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← Return to Tapering off of Prednisone
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I had an "interesting" experience with double vision. I think it was generated by PMR inflammation. It has resulted in the opposite of "tapering".
It was confirmed that this is NOT due to Giant Cell Arteritis, based on an MRI of my head, a close physical exam of my head by an experienced ER doctor, a rheumatologist's review of my symptoms, and a large group of blood tests.
Here's what happened: I awoke with a feeling of pressure behind my right eye. It also hurt to rotate my eyes in any direction away from straight forward. I went about my normal activities and took my prednisone as usual.
However, around noon, just after I climbed stairs to the second floor of our house, I started seeing double. This was uncontrollable and very disturbing indeed. Fortunately, my wife, who was shopping at the time, came home shortly, and drove me to the emergency room. Driving myself seemed like a really bad idea. The concern was Giant Cell Arteritis (GCA), which has to be treated immediately. I took an extra 20 mg of prednisone, beyond my usual 20 mg, as a precaution. This seemed to help. The feeling of pressure behind my right eye and the double vision episodes lessened in about 30 minutes, and it continued to get better throughout the day.
As I described above, the ER personnel confirmed that I do NOT have the inflamed head arteries that characterize GCA, and that I did not have a stroke.
However, they could not explain the double vision.
Here's what I think happened: the PMR had inflamed my eye muscles, and they had become very sore and swollen. Climbing stairs increased the blood pressure in my head, further increasing the size of the swollen eye muscles. That generated double vision.
I was diagnosed with PMR on Feb 3, 2023, and have been taking 20 mg/day of prednisone. Unfortunately, this has still left me quite inflamed and sore (recent CRP = 130 mg/l, down from untreated level of 346 mg/l).
Since this double vision episode, the ER doctors and my rheumatologist have upped the prednisone dosage to 60 mg/day. However, I found that the 40 mg dose on the day of the double vision (two days ago) actually seemed to work quite well at relieving my symptoms, and have stuck with that so far.
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I was diagnosed with PMR about 15 years ago. For twenty years before PMR was diagnosed I would have problems with my eyes because of uveitis. Uveitis is a serious condition too and caused pain, floaters, light sensitivity, visual disturbances and could lead to blindness if not treated.
https://www.mayoclinic.org/diseases-conditions/uveitis/symptoms-causes/syc-20378734#:~:text=Uveitis%20is%20a%20form%20of,redness%2C%20pain%20and%20blurred%20vision.
I was also diagnosed with trigeminal neuralgia about the same time when I was seeing my ophthalmologist for the treatment of uveitis. He said the temporal headaches and jolts of electricity around my eye had nothing to do with the inflammation inside my eye. My ophthalmologist referred me to a neurologist who made the diagnosis.
https://www.mayoclinic.org/diseases-conditions/trigeminal-neuralgia/symptoms-causes/syc-20353344#:~:text=Overview,your%20face%20to%20your%20brain.
Uveitis and trigeminal neuralgia never really went away when PMR was diagnosed. When my rheumatologist told me the symptoms of GCA were headaches with visual disturbances and could cause blindness it made me chuckle a bit. I told my rheumatologist that I had those symptoms all the time.
I explained to my rheumatologist that I usually would take 60-100 mg of prednisone for uveitis and/or trigeminal neuralgia. I asked my rheumatologist how would I know if it was GCA or not?