Patient's Complete Guide to Diplopia

Overview of Diplopia

Diplopia meaning in Urdu (do nazri/دو نَظری) creates double images of one object, side by side. It is also known as double vision. This condition is caused by an underlying disease such as myasthenia gravis, cataracts etc. Identifying and treating the exact cause of disease helps to prevent it.

Prevalence of Diplopia

International incidence rates of diplopia are not known. The prevalence of diplopia is a chief complaint of various eye abnormalities. About 1.4% of presenting cases were reported worldwide.

Signs and Symptoms of Diplopia

Diplopia produces the two images in front of the eyes at various angles, but there are no other signs that may appear. But some general signs associated with its cause are as follows:

  • Misalignment of one or both eyeballs
  • Feeling pain as the person moves the eye
  • Pain around your eyes, like eyebrows
  • Headache
  • Nausea
  • Weakness in eyes or anywhere else
  • Exhausted eyelids

Types of Diplopia

The diplopia forms double visions at different angles that are further categorized into different types of diplopia such as:

  1. Monocular Diplopia- It is a type of double vision that shows only from one affected eye. This is also called monocular double vision. It occurs because of changes in the opacity of the visual axis.
  2. Binocular Diplopia- Double vision is produced due to misalignment of the eyeballs. This type is caused by affecting one or more muscles around the eyeball. These muscles play a role in controlling the direction of vision.  Another name of this type is referred to as extraocular muscles. The binocular diplopia is sub-classified into two forms according to its angle of vision. It includes:
  • Horizontal Diplopia- In this type, double vision is formed due to the lateral separation of two images. It is also known as binocular horizontal diplopia.
  • Vertical Diplopia- This type is produced by a double vision in which one image is on top over the other.

Causes of Diplopia

The causes of diplopia depend on the underlying condition of patients related to its type. Some of them are as follows:

Monocular Diplopia Causes

Monocular diplopia is caused by the following conditions and is less common than binocular diplopia.

  • Astigmatism- This condition generates two curve like images due to the deformation of the cornea (outer transparent layer of the eye)
  • Dry Eye- In this condition, the eyes dried out quickly.
  • Keratoconus- It is a degenerative condition of the eye that causes thinning of eyes and becoming cone-shaped.
  • Retinal Abnormalities- It is caused due to a variety of retinal abnormalities in which the most common is macular degeneration (the central focus of vision slowly disappears and causes swelling of the eyes). In this way, double vision is produced.
  • Cataracts- This condition is more likely to cause over the age of 80 years. This can sometimes produce double vision in one or both eyes, depending on the severity of the eyes.

Binocular Diplopia Causes

Binocular diplopia is the most common type and results from misalignment of the eyes. The most common cause is a squint or strabismus.

Following are the conditions associated with binocular diplopia:

  • Strabismus- This condition results from the weakness of eye muscles and the inability to eye vision in slightly different directions. The most common symptoms of strabismus are as follows:
  • Both eyes are either paralyzed or weak
  • Limited movement of affected eyes
  • Affects the nerves controlling the eyes muscles cause abnormalities
  • Thyroid Dysfunction- Any abnormalities in the thyroid gland (in the neck) have an effect on the external muscles of the eye that controls the eye. The condition includes Grave’s ophthalmopathy, which causes the deposition of fats behind the eyes.
  • Aneurysm- In this condition, the bulge in a blood vessel is produced. This helps to press the nerve of the eye muscle.
  • Myasthenia Gravis Diplopia- This is due to the weakness of the muscles, including those that control the eyes.
  • Black Eye- This is caused due to an injury and blood and fluid accumulation around the eye. This helps to exert pressure on the eye itself or the muscles and nerves around it.

Risk Factors of Diplopia

People suffering from diplopia may experience nausea or vertigo because of the changed and disturbed vision and focus. Some people may also feel eye strain or light sensitivity. This condition can also result in brain tumours or infections. But the onset of these severe conditions is rare.

Prevention

The best way to prevent diplopia is to treat eye conditions. Certain natural remedies along with other ways are the efficient approach for strengthening the eyes such as:

  • Using the ginkgo Biloba in a healthy diet helps to improve the blood circulation of the eyes.
  • Drinking coffee in the morning prevents people from eyesight deterioration and blindness.
  • Making a habit of eye exercise makes the eye muscles stronger.
  • Excessive use of eyes makes it exhausted due to work or any other issue. For this, put cucumber or tea bags on the eyes for a soothing effect.
  • Give proper rest to the eyes for efficient working.
  • Taking omega-3 is good for the eyes.

Diagnosis

Firstly an ophthalmologist asks questions about the symptoms and condition of the eyes. Then complete eye examinations are performed for position, vision or movement of the eye.  After the physical examination, the identification of diplopia is determined on the basis of symptoms and associated conditions. In some cases, blood tests, CT scans or MRIs are required for the diagnosis of eyes, but in some, any one of the above tests may be recommended.

In children, the diagnosis of the eye is very difficult. That's why we determine the problem according to the physical signs of the eyes. They include:

  • Squinting or contracting of the eyes
  • To cover the one eye with a hand
  • Moving the children heads in different directions
  • Observing the children the way to look at objects from the side rather than the front.
  • Flickering of eyes side to side when the children see the images

Treatment of Diplopia | When to Consult a Doctor

Before selecting any treatment option, the doctor first diagnoses the cause of the vision problem. In most cases, treating the underlying condition is the main way to prevent diplopia.

Treatment of diplopia depends on the cause but there are some most common treatment options, as follows:

  • Corrective Lenses- Adjust the vision through different sizes of prisms. In this way, eyesight glasses or special lenses may suggest to the patients.
  • An eye patch or cover- The eye cover is placed over one eye to protect it from double vision temporarily. This is useful to manage diplopia in the short term.
  • Eye exercises- If double vision leads to weakened eye muscles then a doctor suggests eye exercises for strengthening the eye muscles. Therefore, eye vision is improved.
  • Surgery: Another way to treat eye problems is surgery. Surgery helps to treat cataracts or any problems within the eye. After that, eye exercises may be recommended according to the condition. This helps to treat diplopia permanently.

 If a person is showing two images at one time and cannot focus on one object. Before it gets worse, immediately consult an ophthalmologist.

Speciality for Diplopia

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