book/magazine in my bed). For driving I’ve gone back to my glasses I normally wear but still need to use the sticker prism. I’m glad I had the MRI and CT scan just because at 61 it’s nice to know I don’t have issues in those areas and that my blood pressure meds are working as expected.
See my entries on the following dates and check out Marie’s entries:
Comment by Bob — October 14, 2013
Comment by Bob — October 20, 2013

Comment by Bob — November 14, 2013

This morning, exactly 2 months from when I woke up with double vision, I woke up without it. Amazing. One event as strange as the other. I keep a spare set of regular glasses on my nightstand. Each morning I put them on to test my eyes. Each morning it was, yep…still there…no change. Today was different. What a shock! I actually drove the highway to work 65 mph with no prisms, no patch, and no problems! Yes, I still have some double vision looking down. Tonight is not quite as clear as this morning was. But I am so hopeful for recovery. Sarah, I know your frustration. Read my first earlier posts. Be careful not to have a secondary accident and give it time, a lot of time.

Comment by Marie — November 14, 2013

After on month today is a happy day for me as my diplopia is almost gone.I thank God and the doctors for this.In my case I was started on high dose of steroids by my neurologist because in my case it was recurrence and that too of a different nerve.In some cases the cause is some inflammation in the cavernous sinus or the apex of the orbit.I strongly feel those of you who have long standing palsy which started with pain in the same side should discuss the option for steroid therapy with your doctor.I am advised to continue the treatment for six months and then taper slowly.I have been prescribed additional medicines for the diabetes and hypertension as the steroids cause worsening of both the conditions.Thank you all.

Comment by Subhash Lazarus — November 20, 2013

My doctor ordered an MRI with contrast to evaluate my 4th nerve palsy but my insurance company will only approve an MRI without contrast. The MRA he also ordered was denied completely. So I guess my questions is: should I accept just doing an MRI without contrast or fight for the use of contrast? What is the difference in terms of a diagnosis for my condition? I would rather not go through the time and huge expense of doing the wrong exam only to have a radiologist suggest to do an MRI with contrast after reviewing a noncontrast study.

Comment by Mark — November 26, 2013

Mark, if your doctor ordered contrast … you should get the contrast as it will enhance the detection of small lesions like tumor or inflammation. The fourth nerve has a fairly long track from the brain-stem, around the brain, into the cavernous sinus, and eventually into the eye socket.

As far as the MRA … I don’t know. I don’t routinely order this study for fourth nerve palsies (but maybe I should). These are all good questions to ask your ophthalmologist. Call their office.

Comment by Timothy Root, M.D. — November 26, 2013

I have a question for all who have experienced CN 4 palsy.. I am now 8 weeks post op from a craniotomy for a tumor resection. I woke up from surgery with diplopia resulting from the palsy. I have had a couple of episodes where the double vision has resolved momentarily, then returned. Has anyone else experienced this and has the doplopia resolved permanently at some point?

Comment by Tara — November 27, 2013

Merry Christmas to my Ortho friends. Even though I don’t know you, you have been a big part of my 2013 year. I am still improving daily. Last visit to Ophthalmologist was 12/17. He said my corrective prisms started at 3 on the top for distance, 9 on the bottom half of my glasses for reading. I am now 20/20 for distance and need nothing on the top. The bottom corrects with a prism strength of 4. It’s been 3 months. He wants to wait another 3 months for further improvements before putting me in something more permanent. With the 4th nerve palsy resolving, he doesn’t feel we will be discussing surgery at any point. Even it there is some residual diplopia, he can correct with ground in prisms into the glasses. It’s a very Merry Christmas. Wishing everyone health and prosperity for 2014!

Comment by Marie — December 24, 2013

Typos…Ophtho not Ortho, if not it. oops

Comment by Marie — December 24, 2013

Merry Christmas to all! Marie, that’s great. I went in for a followup exam on 12/12 and I don’t need to go back. I’m about 99% back to normal vision (7 months since the beginning of the double vision). I’ve been wearing my normal glasses now for about 2 weeks. I still have issues when I’m lying in bed reading and I get glimpses of the double vision if I turn my head a certain way but it is not enough to impair my vision. The doctor said my double vision was probably a one off incident and good chance it won’t happen again.

To all that have this hang in there. If you don’t fight it and try to adapt to the situation it can be a very unique experience. Wearing the prism glasses and looking at stained glass was really cool (lol). It has caused me to reflect on how much longer do I want to continue working (lol).

