Double Vision: Diagnosis and Treatment

This is Part 2 on the topic of “Understanding Double Vision?”

Part 2: Diagnosis and Treatment

Article Image | Understanding Diplopia

Because there are so many causes for double vision, getting to the root cause can be a challenge. “Diplopia” is a symptom and not the cause. The cause can be as simple and benign as dry eye or as life-threatening as an intracranial tumor and many other causes in between those extremes.

The exam to determine the cause of diplopia starts with a thorough medical history and questions about how the double images look to you. Are the images in only one eye or both eyes? Are the doubled images horizontal or vertical or oblique? Does the direction of your gaze help separate the two images? These questions help determine if your double vision is monocular (one eye) or binocular (involves both eyes) and if one of the six extraocular muscles is involved.

A complete examination of the cornea, lens, retina, and optic nerve of each eye is done. Then your eye movements will be observed while you report any double images you see during your eye movements.  

The most common causes of double vision are refractive errors, dry eyes, cataract, and eye misalignment. All of these can be diagnosed with a comprehensive eye exam.

A CT or MRI to detect a tumor or a stroke is only necessary if all the common causes are ruled out as the cause of your diplopia and you have additional symptoms along with the double vision such as pain or numbness around your eye sockets, facial weakness, and/or swallowing or speech problems.

Treatment of Double Vision

Treatment depends on the cause. If the cause is astigmatism, sometimes a new eyeglass prescription will take care of the problem. A prism can be used in the glasses to align the overlapping images when the cause is eye misalignment caused by eye muscle problems. Surgery on eye muscles is also used to treat some cases of double vision. If the cause is cataracts, they can be surgically removed.

A common cause of diplopia and blurred vision is dry eye syndrome. Treatment of dry eyes begins with the use of artificial tears or anti-inflammatory drops.  

If the double vision is caused by poor blood supply to the nerves in diabetics, the condition often resolves in time as their blood sugar is stabilized.

When double vision is caused by any issue that is temporary and expected to resolve in time, you may be given glasses with prisms or you may wear a patch on one eye as a way to temporarily correct the diplopia until it resolves naturally.