Double Vision (Diplopia)

Some potential causes:
Eyes-dry eye, eye strain, uveitis, wrong glasses/contacts
Infections-sinus fungal infections, Lyme disease
Autoimmune conditions- arteritis, diabetes, Graves disease, myasthenia gravis
Medicines - antibiotics (fluoroquinolone), anticonvulsants
More serious causes - aneurism, stroke, TIAs, tumor.

Questions about signs & symptoms:
1) Pain with it?
2) New type of headache or tender scalp?
3) Problems with chewing or other changes in facial sensation or muscle strength?

1) Monocular or Binocular?
(Monocular-“sees double with only one eye open” & extra image is usually a ghost. Binocular-“sees double only if both eyes are open” & the problem disappears when covering either eye.)
2) Is pupil reactive to light or sluggish?
3) Eye movement issues?
4) Comitant or Incomitant?
(Comitant-“double vision is the same no matter where the patient turns his head.” Incomitant-“double vision goes away when the patient turns his head to the left but remains bad when turned right.”)

Blood Tests:
1) Sed rate aka erythrocyte sedimentation rate (ESR) for possible autoimmune/inflammatory conditions
2) glucose for possible diabetes

Depending on the cause, sometimes it can be corrected by special glasses or eye muscle exercises

(Always see an ophthalmologist)

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There are many types of anemia. It can be due to decreased production or increased destruction of red blood cells (RBCs). RBCs carry oxygen to tissue.

Potential Signs & Symptoms:
Fatigue, weakness, or shortness of breath, especially upon exertion
Cognitive complaints, headaches, or dizziness
Peripheral neuropathy (in B12 deficiency anemia)

Potential Causes of Anemia:
Autoimmune attacks against RBCs
Endocrine diseases (hypothyroidism)
Infections (parasites)
Inherited blood disorders
Renal failure
Deficiency of iron, folic acid, or vitamin B12 
Medicines (calcium-containing antacids, Methotrexate, … )
(Check #anemia for more causes)

Iron Deficiency Anemia (IDA)

(Most Common Type & More Prevalent in Women)

Potential Signs & Symptoms:
Hair loss
Whites of eyes may have blue tinge
Sore tongue
Pale skin
Restless legs syndrome

Potential Causes of IDA or iron deficiency:
Celiac disease
Diet may not contain adequate iron
Endocrine disease (subclinical hypothyroidism)
GI bleeding (ulcers, GI diseases, GI polyps, GI cancer, varices from cirrhosis)
Infection (parasites)
Heavy menstration
Medicines (calcium-containing antacids)
Pancreatic enzyme supplements

Potential Options:
Gluten-free diet in celiac disease
Thyroxine in Hashimoto’s thyroiditis
Dietary iron in meat, whole grains, vegetables containing beta carotene
Iron supplements (may cause stomach upset)
IV iron or IM Iron (IV iron may cause hypersensitivity reactions)
Hyperbaric oxygen in some cases

(Please get tested first since too much iron can cause other health problems)

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