Comment by Bob — December 26, 2013

Great news, Bob! Scary as this has been, I’m sure it is encouraging to others to know that, at least in our cases, it’s not permanent nor is it expected to recur.

Comment by Marie — December 29, 2013

I am writing this because I have a student who has been diagnosed with fourth nerve eye palsy. He struggles with reading and writing, and isn’t making the progress that I know he could be making. Parents have been told nothing can be done and when I received info. from the doctor, the doctor told me this would not affect his learning that something else is causing his inability to learn. I am very concerned. Any suggestions?

Comment by Concerned teacher — January 17, 2014

Concerned teacher:- how old? Of course this can affect his learning, reading and writing. The double vision can be disabling. A patch can cause undue attention. The entire experience can mess with one’s self-confidence and bring on depression and isolation. I didn’t want to go anywhere, do anything, see anyone or have anyone see me. Suddenly you go for absolutely healthy to feeling like a spectacle (no pun intended) Put some prism glasses on your normal eyes and it might give you some insight into what the student is experiencing. Depending on the age, he may need some counseling, some encouragement, hope, and one-on-one tutoring in the interim. How long has he had it? What is being done? Has he been able to connect with someone else who has experienced this? Read previous comments. There are lots of good suggestions on this site. HELPED me tremendously to find it!

Comment by Marie — January 22, 2014

I have had a prism is my glasses for 2 yrs now but never diagnosed After many drs. I was diagnosed with 4th nerve palsey on Feb 7th 2014 I am going to see a orthoptist about new prism Is this something common

Comment by Lorraine Sofia — February 8, 2014

hi all new to all this. 3 weeks ago I was injured in a freak cub scout sledding accident. I was hit in the face with a boot at the bottom of a snow hill. result is a broken face orbital floor fracture and other facial fractures and lacerations. 3 weeks later the double vision I have was diagnosed as 4’th nerve palsey. the Dr is going to take a wait and see approach to treatment which I see seems to be common place. is there any kind of suppliments that help with nerve health. from the sounds of it she wants to wait up to 1 year before a surgery is explored. personally I would rather not go down that road at all after having to have my face fixed in the next week or so. the face surgery guy didn’t want to touch me until he got the green light on the eye diagnosis which came just today so I move on. as it stands right now I can’t see straight sleep well or eat solid foods I’m a mess.

Comment by todd — February 18, 2014

Todd, see my entries on the following dates:
Comment by Bob — October 14, 2013
Comment by Bob — October 20, 2013
Comment by Bob — December 26, 2013

If you read everybody’s entries (yes I know it’s a lot, lol) you’ll get a better understanding how each case seems to be different but a common theme is the waiting of 6 months to a year. There are options during that waiting period such as: prism glasses, stick on prisms, eye patches. Hang in there, it’s goofy but it can be a positive experience.

Comment by Bob — February 19, 2014

Not the answer I was looking for but thank you. I was looking for some sort of supplement that helps eye health exercise regiment for increased blood flow etc… I have broken bones damaged ligaments before but never had any kind of nerve damage bones heal quickly soft tissue takes time I hope sooner rather then later. I really don’t see any + out of it right now to tell you the truth. I work a very strenuous job and need my Vision to work this is not helping matters once my nose/face gets fixed I can look at the prism glasses option but right now I can’t even touch my nose let alone put glassed on on it.

Comment by todd — February 20, 2014

I haven’t been diagnosed with 4th nerve palsy, but my optometrist did confirm I had vertical binocular diplopia (mild) so he prescribed a prism in my glasses (with 3 diopiter). The ophthalmologist at Kaiser seemed skeptical I had diplopia and said my eyes were not misaligned. I just got my prism glasses and wore them for 8 hours, but I found they worsen my double vision when I take them off and I can’t see without the glasses. I can see perfectly with them on, however, but I prefer to tolerate the subtle double vision (2nd image partial image to the left and above image) rather than have to become totally dependent on the prism glasses. I’ve heard prism glasses will worsen the double vision, is this true?

