What is Double Vision (Diplopia)?

What is Double Vision (Diplopia)?

Double Vision (Diplopia) is the perception of more than one image of an object. Patients may experience double vision in one or both eyes. Binocular diplopia is the patient’s multiple vision with both eyes open. It is usually caused by a problem with the eye muscles and the nerves that supply the eye muscles.

The eyes cannot look at the same point in coordination and diplopia occurs. Under normal circumstances, the visual focus should be parallel. A person can see everything easily with one eye, but when both eyes are opened, they see double. The most common cause of this condition is neurological diseases.

There may also be double vision, called monocular diplopia, in one eye. In this case, the cause is usually the eye’s inability to focus on a single point. This condition is most often caused by an eye disorder called astigmatism.

What are the Types of Double Vision (Diplopia)?

Diplopia (Double Vision) has two types of diplopia, monocular diplopia and binocular diplopia:

• Binocular Diplopia:

This type of vision problem is present in both eyes. This condition is called binocular vision.
Binocular double vision occurs if the double vision disappears when you close both eyes while experiencing double vision.
Binocular diplopia occurs when both eyes are open.
Therefore, it can be corrected when one eye is closed or closed.

• Monocular Diplopia:

Monocular double vision occurs less frequently than binocular double vision. This condition manifests as double vision in just one eye, distinguishing it from binocular forms.

The affected eye is often referred to as the “bad eye,” while the unaffected one is termed the “good eye.”

In cases of monocular diplopia, vision returns to normal quality when the individual covers the bad eye with their hand.

What are the Causes of Double Vision (Diplopia)?

1. Causes of Binocular Double Vision

One cause of binocular diplopia may be double vision due to strabismus. It is a disorder that occurs when the eyes are not aligned properly. Although it is more common in children, it may not always result in double vision.

Strabismus is the condition of the eyes looking in different directions. Strabismus can occur due to the fact that the affected eye muscles face certain difficulties.

Eye muscles;

• Paralyzed or weak
• Movement restriction, very vigorous or overactive movement,

It can occur due to abnormalities in the nerves that control the muscles. Sometimes a strabismus treatment can lead to double vision when it is seen that the person’s vision is normal in the period before the strabismus is treated. This is because the brain suppresses signals from one of the eyes to maintain normal vision.

Other conditions that can cause double vision include:

• Thyroid Dysfunction:

Disorders in the thyroid structure and changes in its functioning may affect the control mechanism of the eye. Grave ophthalmopathy, in which the eyes appear protruding due to the fat and tissue accumulating behind the eye, can also be seen in patients.

• Stroke or Transient Ischemic Attack (TIA):

Stroke, which prevents blood from reaching the brain, occurs due to a blockage in the blood vessels. This formation can also negatively affect the blood vessels that feed the brain and the nerves that control the eye muscles, which is one of the factors that can cause double vision.

• Aneurysm:

Aneurysms can press on the nerve of the eye muscle due to swelling in the blood vessel.

• Convergence Failure:

It is the inability of the eyes to work together in sync. Although the cause varies, there is no definite reason. It is thought to be due to the fact that the muscles controlling the eye are not properly aligned.

• Diabetes:

Diabetes can have an effect on the blood vessels that feed the retina at the back of the eye. This condition can also impact the nerves responsible for controlling the movement of the eye muscles.

• Myasthenia Gravis:

It is thought to be caused by weakness in the eye muscles.

• Brain Tumors and Cancers:

Tumor or growth in the back of the eye may cause disturbances in the free movement mechanism or damage the optic nerve.

• Multiple Sclerosis:

Multiple sclerosis is a disease that affects the central nervous system as well as the optic nerves.

• Head Injury:

Blow or injury to the head; If it coincides with physical damage to the brain, nerves, muscles, or eye socket, it may impose movement restriction on the eye itself or its muscles.

2. Causes of Monocular Double Vision

• Astigmatism
• Corneal shape changes
• Cataract
• Dry eye syndrome
• Pterygium (eyeball attached to the cornea layer)
• Iris (colored part of the eye) abnormalities

Transient Double Vision (Diplopia)

There may also be cases of temporary double vision. Alcohol poisoning, opioids (morphine-based), benzodiazepines (psychoactive drugs), or some drugs used for seizures and epilepsy can cause temporary double vision. Head injuries caused by concussion can also cause temporary double vision.

