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Eye and Vision Care

Optic Nerve Sheath Distention



I have had both eyes turning out with double vision for the past couple of months. The orbital MRI showed "No evidence of orbital mass lesion, borderline proptosis as well as distention of the optic nerve sheaths." I have previously had a brain MRI do to having a bone meningioma in the skull, which shows nothing besides what is associated with the bone meningioma, it shows nothing within the brain. What does this mean and what would be the cause of it?


Since the orbital MRI showed no evidence of a mass lesion, that rules out cancer. But borderline proptosis and distention of the optic nerve sheaths indicates swelling either behind your eyes or in your eye muscles. When swelling in and around the eyes occurs, double vision is a common symptom.

You need to be seen by a neuro-ophthalmologist. These specialists are experts in ocular nerves and muscles, and can evaluate you for inflammatory conditions such as meningitis (inflammation of the outer layer of the optic nerve) or neurological diseases such as retrobulbar neuritis or pseudotumor cerebri. Some of these conditions can be caused by bacteria or viruses; and when a definite diagnosis is made, a specific treatment can be started to reduce the swelling and hopefully eliminate your double vision.

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Response by:

Robert D Newcomb, OD, MPH, FAAO Robert D Newcomb, OD, MPH, FAAO
Professor Emeritus of Clinical Optometry
College of Optometry
The Ohio State University