Double Vision (Diplopia): Causes, Symptoms & Treatment
Diplopia occurs when you see two images instead of one. It can be side-by-side, on top of the other, or both. Diplopia is usually temporary, but it can signify a more serious condition. It can be caused by issues in your body and eyes, including diabetes.
Diplopia greatly affects reading ability, balance and movement. To understand more, this post will discuss the causes, symptoms and treatment of diplopia (double vision).
What is Double Vision?
Diplopia is an eye condition where a person sees two images of the same object instead of one. One of its images is faint and referred to as a "ghost image". The type of diplopia depends on what a person sees.
Horizontal diplopia - images appear side by side.
Vertical diplopia - an image appears on top of the other.
Diagonal diplopia - images are horizontally and vertically displaced from one another.
Most of the time, people associate diplopia with blurred vision.
Diplopia (double vision) can affect an eye or both. Monocular diplopia persists even when the other eye is closed. It can be caused by eye problems or, unlikely, neurological problems.
Binocular diplopia sees two images only when both eyes are open and can be caused by more serious conditions.
Double Vision Causes
Problems within the eye, muscles, or nerves controlling eye function and movement or issues in the brain can cause double vision. The most common causes of diplopia include:
Monocular diplopia:
Ill-fitting glasses or contact lenses
Iris abnormalities
Binocular diplopia:
Misaligned eyes
Cranial nerve palsy
Myasthenia gravis or multiple sclerosis
Systemic disorders like hyperthyroidism
Stroke, aneurysm, or head or facial trauma
Utilising protective safety eyewear can play a significant role in preventing injury-induced double vision. This preventive measure can help avoid cases of double vision arising from accidents or occupational hazards.
Binocular vs. Monocular Double Vision
As the name suggests, binocular diplopia is when you see two images using both eyes. It typically occurs due to misalignment in the eyes' positioning or coordination, often stemming from conditions like strabismus or nerve damage. Notably, binocular diplopia disappears when one eye is closed.
On the other hand, monocular diplopia is when double vision persists in one eye even when the other is closed. It results from structural issues within the eye, such as astigmatism, cataracts, or retinal abnormalities.
Thus, the primary distinction between the two forms lies in the cause: binocular double vision relates to issues with eye alignment, and monocular diplopia stems from optical or retinal problems.
Horizontal vs. Vertical Double Vision
Horizontal double vision occurs when two images are viewed side-by-side. This diplopia is often related to a misalignment in the medial and lateral rectus muscles, which control the horizontal movement of the eyes.
Vertical double vision, on the other hand, is when two images are seen one above the other. It often results from a malfunction in the superior and inferior rectus muscles that manage the vertical movement of the eye. Both types of double vision can be symptomatic of various neurological, muscular, or structural issues in the visual system, necessitating immediate medical attention.
When to Seek Medical Help
Double vision, or diplopia, can sometimes indicate a medical emergency. Seek immediate medical attention if you experience any of the following situations:
If you suddenly develop double vision without any apparent cause.
If you experience double vision and symptoms like severe headache, dizziness, confusion, weakness, or difficulty speaking.
If you have suffered a head injury and subsequently develop double vision.
If you have persistent or worsening double vision that does not improve with time.
If you experience double vision and symptoms like eye pain, redness, drooping eyelids, difficulty swallowing, or muscle weakness.
Diagnosing Double Vision
The diagnostic process for double vision, or diplopia, involves a comprehensive eye exam, neurological evaluations and image testing.
Comprehensive eye exam
An optometrist evaluates the patient's vision and eye health during a comprehensive eye examination. This assessment typically includes tests that check visual acuity, eye movement and alignment, refraction, and response to light. The optometrist may also inspect the exterior and interior of the eye for any abnormalities.
Neurological evaluations
In the neurological evaluations section, the patient undergoes additional assessments to check for any neurological causes of double vision. Doctors will look for any signs of stroke, multiple sclerosis, or brain tumours that could contribute to diplopia. Detailed neurological evaluations assist in pinpointing the precise cause of the double vision, thereby aiding in the formulation of a targeted treatment plan.
