Double vision in one eye and two eyes
This is the first thing the doctor finds out, and everyone can check: you need to close one eye and the other in turn. If double vision disappears when you close either eye, it is binocular - it is associated with a mismatch in the functioning of the eyes and requires a search for the cause in the muscles, nerves or brain. If double vision persists in one open eye, it is monocular and is almost always caused by the optics of the eye itself: clouding of the lens, unevenness of the cornea, severe astigmatism or dryness. Monocular diplopia is generally less dangerous.
- Binocular double vision disappears when either eye is closed
- Monocular is preserved in one eye
- Binocular - muscles, nerves, orbit, brain
- Monocular – cataract, astigmatism, dry eye, keratoconus
- Doubling vertically, horizontally or at an angle is an important clue
Reasons
The most common cause of sudden binocular double vision in adults is a malfunction of one of the oculomotor nerves, often due to diabetes mellitus or hypertension. Double vision can be a manifestation of a stroke, aneurysm, tumor, multiple sclerosis, myasthenia gravis, endocrine ophthalmopathy in diseases of the thyroid gland, as well as a consequence of a fracture of the orbital wall. In children, the cause is decompensated strabismus. Temporary double vision at the end of the day without other complaints is often associated with fatigue and impaired muscle function nearby.
- Paresis of the oculomotor, trochlear or abducens nerve
- Stroke and other vascular causes
- Myasthenia gravis - double vision worsens in the evening
- Endocrine ophthalmopathy
- Trauma and fracture of the orbital wall
- Decompensated strabismus
- Cataracts and astigmatism with monocular double vision
Survey
The ophthalmologist checks visual acuity, position and mobility of the eyes in all directions, performs cover tests, evaluates the pupils and eyelids, and examines the fundus. The neurologist checks other cranial nerves and the overall neurological picture. For binocular double vision, an MRI of the brain is almost always prescribed, if necessary, focusing on the orbits and blood vessels. Additionally, glucose and thyroid hormones are examined, and if myasthenia gravis is suspected, specific antibodies and tests are performed.
- Testing visual acuity and eye mobility
- Alternating eye covering test
- Examination of the fundus and pupillary reactions
- Computer perimetry
- MRI of the brain and orbits
- Blood glucose, thyroid hormones
- Examination for myasthenia gravis according to indications
What to do before seeing a doctor
If double vision occurs suddenly, is accompanied by a headache, weakness in the limbs, speech impairment or drooping eyelids, emergency help is needed, in Uzbekistan this is number 103. Do not drive and avoid working at heights and with moving mechanisms. For temporary relief, you can cover one eye with a bandage or dark glass: the brain will stop receiving the second image. It is not advisable to constantly wear an occlusion without a prescription, especially for children - this can interfere with the development of vision.
- In case of sudden double vision, call an ambulance (103)
- Do not drive or work at heights
- Temporarily cover one eye for comfort
- Record when and in what direction you look double
- Bring your previous glasses and examination results to your appointment.
- For children, use occlusion only as prescribed by a doctor.
Treatment
It is not the double vision itself that is treated, but its cause: for diabetes and hypertension, control of indicators is achieved; for myasthenia gravis and endocrine ophthalmopathy, specific therapy is carried out; in case of orbital injury, surgery may be required. Paresis of the oculomotor nerve due to vascular factors often recovers on its own within several months, and during this time prismatic correction or temporary occlusion is prescribed. If after 6–12 months the deviation remains stable, botulinum toxin injections into the eye muscle or surgery on the extraocular muscles are discussed.
- Control of diabetes and blood pressure
- Prisms in glasses for image fusion
- Temporary occlusion of one eye
- Treatment of thyroid disease
- Myasthenia gravis therapy
- Surgery on the eye muscles for persistent deviation