Comment by HeyJude408 — February 20, 2014

Todd, I am so sad for you. From fun sledding to everything in your life turned upside down is devastating. It’s a real test of patience and coping skills. No easy or quick fix. No pills. HeyJude408, I understand. I wanted eye exercises, diet supplements, eye drops, something…anything. In the end 4 months, time, was the only thing that mattered. Today, it is now only a memory. I’m as good as I was before it ever happened. My doctor assured me that there was nothing I could do to hasten the healing or worsen the condition. I, too, though wondered about dependence and felt I needed to try to “train” my eyes to focus. So I wore the prisms for work, but in the evening relaxing or whenever I could, I went without the prisms. It’s a tough experience, a difficult one to deal with…but try not to give up hope for recovery. Eat well, exercise, take care of yourself better than usual and pray. Try not to let anything else happen to you to make it even worse like a car accident or a fall down the stairs. Time will be your friend. It might seem like a long time. The weeks went by with no sign of the slightest improvement, and then one day I woke up in disbelief. The room did not have two paintings on the wall, only one. Hang in there.

Comment by Marie — February 20, 2014

Marie if you don’t mind me asking was your issue from Trauma or a medical condition. From what I have read medical conditions can cause this to happen as well like a stroke. did you have an indication that it was getting better or was it just like you said double vision and then none over night? Mt Dr. put in her report to my face surgery guy high likelihood of spontaneous recovery. but in a 6-12 month window.

Comment by todd — February 23, 2014

Todd, Glad to share whatever I can. See my earlier posts:
Comment by Marie — October 12, 2013
Comment by Marie — November 5, 2013
Comment by Marie — November 11, 2013
Comment by Marie — November 14, 2013
No trauma or medical condition in my case, however, I read lots that said a concussion could lead to same diagnosis. As I surfed the net, I found much about Hillary Clinton having prisms and possibly double vision from when she fell. Spontaneous recovery likelihood is much to hold onto and hope for. Note that I wrote on 11/11 noticing no change and 3 days later, what an amazing difference. As my Dr. explained about the nerve (11/5), I thought of it as electrical wiring. Not so much of an in between state, it either makes contact and turns on the light or it doesn’t and you get nothing. At 2 months, I had remarkable improvement. At 4 months, I quit wearing the prisms. Vision is good. I exercised a lot on my elliptical. Maybe didn’t matter, but I figured intuitively if it was a technically a mini-stroke and a interruption of blood flow, then maybe by exercising, I could force my blood to circulate better. This would definitely not qualify as a medical opinion-LOL. I was obsessed with reading everything I could find on double vision and 4th nerve palsy. All links led to “give it 4-6 months”. Take care. It’s not easy. It can be scary. I was there. I got better. I will pray that you do too!

Comment by Marie — February 25, 2014

I found out today that I too, have 4th nerve palsy. I also was told that it happens to quite a few people who have diabetes (that I do have). If it does not improve within a few months, I will have to have an MRI. I only suffer double vision with distance, not with reading, so I hope it returns to normal at some point in time. It is very annoying as I usually drive with one eye shut.

Comment by susan — March 7, 2014

Hello All! Was mesmerized reading all your comments (with a tilted head or by covering one eye). I was diagnosed with 4th CNerve Palsy about two weeks ago! I’m waiting for my bifocal prism glasses to come in this week I hope! One thing my strabismus specialist told me was that my onset could have occurred as a result of an “insignificant” (I.e. one that hurt at the time, but that I don’t remember now) blow or injury to the head, like maybe an open cabinet door over the washing machine? My question, that I haven’t been able to actually find an answer to, unless I missed it, is, WHERE is the 4th CN located in the head (?) so I can try and recall if I every smacked myself in the head in that area, which could have caused the onset of this condition… Thank you for any help you can provide! =)

Comment by Cindy C — April 13, 2014

the 4’th nerve is the easies to be damaged due to trauma. It’s the longest nerve from the brain to one of the eye muscles. Usually from blunt trauma and usually from the back of the head. Also they say that when it happened from trauma that loss of conciseness happens as well. I didn’t have 2 of the 3 my was blunt trauma to the front of my head/face/eye/cheek area. none of the doctors I saw for the face injuries or the eye doctors I saw could believe that the amount of damage that was caused and I wasn’t knocked out. I have total recall of ever moment of my accident. I have also read cases that this can be the end result of a stroke as well. do a google search you will find more cases but it is rare and very rare in my case. I had surgery on 3-11 to repair my face 4 plates and 16 screws are holding the bone behind my nose back onto my skull. I’m doing well from the surgery. Going back to work in 2 weeks. I got the prisim glasses on 3-8 and I have not noticed any change. it straightened my vison up when I have them on I can ever read the new paper. Pretty amazing. I see a chiropractor for an un related issue and he said that never injuries are odd one day you have paralysis and the next day it’s gone. it’ the sheeting on the nerve that transmits the signal that gets gamaged and whe the sheeting (bark) so to speek reconnects where it was torn that the operation of the muscle is no longer retarded. He confirmed that it can take up to a year for it to recover in a case from trauma.

