Double vision: Symptoms, Treatments and Prevention

Double vision can impact people of all ages and often interferes with daily tasks like reading, driving, or walking. Depending on the cause, the experience may vary from mild discomfort to severe disorientation.

Types of Double Vision

• Binocular: The most common type is when the eyes are not properly aligned with one another. Most often, it has to do with strabismus.
• Monocular: A much less common variant when one eye produces double vision. It is linked to an anomaly of the eyes, like astigmatism or cataracts.
• Polyplopia: Rare; the perception of three or more images of a single object.

Common Causes of Double Vision

Double vision can be caused by a variety of issues affecting the eyes, nerves, or brain. Identifying the underlying cause is key to choosing the right treatment and preventing complications. It may be triggered by conditions such as stroke, head injury, brain tumor, brain swelling, or aneurysm of the brain:

• Neurological Disorders: Conditions like brain tumors, stroke, or head injuries can cause sudden double vision. You may be referred to a neurologist for further tests and treatment.
• Corneal Irregularities: Issues like keratoconus or other corneal diseases can lead to double vision. Treatment may include eye drops, special contact lenses, or surgery like corneal transplants.
• Dry Eyes: Lack of moisture can blur vision and cause double vision. Using eye drops, maintaining eyelid hygiene, and taking eye vitamins can help.
• Refractive Surgery (e.g., LASIK): Some people experience temporary double vision after eye surgery. This usually goes away, but sometimes a second procedure is needed.
• Cataracts: When the eye's lens becomes cloudy, it can scatter light and cause double vision. Cataract surgery usually solves this problem.
• Cranial Nerve Palsy: This occurs when the nerves controlling eye movement are damaged, often due to conditions like diabetes, stroke, high blood pressure, or infections. It can affect how your eyes align, causing double vision.

Conditions that Cause Double Vision

• Graves' Disease (Thyroid Eye Disease)
• Multiple Sclerosis (MS)
• Aneurysms
• Brainstem Lesions
• Orbital Fractures or Trauma
• Sinus Tumors or Infections (affecting the orbit)
• Brain Infections (e.g., encephalitis)
• Pituitary Tumors
• Oculomotor Nerve Palsy
• Diabetic Neuropathy (specific to eye muscles)

Related Symptoms of Double Vision

If you have double vision (diplopia), you may notice these symptoms:

• Seeing Two Images: Seeing two images of one object, side by side, on top of each other, or both.
• Blurred Vision: Trouble seeing clearly with fuzzy images.
• Difficulty with Focus: Trouble keeping a clear and steady image.
• Eye Strain: Tired or uncomfortable eyes.
• Headaches: Persistent or recurring headaches with vision issues.
• Disorientation: Feeling confused or having trouble with spatial orientation due to overlapping images.
• Misalignment: Noticing that eyes may not appear to be correctly aligned.

If you have double vision, it's important to see a healthcare professional for the right diagnosis and treatment.

What is the Double Vision Test?

• Visual Acuity Test: Measures vision sharpness.
• Eye Alignment Test: Checks if eyes work together properly.
• Cover Test: Observe eye adjustment when one eye is covered.
• Prism Test: Diagnoses and measures double vision extent.
• Ocular Motility Test: Assesses eye movements and coordination.
• Slit Lamp Examination: Examines the cornea and lens for irregularities.
• Neurological Examination: Identifies underlying neurological issues.

When to Visit a Doctor?

Double vision frequently requires a medical check to determine the cause. Having double vision is a sign that something is wrong with your neurological system, brain, or eyes. A thorough assessment is required to determine the cause of the issue.

A curable disease is often the cause of the additional picture that appears in your range of vision. However, if your vision suddenly changes, you should get medical help right once. Certain disorders require immediate medical intervention in order to avoid life-threatening complications or permanent visual loss.

Diagnosis and Tests

Pay attention to the present condition of your health

You and your doctor may spend some time updating your medical history. This includes:

• A complete history of your symptoms: Your doctor can help you check out potential reasons and determine which tests would be beneficial if you fully describe your vision problems. If you have noticed any unexpected symptoms, even if you don't think they have anything to do with your visual issue, make sure you report them to your doctor.
• Your personal health history: Your doctor may consider underlying factors such as diabetes, thyroid problems, or neurological disorders that could be causing your vision problems.
• Your family health history: Inform your doctor if any members of your family suffer from conditions that can cause double vision. These issues may serve as a solid basis for your diagnosis.

Physical examination

A thorough physical examination can assist your physician in determining the potential cause of your double vision. This exam may include:

• blood tests to look for an infection
• eye exam and dilated eye exam
• eye movement tests
• toxicity tests
• blood sugar readings
• imaging tests, such as a CT scan or MRI

Treatment and Management

Treatment depends on the root cause:

Astigmatism

This happens when the cornea (front part of the eye) has an irregular shape. It can cause blurry or double vision. Glasses, contact lenses, or laser surgery can fix the problem by reshaping the cornea.

Cataracts

A cataract makes the eye's lens cloudy, which can lead to double vision. Surgery is usually the best option and removes the cloudy lens, often curing the problem. Treating cataracts early can help prevent other issues like infections or long-term blurry vision.

Dry Eye

When your eyes don't produce enough tears or dry out too quickly, they can become irritated and lead to double vision. Using prescription eye drops to replace moisture usually helps reduce the symptoms.

Cranial Nerve Palsy

May involve steroids, managing underlying conditions like diabetes, or surgery.

Eye Muscle Imbalance

• Wearing glasses
• Eye exercises
• Using an opaque contact lens
• Injections of botulinum toxin (Botox) into the eye muscles, causing them to remain relaxed
• Wearing an eye patch
• Surgery on the eye muscles to correct their position
• An adhesive prism, placed between the eyes in the centre of the glasses frame, can also help realign the images from each eye.

Prevention of Double vision

Prevention of diplopia begins with prevention of the underlying cause. To keep your eyes safe, here are some tips:

Manage your diabetes

Following your diabetes treatment plan can help prevent double vision. Eating a healthy diet, staying active, and maintaining a healthy weight can lower your risk of type 2 diabetes, which is a common cause of double vision.

Prevent cataracts

Protect your eyes by eating well, quitting smoking, and wearing sunglasses to reduce your risk of cataracts.

Soothe Dry Eyes

Keep your eyes moist to avoid double vision caused by dryness. Take breaks during screen time and use eye drops if needed.

Avoid Head Injuries

Wear seat belts, helmets when biking or riding, and protective gear during sports or heavy work to prevent brain injuries that may cause double vision.

Home Remedies of Double Vision

• Warm Compresses: May reduce eye muscle tension.
• Hydration & Omega-3s: Supports eye moisture and reduces dry eye risk.
• Rest & Eye Exercises: Can help reduce strain-induced temporary diplopia.
• Eye Patch: Helps in temporary relief, especially in one-eye involvement.

Lifestyle Changes of Double Vision

• Adjust Screen Usage: Use screen filters and maintain proper lighting.
• Improve Nutrition: Eat leafy greens, carrots, and fish rich in omega-3.
• Quit Smoking: Reduces risk of cataracts and nerve damage.
• Limit Alcohol: Protects neurological and visual health.
• Physical Activity: Improves overall blood circulation and eye health.
• Regular Checkups: Manage chronic conditions that may cause diplopia.