Tired or tense periods can also cause double vision. In cases where double vision does not return to normal vision, it is recommended to seek medical attention as soon as possible.

What are the Symptoms of Double Vision (Diplopia)?

Although the most characteristic symptom is double vision, diplopia can also be seen in the following other symptoms:

• Headache
• Nausea, stomach discomfort
• Drooping eyelids (Ptosis)
• Pain with eye movements in one or both eyes
• Dizziness, sudden loss of balance
• Pain that can be seen even with small eye movements

At Which Stage Should Those Who Have Double Vision (Diplopia) Apply to a Doctorate?

Individuals experiencing double vision should promptly consult a doctor. Even if the condition resolves quickly, it is important to have it properly evaluated.

One common concern among those with double vision is determining the appropriate specialist or department to consult.

This is particularly crucial as the issue could stem from either eye–related conditions or neurological problems. If you notice double vision, it’s essential to visit a healthcare facility without delay.

A thorough examination will help identify whether the issue involves one eye (monocular) or both eyes (binocular). Generally, double vision concerns are addressed by specialists in either the ophthalmology or neurology departments.

If the double vision occurs in just one eye, it is likely related to an eye condition. However, if it affects both eyes, the underlying cause is more often associated with the nervous system.

How Is Double Vision (Diplopia) Diagnosed?

Double vision should be initially diagnosed as monocular or binocular. Although it is difficult to determine the cause, it is easy to determine the double vision. Statement of your symptoms and vision experiences will facilitate the diagnosis.

Your doctor may do additional vision tests to analyze your symptoms at your visit. They will also do a short test to diagnose the type of diplopia. The following may be necessary to find the cause:

1. Evaluation of Your Current Health Status

• A Complete History of Your Symptoms:

Telling your doctor about your medical history and vision problems can provide useful data to rule out possible causes and to perform the right tests. Even if you have any doubts about your vision problem, it is important to report any unusual symptoms you are experiencing to your doctor.

• Your Personal Health History:

The source of your vision problem; may be due to diabetes, thyroid disorders, or neurological disorders.

• Your Family Health History:

Finding out if there are other members of your family with the same problem.

2. Physical Examination

• Blood tests for infection analysis
• Vision check and dilated eye examination
• Eye movement tests
• Toxicity tests
• Blood sugar tests
• Imaging tests such as CT scan or MRI

How Is Double Vision (Diplopia) Treated?

Treatment for double vision depends on what is causing the double vision. In many instances, double vision issues resolve once the root cause is addressed effectively.

The most common treatments for diplopia include:

Monocular Double Vision Treatment

• Astigmatism:

With the use of glasses or lenses, double vision defects caused by astigmatism can prevent monocular double vision by correcting the passage of light into the eye.

• Laser Surgery:

Double vision can be treated by reshaping the cornea with laser surgery.

• Cataract:

The best treatment option for cataracts, which blurs vision and is one of the most common causes of double vision, is surgery. Today, a person can get rid of the double vision problem with a very easy operation.

• Dry Eye:

Dry eye, which is one of the causes of double vision;

1. Artificial tear drops used instead of tears,
2. Anti-inflammatory drops,
3. It can be treated with punctal plugs and warm compresses.

Binocular Double Vision Treatment

Binocular vision treatment varies depending on the cause of the double vision. Treatments include:

• Using glasses
• Eye exercises
• Using an eye patch
• Using lenses
• Filling application
• Surgery to correct the position of the eye muscles

How Can Double Vision (Diplopia) Be Prevented?

There is no sure way to prevent double vision disorder.

But it may be possible to protect eye health with some simple steps:

• Do not smoke
• Do not consume excessive alcohol
• Include foods in your diet that are recognized for supporting eye health, particularly those rich in phosphorus.
• Do not look at the phone, television, computer, tablet screen for a long time. Make sure to rest your eyes by taking small breaks.
• Wear protective glasses suitable for your work or sports activities.
• Get regular sleep
• Do not neglect to have your eye examination every 1-2 years.