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Double vision, medically known as diplopia, is an eye condition where a person sees two separate images of a single object. These images can appear side by side, on top of one another, or at a diagonal. It can occur for many reasons, ranging from minor issues to serious medical conditions like diabetes or a head injury.

Double vision can significantly affect a person’s balance, movement, and reading ability.

There are two main types:

• Binocular double vision only occurs when both eyes are open. Closing one eye makes the double image disappear. This is caused by the eyes being misaligned and seeing things slightly differently.

• Monocular double vision is present even when one eye is closed, indicating the issue is likely within that single eye itself.

Treatment depends entirely on the underlying cause and type. Options can include eye exercises, specially designed glasses with prisms, or surgery.

This article looks at the causes, diagnosis, and treatment of double vision.

Key Facts About Double Vision

• Double vision can result from a range of underlying conditions.

• It can affect just one eye or both.

• A childhood eye turn (strabismus) can sometimes recur later in life and cause double vision.

• Substances like alcohol or recreational drugs can cause temporary double vision.

• Treatments can include surgery, eye exercises, or corrective lenses.

What Does Double Vision Look Like? What a person sees depends on the type of diplopia they have:

• Horizontal: The double image appears side by side.

• Vertical: One image appears on top of the other.

• Diagonal: The images are both horizontally and vertically displaced from each other.

The misalignment is sometimes constant and obvious, but it may only appear when a person moves their eyes in a particular direction. In some cases, a person may not be consciously aware of the double vision because their brain has learned to ignore, or “suppress,” the image from one eye to avoid confusion.

Causes of Double Vision Vision relies on both eyes creating individual images that the brain combines into a single, clear picture with depth perception. Anything that disrupts this process can cause diplopia.

Causes of Binocular Double Vision A common cause is strabismus (a squint), where the eyes are not correctly aligned. Other conditions include:

• Thyroid dysfunction: Such as Graves’ ophthalmopathy, which can affect eye muscles and cause the eyes to protrude.

• Stroke or transient ischemic attack: Can affect blood supply to the nerves controlling the eye muscles.

• Aneurysm: A bulge in a blood vessel that can press on an eye nerve.

• Diabetes: Can damage the nerves that control eye movement.

• Myasthenia gravis: A condition causing muscle weakness, including in the eye muscles.

• Brain tumors: A growth behind the eye can impair movement or damage the optic nerve.

• Multiple sclerosis (MS): Affects the central nervous system, including the eye nerves.

• Head injury: Physical damage to the brain, nerves, or eye socket can restrict eye movement.

Causes of Monocular Double Vision If double vision persists when one eye is closed, the cause is usually within that eye. Conditions include:

• Astigmatism: An irregularly curved cornea that distorts light entering the eye.

• Dry eye: The eye doesn’t produce enough tears, leading to inflammation and distorted vision.

• Keratoconus: A degenerative condition where the cornea becomes thin and cone-shaped.

• Cataracts: The lens of the eye becomes cloudy, which can sometimes cause double vision in one eye.

• Retinal abnormalities: Conditions like macular degeneration can cause swelling and distortion.

Temporary Double Vision Double vision can sometimes be short-lived. Common causes include:

• Alcohol intoxication

• Use of certain medications (e.g., benzodiazepines, opioids)

• Extreme fatigue or eye strain

• Head injuries like concussions

If normal vision does not return quickly after a suspected cause, it is essential to seek medical attention.

Diagnosing Double Vision Diagnosis can be complex due to the many possible causes. An eye specialist will first determine if the double vision is monocular or binocular, as this points to whether the issue is within the eye itself or related to the nerves and muscles controlling eye alignment. Diagnosing children can be challenging, but signs include squinting, covering one eye with a hand, or turning their head in an unusual way to see.

Treatment for Double Vision Treatment is tailored to the specific cause.

Treatment for Monocular Double Vision

• Astigmatism: Corrected with glasses, contact lenses, or laser surgery.

• Cataracts: Treated with surgical removal of the cloudy lens.

• Dry eye: Managed with artificial tear eye drops.

Treatment for Binocular Double Vision

• Glasses: Sometimes with prisms ground into the lenses to help realign the images seen by each eye.

• Eye exercises: To help the eyes work together better.

• Opaque contact lens or eye patch: To block the image from one eye and eliminate double vision.

• Surgery: To adjust the position of the eye muscles and correct alignment.

• Botox injections: In some cases, Botox can be used to relax an overactive eye muscle.

 

Conclusion

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