Comment by Todd — April 14, 2014

Comment by Marie — November 5, 2013

I remember finding some sites with pictures and descriptions. It’s the thinnest of nerves. I sort of remember bonking my head one night on the lower corner of the freezer door or an upright refrigerator/freezer as I was putting things in and out …but who will ever know if that was the cause? My last appointment was 3/19/2014. I don’t go back for 2 years now. Only a very slight trace left and he said I’ve learned to compensate to the point where I don’t even know it’s there. Feeling very fortunate compared to some.

Comment by Marie — April 14, 2014

All of the comments are funny to me. I am a 20 year old and I’ve had this condition my whole life, I was born with it. It’s really not as bad as you are all making it sound, and this is coming from the girl with all of your symptoms. You learn to deal and to compensate. I don’t mean to sound harsh but having this condition isn’t the worst thing in the world.

Comment by Whitney — May 7, 2014

Whitney, I have read that people who have diplopia from a young age learn to deal with it a lot better than those of us who have had normal vision for 50 or more years.

I’m in the first month of the condition and wondering if it is as intermittent for others as it is for me. I have the condition for a few seconds or an hour at a time and may have it every few minutes or once a day. There doesn’t seem to be anything I’m doing to cause the condition, it just happens randomly. It does always seem to happen if I drive so I have some black tape on my glasses over the central vision area of one eye. That lets me keep the peripheral vision for both eyes without the confusion of the double image in the central area. I know a lot of people drive with monocular vision but it is taking some getting used to. I’m assuming that corrective lenses are not going to work well as long as the amount of eye droop is variable and not continuous. My doctor says we can give them a try but wants to wait a while to see if the condition goes away or at least becomes more stable.

Comment by Jay — May 9, 2014

Hi Whitney,
I too may have had this all my life (as my neuro-opth. is asking me to research old pix to look for my head tilting to one side), but please don’t minimize it for the rest of us! You are only 20- I am 46, and my neuro. said I had exhibited a super-human ability to compensate all those years. But now with aging, comes decompensating. I can no longer just keep shutting an eye (which I was apparently unaware I was doing for quite some time!) or forcing the objects to converge in to one in my field of vision. I am awaiting an MRI just to make sure all is clear (relief to hear all that posted here seemed to have clear MRIs) before deciding next course. With it not seeming to be related to acute trauma, I don’t seem to fall in to that spontaneous 6-12 mo. recovery! It has been nice to see that I’m not the only one experiencing this. I’m just worried that it appears to have worsened and now I’m getting those mini or very brief dizzy/ off kilter spells!

Comment by Cheryl — May 18, 2014

My husband was diagnosed with IV nerve palsy after a serious concussion following a bicycle accident 3.5 months ago. His vision is both shifted and rotated such that prism glasses do not rectify the double-vision. Regular ophthalmologist appointments have shown no improvement to date. We know from reading that about 60% of those who experience this type of palsy from head trauma will have spontaneous recover in about 6 months. My question is whether or not you will have gradual improvement or is it spontaneous and complete for those of you who have had a full recovery? My husband seems to think that if it were to get better on its own, he would have had some evidence of gradual improvement by now – but I am not sure that that is true….advice?

Comment by Gilly — May 22, 2014

Hi all. I found this a really interesting collection of posts.

I’ve been recently diagnosed with this (or something else that is affecting the superior oblique) and suspect I have had it for around 10 years. Some interesting points in my case:

– I have double vision – but I cannot ‘see’ it unless reading or make a quick, sharp turn to my left hand side. Presumably I am alternating suppression of my eyes. Sometimes long vertical objects that bisect my vision trigger me to see left and right objects massively misaligned. I also occasionally suffer from severe neck pain.

– I find reading completely intolerable. Its as though my brain expects to move faster than my eyes will allow – which makes me feel drowsy.

– At about age 17 I noticed a tendency to look at things but not focus on them – but did not view this as an issue at the time. I would always pass eye tests without any problems.

