Eye Focus Issues: Insights for High Myopia Patients

Q: Eye Focus Issues: Insights for High Myopia Patients

Hello： <br>1. <br>Focus issues with your eyes： You mentioned that two ophthalmologists provided different diagnoses. <br>Since there has been no improvement with the first one, it is advisable to prioritize the recommendations of the second ophthalmologist. <br>If the new prescri

Focusing issues with the eyes?

Hello Doctor, I have high myopia.
I uploaded two videos for your reference.
One was taken with my arms fully extended, where the outward deviation of both eyes is not very noticeable.
The other video, marked with a blue dot, was taken from about half an arm's length away, and the outward deviation, especially in my right eye, is quite pronounced.
This condition has persisted for over a month.
Normally, I can focus on objects, but not for extended periods.
However, when relaxed, my eyes tend to deviate outward, making it difficult to focus on closer objects, which also leads to double vision.

I visited two different ophthalmologists and received different diagnoses.
The first doctor said my eyes were too fatigued, resulting in a latent exotropia.
He advised against changing my prescription, even if it was slightly insufficient, as adding more correction could increase eye strain.
He prescribed fatigue drops and 0.01% atropine.
However, after a month with no improvement in focus, I consulted another doctor.
I mentioned the exotropia, but he claimed it was something I had since childhood and would not change as I grew older.
He attributed my blurriness and focusing issues to insufficient prescription strength, noting a difference of 50 diopters in one eye and over 100 in the other.
He also used a flashlight-like pen to examine my eyes and concluded that the angle of my exotropia was not significant enough to be a concern.
He prescribed fatigue drops as well.
This situation leaves me uncertain about whether I should change my glasses or seek another opinion.
I've significantly reduced my screen time, and although I've been using the prescribed drops for a while, there has been no improvement.
I'm worried my focus may not return.
Additionally, I noticed upon waking yesterday that my eyes felt swollen and itchy.
I'm unsure if this is due to allergies or a stye, as I often wake up with allergy symptoms.
Although there isn't much visible swelling, I applied allergy drops, which helped somewhat, but the swollen feeling persists.
Should I see a doctor for a prescription ointment or drops, or would warm compresses help improve the situation? I apologize for the many questions and appreciate your guidance.

xuesheng, 20~29 year old female. Ask Date: 2023/09/23

Dr. Gao Pilin reply Ophthalmology

Hello:
1.
Focus issues with your eyes: You mentioned that two ophthalmologists provided different diagnoses.
Since there has been no improvement with the first one, it is advisable to prioritize the recommendations of the second ophthalmologist.
If the new prescription glasses still do not resolve the focus issue, you may consider visiting an ophthalmology clinic that specializes in strabismus (at a large hospital or medical center), as surgery may be necessary for correction.
2.
Eye allergies or stye: If you are experiencing swelling and itching in your eyes, this may be a symptom of eye allergies.
You can continue using allergy eye drops, but it is recommended to do so under the guidance of a physician to ensure proper treatment.
If the swelling persists or worsens, or if you suspect a stye, please seek an ophthalmological examination as soon as possible for professional assessment and treatment advice.
You may consider gentle warm compresses to relieve discomfort, but be careful not to use water that is too hot to avoid damaging your eyes.

Reply Date: 2023/09/23

More Info

High myopia, or severe nearsightedness, can lead to a variety of visual disturbances and eye-related symptoms. Your concerns about focusing issues, eye fatigue, and potential eye conditions are valid and warrant a comprehensive understanding.
Firstly, the phenomenon of difficulty focusing, especially when viewing objects at close range, can be attributed to several factors. In high myopia, the eye is elongated, which can lead to changes in the shape of the retina and the vitreous body. This elongation can cause the eye's focusing mechanism, primarily controlled by the ciliary muscle and the lens, to become less effective, resulting in blurred vision or difficulty in maintaining focus. The symptoms you describe, such as the inability to focus on close objects and the perception of double vision, may indicate a condition known as "pseudomyopia," where the eye temporarily loses its ability to focus due to muscle fatigue.

The external appearance of your eyes, particularly the outward deviation (exophoria), may also be a sign of eye strain or fatigue. When the eyes are overworked, especially in individuals with high myopia, they can exhibit a tendency to drift outward, which may be perceived as a misalignment. This can be exacerbated by prolonged screen time or near work, leading to discomfort and visual disturbances.

Regarding your experience of eye swelling and itchiness upon waking, this could indeed be related to allergies or other irritants. Allergic reactions can cause the eyes to become puffy and itchy, often accompanied by redness. If you frequently experience these symptoms, it may be beneficial to consult with an ophthalmologist who can provide a thorough examination and recommend appropriate allergy management strategies. Over-the-counter antihistamine eye drops may offer temporary relief, but persistent symptoms may require prescription medications or further evaluation.

As for the differing opinions from the two eye care professionals you consulted, it is not uncommon for practitioners to have varying perspectives based on their clinical experiences and diagnostic approaches. If one doctor suggested that your symptoms are due to fatigue and the other indicated that your prescription may not be adequate, it might be worth considering a third opinion, especially from a specialist in strabismus or a comprehensive eye care center. They can perform a detailed assessment, including refraction tests and binocular vision evaluations, to determine the most appropriate course of action.

In terms of managing your symptoms, reducing screen time and taking regular breaks during near work can help alleviate eye strain. The use of artificial tears can also provide relief from dryness and discomfort. If your symptoms persist despite these measures, further investigation into your visual acuity and eye alignment may be necessary.

In conclusion, high myopia can lead to a range of visual disturbances, including focusing difficulties and eye fatigue. Your symptoms of visual distortion and discomfort warrant further evaluation by an eye care professional. It is essential to address both the refractive error and any underlying conditions contributing to your symptoms. Regular follow-ups and a tailored approach to managing your eye health will be crucial in maintaining your vision and overall eye comfort.

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