Imaging tests (MRI, CT scan)
Magnetic Resonance Imaging (MRI) and Computerised Tomography (CT) scans are important for diagnosing double vision. These tests provide detailed images of the brain and other structures inside the skull for medical professionals to identify what contributes to diplopia.
Diplopia Treatment
There are various treatment approaches for diplopia, depending on the underlying cause:
Eyeglasses or contact lenses
Corrective lenses or glasses may be prescribed to correct refractive errors and ocular misalignments. It is the simplest and most effective approach for treating diplopia that arises from such underlying conditions.
Eye patching or prism glasses for misaligned eyes
If the misalignment is due to strabismus, patching or prism glasses may be used to treat diplopia. Patching prevents one of the eyes from seeing double images by covering it while the other eye is doing all the work. Prism glasses, however, can provide a realigning force that helps align both eyes and reduce double-vision blurring.
Surgery for eye muscle correction
Eye muscle surgery may be necessary when the vision is distorted due to misalignment of the eye muscles caused by conditions such as Graves' Disease or trauma. Surgery involves realigning the eye muscles and resetting them into their normal position.
Medications for neurological causes
In cases where a neurological condition causes double vision, medications may be prescribed to control the symptoms of diplopia. Such medications include muscle relaxants and antispasmodic drugs that can help reduce misalignment in the eye muscles.
Living with Double Vision
Living with double vision can be challenging, but strategies can help individuals manage it effectively.
Depth Perception Exercises
These exercises help train your eyes to work together and improve spatial awareness. Slowly move the object closer to your face, keeping your eyes focused on it. It helps to strengthen the ocular muscles and improve depth perception.
Adjustments to Daily Activities
Small adjustments to your daily activities can also help manage double vision. It could include using brighter lights for reading, taking regular breaks if you're doing a task that requires much focus, or using tools and gadgets with bigger fonts.
Emotional Support and Counselling
Living with double vision can be emotionally challenging. Emotional support and professional counselling can provide strategies for managing stress and anxiety related to your condition.
Preventive Measures
Regular eye check-ups
During regular check-ups with your optometrist or an eye specialist, comprehensive eye exams detect abnormalities that cause double vision.
Protecting eyes from injuries
Wearing protective eyewear when playing sports or any activity that poses a risk to the eyes can help reduce the chance of suffering injuries and double vision.
Frequently Asked Questions (FAQs)
Is double vision always a sign of a serious medical condition?
Diplopia is not always a sign of a serious medical condition. Minor eye problems like dry eyes and astigmatism cause some. If you're concern, visit a healthcare professional as soon as possible.
Can double vision go away on its own?
Diplopia can go away on its own but seek help from a healthcare professional if it comes and goes.
Are there any home remedies to alleviate double vision?
Home remedies like eye patches, eye exercises and drops can alleviate double vision. However, these remedies should not replace medical treatment and should be in conjunction with a healthcare professional's advice.
Can stress or fatigue contribute to temporary double vision?
Stress or fatigue can cause eye strain and muscle fatigue, causing temporary double vision. But this may not be the underlying cause of diplopia.
Conclusion
Diplopia is a symptom that eye issues or neurological problems may cause. Diagnosis involves a comprehensive eye examination, neurological evaluations, and/or imaging tests like MRI or CT scans.
Treatment can range from corrective lenses, eye patching, or prism glasses to more invasive procedures like eye muscle surgery, depending on the underlying cause. Medications may be used to control symptoms stemming from neurological conditions.
Living with diplopia can be challenging, but strategies like depth perception exercises, adjustments to daily activities, and seeking emotional support can help manage the condition. Regular eye check-ups and protecting the eyes from injuries are essential preventive measures.
It's important to remember that while some instances of double vision may be linked to minor issues and can be resolved independently, a healthcare professional should always evaluate ongoing symptoms.