– However. It did coincide with a complete collapse of my academic standing because of my sudden refusal to read anything. As ridiculous as it sounds – I did not link one with the other (though I was very aware of feeling tired all the time).

– I coasted through University … underachieving but ultimately getting by without doing any work.

– When I started employment it hit me like a freight train… I immediately began seeing significant visual distortions and double vision that would get worse as the day progressed.

So… as implausible as it sounds I’ve found you can develop these symptoms and hide them from yourself by sub-consciously adapting your behaviour … in much the same way as the involuntary head tilt.

Since I’ve started to understand the mechanics on the issue management has definitely improved. I’ve recently started needing very weak prescription glasses and I’ve found they make a huge difference. I suspect it might be because of the visual cues of seeing the frames rather than the actual lenses. Aside from providing some immediate relief when eye strain becomes intolerable – I don’t find prisms help much with general management of the condition.

Comment by NervyDude — October 24, 2014

Tara, five weeks ago I also had a craniotomy to remove a benign tumor. Although it has gotten better, I’m still experiencing double and blurred vision. I’ve seen a neuro- ophthalmologist and got the stick on prism for my glasses. Any insight or thoughts that could help would be appreciated. Also, curious if your CN 4 palsy resolved itself with time. Thanks!

Comment by Robin — October 29, 2014

Just found out today that I have 4th nerve palsy. Saw my regular ophthalmologist on Saturday and he said my eyes were okay. Didn’t diagnose the palsy. Condition worsened in one day and because my regular eye doc was in surgery all day, I saw another eye doctor who diagnosed my problem. He gave me the name of a pediatric ophthalmologist to see next. This thing is very scarey as I’m afraid to drive or even leave the house. Some of the comments here have been reassuring, others not so much.

Comment by Noelle — November 5, 2014

For my 80th birthday I awoke with double vision, what a bummer!. Diagnosed with “4th Nerve Palsy”. On blood pressure meds and went to the ER with extremely high BP as I was so anxious. I have IOL’s in both eyes and my vision is great with a patch on. Awaiting prism glasses because the 1st pr. didn’t work, so these will be stronger. Sure hope it helps me cope. My hubby drives as I don’t trust myself. I’m just praying to have my double vision disappear the way it came, suddenly. Have had ER brain scan and treatment as my blood pressure soared (perhaps anxiety)?
I’m happy I found this site and hope we all recover…Wouldn’t that be nice for the holidays?

Comment by Joanne Binder — December 2, 2014

I woke up with a stinging sensation in my left eye 18 months ago, went to have the CT scan and eventually the MRI but they found nothing wrong, been under the ophthalmologist in West Wales Carmarthen, who gave me prisms to ware which helped, correct the horizontal double vision, had every blood test possible done to find out what might be effecting my vision but nothing came up. Had a chance meeting with an optometrist who was interested in my wondering left eye and double vision. He suggested that it was a damaged fourth nerve, so I have looked this up and found that I am not the only one with this. Hurray! Thank you all for your helpful comments. The optometrist has now tested my vision and although I see well in both eyes my double vision is now controlled by strength 12 prism glasses. Sadly I love orienteering on horse back, and cannot really see myself doing so much of it any more, but I am driving to work, but for how long I am not sure either.

Comment by Polly Lloyd Owen — December 2, 2014

Noelle, Joanne, Polly….don’t give up hope. As I went through this past year, I kept expecting the double vision to return, but it hasn’t. I’m grateful. I have several posts earlier describing my experience. What helped me the most, was learning of others that had experienced the same 4th nerve palsy and being able to reach out and talk to them. I look back and think of that time as a life changing experience that has made me “see” things today differently in so many ways. Praying for all of you to have a full recovery.

Comment by Marie — December 11, 2014

Noelle, Joanne, Polly. I want to add to what Marie said, every case is different. If you can read all the posts (I did it initially with one hand over my right eye until I got a patch for reading, lol) they should help. I had to drive 35 miles to work each day and work on computers so my days weren’t pleasant but the prism glasses helped with the driving and the patch for the computers. It didn’t stop me from enjoying life, I was still able to mountain bike (I had to take it a little bit more careful and slower), take photos and read, I adapted. I was 61 years old when this happened.
My double vision didn’t start right away, it took about 3 weeks before I was seeing complete double. This happened in 2013 from the end of June to about October it was complete double then it slowly went away. I was able to stop using the prism glasses and patch by the end of December. I hope this helps.

