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Diplopia: Double Vision – Causes and Treatment

Diplopia is the medical term for double vision. Affected individuals perceive a single object as two separate images, either side by side or overlapping.

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Things worth knowing about "Diplopia"

Diplopia is the medical term for double vision. Affected individuals perceive a single object as two separate images, either side by side or overlapping.

What is Diplopia?

Diplopia is the medical term for double vision, a condition in which a single object is perceived as two distinct images. It can affect one eye only (monocular diplopia) or both eyes together (binocular diplopia). Binocular diplopia disappears when one eye is closed, whereas monocular diplopia persists even with one eye covered. The condition can be temporary or chronic, and its underlying causes range from minor eye problems to serious neurological emergencies.

Causes

The causes of diplopia vary depending on whether the monocular or binocular form is present.

Causes of Monocular Diplopia

Corneal irregularities (e.g., keratoconus, scarring)
Lens opacity (cataracts)
Retinal disorders
Astigmatism (irregular curvature of the cornea)
Dry eye syndrome

Causes of Binocular Diplopia

Extraocular muscle palsies due to damage to the III, IV, or VI cranial nerves
Strabismus (misalignment of the eyes)
Graves disease (thyroid disorder with eye involvement)
Myasthenia gravis (neuromuscular disease)
Multiple sclerosis
Stroke or transient ischemic attack (TIA)
Brain or orbital tumors
Head or eye trauma
Diabetes mellitus (diabetic neuropathy affecting eye muscles)
Cerebral aneurysms

Symptoms

The hallmark symptom of diplopia is seeing two images of a single object. Additional symptoms may include:

Headaches
Dizziness and nausea
Eye pain or pressure behind the eye
Drooping eyelid (ptosis)
Squinting or misaligned eyes
Balance disturbances
Compensatory head tilting

Sudden onset of double vision accompanied by other neurological symptoms such as speech difficulties, numbness, or limb weakness constitutes a medical emergency and requires immediate evaluation.

Diagnosis

Diagnosis of diplopia involves a thorough clinical assessment, often conducted jointly by ophthalmologists and neurologists. Common diagnostic steps include:

Ophthalmological examination: Assessment of eye movements, pupil responses, and lens clarity
Cover test: Used to distinguish monocular from binocular diplopia
Imaging: Magnetic resonance imaging (MRI) or computed tomography (CT) to evaluate the brain, cranial nerves, and orbital structures
Blood tests: To rule out systemic conditions such as diabetes, thyroid disorders, or autoimmune diseases
Neurological examination: Assessment of cranial nerve function and other neurological indicators

Treatment

Treatment depends entirely on the underlying cause and aims to resolve or reduce double vision while addressing the root condition.

Prism lenses: Corrective eyeglasses with prisms to optically realign the two images
Eye patch: Temporary occlusion of one eye to eliminate double vision
Strabismus surgery: Surgical realignment of the eye muscles
Botulinum toxin injections: Relaxation of overactive eye muscles
Medication: For underlying conditions such as myasthenia gravis, Graves disease, or inflammatory causes
Neurological or neurosurgical intervention: For tumors, aneurysms, or stroke
Refractive correction: Glasses or contact lenses for astigmatism-related diplopia

References

Pschyrembel Clinical Dictionary. 268th edition. De Gruyter, Berlin 2024.
Kaufman PL, Alm A (eds.): Adler's Physiology of the Eye. 11th edition. Elsevier, 2011.
American Academy of Ophthalmology (AAO): Diplopia – Preferred Practice Pattern. Available at: www.aao.org

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