Comment by Bob — December 12, 2014

Thank you Bob for your encouraging words. It helped me so much and I’m trying to cope TOO as you did. Patch one minute and prism next. Made some cookies and wrote out cards, but my eyes tire and I have to rest. I will cherish my eyes more than ever if single vision returns. I also have AOL implants and my eyes are otherwise healthy. I’m having an MRI Monday before seeing a Specialist. Hopefully it will not reveal anything too terrible as my brain cat scans were normal. I’m looking forward to single vision thanks to your comments and my physician too…

Comment by Joanne Binder — December 14, 2014

I woke up two weeks ago with a feeling of pressure behind my left eye, and my vision was blurred. blood tests were ok and the dr said it will take up to six weeks to heal. what can I do to help the healing ? I do close my left eye when I read etc. Otherwise when driving I tilt my head !! please help with advise.

Comment by christa — December 17, 2014

I too have double vision, fourth nerve palsy. Started about 7 mths ago (or that is when i first remember someone commenting on my weird eye position when looking right). I ignored it thinking the double vision only happened when i was tired and would go away. Then i mentioned it to my optometrist, who referred me to an opthamologist. Who sent me for an MRI. That was a stressful wait as they kept insinuationg that ‘something’ could be pressing on the nerve. Thankfully it came back clear. Then referred to neurologist. Another MRI to ensure no aneurysm or vascular issues, thankfully again came back clear. 3 lots of blood tests to ensure no autoimmune diseases. Am now awaiting appt with opthamologist after xmas i presume to get some prisms. I only experience double vision when looking right and when looking extreme upwards. I work on a computer all day and find it hard at the end of the day when tired so i just take that as my cue to pack up and go home for the day. Early in the day is certainly better for me. I am holding onto hope that if this spontaneously appeared, it will spontaneously disappear. This thread has been very helpful to find that i am not alone. I am only 34 and really worry that other nerves may also spontaneously be affected. While i am glad that there were no nasties in my tests, it is hard to accept that this can be idiopathic and just one of those things.

Comment by Lolli — December 18, 2014

Well I’m 11 month post accident and 9 months post surgery to fix my face. the surgery to repair my skull/face consisted of 4 plates and 21 screws to put it all back together. physically I feel great and my appearance is fine the skull surgery was all done from inside my mouth so I have no scars other then where my noise bone poked though the skin. and it’s crooked the face guy didn’t want to get anywhere near my eye so my nose is still deviated the least of my worries right now. I just went back for a follow up and it looks as if the 4’th nereve is NOT coming back so surgery is in my future but she needs to wait past the 1 year mark before she will do it. She told me the surgery is at about 80% success rate on paper but it is actually higher she said. I’m scared to death to have this done. my skull surgery was pretty easy re align the bones done and dusted this is a soft tissue surgery and from what I gather it’s a judgement call on how much to cut the muscle to compensate for the 4’th nerve problem. she said the surgery is only about 1/2 hour to do but I have to be put out for the surgery due to where they do it. my face surgery was 5 hours and I’m really fretting this minor surgery. anyone have any lick with the surgery route?

Comment by todd — December 21, 2014

Recently, there’s been an increase of activity on this site and in my mailbox. I read through most the posts tonight. I recall then, as I do now, how thankful I was that there was a place to share our stories and find mutual support. Who could understand our situation more than others likewise diagnosed?

Two years ago I spent Christmas ‘under the patch’. It was a frightening an uncertain time for sure.

My own IV Nerve story had a happy ending. Mine was idiopathic. I am relatively healthy with normal blood pressure, and no diabetes. It came on rapidly and fiercely for me one night with a pronounced double vision, following a severe headache and eye twinges just days before. It’s severity prevented me from functioning properly, even walking unassisted, until my doctor recommended an eye patch. I had the good fortune of having a skilled Kaiser doctor that performed the right tests, diagnosing me correctly, and fast-tracking me through MRI scheduling and subsequent neurologist visit. With the patch, and I saw immediate relief in that twisted world, enough to return to work, although driving was out of the question. As I wrote in earlier posts, I drew a big X on the calendar each day, aware that many idiopathic cases begin reversing at 90 days. Mine did. Although it was an additional few months before my vision was fully restored.

Just shy of 2 years later, I’ve had no recurrence – it leaving me as mysteriously as it came. For those of you newly diagnosed with idiopathic IV nerve, please stay positive that you may very well have a similar success story. All of on this board of ‘afflicted’ strangers will always have this common bond. Good luck and best wishes in your recovery.

Comment by Cinny — December 21, 2014

Thanks for the update,cinny. Glad to hear yours has resolved, gives me hope although I am well past 90 days. Did you try anything besides the patch? Ie acupuncture, your own eye exercises?

Comment by Lolli — December 31, 2014

Lollli, the patch was it. No exercises, no prisms, just waiting, praying, songwriting and leaning on friends and family for physical and emotional support.

As a general rule, I think many people that have never experienced full on double vision have a perception that it can’t be ‘that bad’. I remember asking friends to cross their eyes, and hold it — that was my world. They were instantly enlightened.

The return to normal vision for me was not immediate, but a process. You may very well be improving in baby steps. I hope so. I hope that you, like me, heal beautifully and are able to revisit this board with great recovery news. It was such s profound experience for me, that I stay connected to this board. Please stay encouraged!

Comment by Cynde — January 1, 2015

I’m almost a year out from noticing first episodes of vertical double vision. MRI’s showed nothing. Have been wearing prism glasses to drive at night, with no improvement seen… Pun intended. Guess I need to revisit with neuro-ophthalmologist to see what’s next. Just curious… have any/many of you had LASIK surgery in the past? Wondered if that was a commonality amongst afflicted.

Love reading what others are experiencing. Happy New Year to all and wish everyone of us a clearer vision in 2015!
Cindy C

Comment by Cindy C — January 1, 2015

Side note:
Dear Dr. Root,
Any chance you can reverse the “school” of comments on this site to have most recent appear at the top?
Just a thought.
Thank you!

Comment by Cindy C — January 1, 2015

I’ve tried to flip the comment order, but I’m not sure it will work. Just don’t have time to redesign the back end of the site. Thanks!
Tim Root

Comment by Timothy Root, M.D. — January 1, 2015

Cindy, You asked about LASIK surgery. I have not had. Am nearsighted. Mostly wear progressive bi-focal lenses, sometimes contacts when waterskiing. Age 62 when it happened. Healthy. Take no prescribed meds. Completely idiopathic. Agree with Cynde that the experience was such that it has kept me connected to this Board. I wore the prisms and patches, depending on the situation and what worked best. I will say, that if there was anything that I was guilty of that could have possibly contributed to mine, it was overexposure to the sun. I never even used to wear sunglasses and we are regular boaters! I didn’t realize the value of sunglasses. I thought they were just to look cool and I’m not much into vanity. Not now. I have two pairs of the best polarized lenses to protect my eyes. And wear them even in the winter when the sun is bright! No acupuncture or eye exercises, however I kept a regular routine of a 30 minute cardio workout on my elliptical. I figured if the the “palsy” was technically a paralysis, any cardio to pump up my system couldn’t hurt. The mystery of it all will remain a mystery but I am grateful for a full recovery and pray those in the medical field learn more with how to understand and treat.

Comment by Marie — January 1, 2015

Newcomer to this forum.

My story is being diagnosed with fourth nerve palsy just after Christmas 2014. I returned to the UK from a visit across the Atlantic. I’m a reasonably frequent traveller and had found that to see me through the jet lag on my return, I took one of those “high energy” drinks that you can buy at US news stands in airports. I have taken just one soon after arriving back home. Whether this caused me a problem I don’t know……I awoke the next morning with double vision and a bad headache. Thinking it was just jet lag and would go away, I didn’t do anything, until after the Christmas period. When I visited hospital they found my bp was 187/95…..so I can only guess what it might have been when the double vision was caused. Anyway, I have had a prism fitted to the left lens of my varifocals and it seems to be working. The double vision seems to come and go, but seems most apparent after sleeping or having the eye closed. I’m monitoring my bp which is back around its usual 132/75. Just at the early stages of the problem and have set an expectation of six months for improvement but obviously hoping for a faster correction. I’d appreciate any thought, ideas, comments on how I might help the improvement.

Comment by Brian — January 4, 2015

Just and update from my previous posting, since there has been no improvement to my Superior Oblique forth nerve palsy, I have revisited my Doctor and he seemed to think that it could have started with a Shingles attack, and that there could be a possibility that the nerve damage due to this virus, I have had Shingles previously but to my belly area. Shingles is an infection of a nerve area caused by the varicella-zoster virus. It causes pain and a rash along a band of skin supplied by the affected nerve. Symptoms usually go within 2-4 weeks. Pain sometimes persists after the rash has gone, more commonly in people over the age of 50. Other complications are uncommon. Antiviral medication may be prescribed to limit the severity of the condition. However I seemed to have an extended reaction with it affecting my head, and spots on my neck and in my hair. I am keeping positive and have got some amazing glasses that help me at work and driving, although I hate driving at night. Polly

Comment by Polly — January 5, 2015

cindy C, no LASIK for me. I am near sighted though

Comment by Lolli — January 9, 2015

Yes, LASIK here 13 years ago (mono vision technique). Lots of sun exposure like Marie, too.

Comment by Cynde — January 9, 2015

Hello to eveyrone, another newcomer to the forum although I have been lurking here for some time. Figured it’s about time to share my experience and hope it benefits others.

My vertical diplopia began Sept 9, 2014 while driving to work. Prior to that, I didn’t hit my head or anything although I did a few yoga poses in the morning that arched my neck backward and forward. The days before, I was itching badly in my arms from several mosquito bites.

I saw a team of opthalmologist, neurologist and neuro-opthalmologist and all agreed it was Fourth CN Palsy. My CT Scan was clear and normal so the docs say the palsy is idiopathic and are guessing micro-vascular related although my BP is normal and I don’t have diabetes nor cholesterol issues at age 50. I told them about the yoga pose and mosquito bites but they ruled out any connection. Yet I keep wondering if the pose could have pinched the Fourth CN at the brain stem or if the mosquito bites caused a viral infection like in other CN palsies.

It’s been 4 months since and I’ve recovered around 90% as the DV only occurs on extreme left gaze. Didn’t take any medications nor use prisms or patches – just dealt with the disorientation as best I could. Stayed home the first 3 month and during this time there would be more good days when the DV seemed to diminish and some bad days that felt like a step back. During this period, peripheral vision, panning, far-sighted vision and medial near-sighted vision were the aspects of vision that improved in their respective order.

I returned to work after the 3rd month when I was around 80%. During this time and until now, I’d notice my eyes feel best in the morning upon waking and then gradually feels fatigued towards the afternoon. As the days continue to pass, the eyes get stronger in accommodating and the area of DV gradually diminishes. Hoping for a full recovery soon.

One thing I still notice is that if I look at a curtain rod about 10 feet away, the good eye by itself (with other eye covered) sees the rod perfectly horizontal but the affected eye by itself sees the rod slightly tilted below. When looking at the rod with both eyes (binocularly), there is no DV so it’s obvious that the brain is blending the 2 planes through accommodation. Was wondering if those who have fully recovered experienced the same. Did the 2 planes of monocular vision ever “line-up” when you fully recovered?

Thanks for any feedback. Best of luck and good health to all in 2015!

Comment by Geevs — January 10, 2015

Ive had a fourth nerve play over a year now. I still havent been told what the cause was. Im 43 and had No surgery or trauma.

Comment by Vince — January 11, 2015

In 2008 I had 6th CN palsy that was most likely caused by high blood pressure. I went to the hospital and was admitted for four days as the examining physician insisted that I had had a stroke. I presented with double vision that was deviated both vertically and laterally. I wore a eye patch for the first month and then got prism glasses which helped me immensely. The diplopia resolved itself in about 3 months and never came back so I was able to rid myself of the prism. Fast forward to 2015. A few days ago (January 12, 2015) I noticed an extremely sharp stabbing-like pain in the medial right portion of my brain which lasted for only a second then was gone. After that I began to note a very gradual change in my vision – yes, I was beginning to see double again. I went to my family doctor who immediately referred me to an Optometrist (test results indicated 20/20 vision) who then referred me to a Ophthamologist STAT. There I was diagnosed with 4th nerve palsy. My blood pressure is within the range of normal, I am a tournament racquetball player, ride mountain bike, an avid skiier, and I weight train when I am not doing the other activities. The ophthamologist stated that because I had the insult to the 6th nerve that the chances of other CN damage occurring was quite high. I don’t want to scare myself but … what the heck!! What’s next?? I am 66 years old – does that have something to do with this? Anyways … I’ll get over this and keep on keeping on.

Comment by Jim — January 15, 2015

Leave a comment

Your Comment:

Copyright Root Eye Network Inc., All Rights Reserved