Double Vision (Diplopia)

  • Medical Author:
    Patricia S. Bainter, MD

    Dr. Bainter is a board-certified ophthalmologist. She received her BA from Pomona College in Claremont, CA, and her MD from the University of Colorado in Denver, CO. She completed an internal medicine internship at St. Joseph Hospital in Denver, CO, followed by an ophthalmology residency and a cornea and external disease fellowship, both at the University of Colorado. She became board certified by the American Board of Ophthalmology in 1998 and recertified in 2008. She is a fellow of the American Academy of Ophthalmology. Dr. Bainter practices general ophthalmology including cataract surgery and management of corneal and anterior segment diseases. She has volunteered in eye clinics in the Dominican Republic and Bosnia. She currently practices at One to One Eye Care in San Diego, CA.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Double Vision Symptoms

Double vision, or "seeing double," occurs when two nonmatching images are sent to the part of the brain that is responsible for processing visual input. If this occurs over the long term, the brain will eventually compensate for the two signals by suppressing one signal, so that a single image is perceived.

What is double vision?

Double vision is the perception of two images of a single object seen adjacent to each other (horizontally, vertically, or obliquely) or overlapping. Double vision is medically termed diplopia. Polyplopia is the perception of three or more images of a single object overlapping each other.

What causes double vision?

There are dozens of causes of double vision ranging from benign to life-threatening. Therefore, it is important for the doctor to carefully review the history and the examination to determine the cause and initiate appropriate treatment when necessary. Sometimes, emergency treatment is needed.

Most causes of monocular diplopia stem from poor focusing of light by the eye. Refractive errors (myopia, hyperopia, astigmatism) are common. Dry eye (from a variety of causes such as meibomitis, Sjögren's syndrome, and decreased tear production following refractive surgery) can produce diplopia that varies with blinking. Cataracts (clouding of the natural lens) and posterior capsule opacification (after cataract surgery) are common in people over 60 years of age. Other conditions that interfere with proper focusing of light include corneal irregularity from swelling or scars and retinal conditions, such as epiretinal membranes. Rarely is the underlying cause a medical emergency in cases of monocular diplopia.

Binocular diplopia on the other hand is produced by a misalignment of the eyes, which can be caused by life-threatening conditions. For example, aneurysms, strokes, trauma (head injury), and brain swelling (such as from brain cancer) can interfere with the nerves that control the extraocular muscles. The extraocular muscles move the eyes in different direction of gaze, much like the strings on a marionette, and when one or more muscle is weakened or paralyzed, it is referred to as cranial nerve palsy. In multiple sclerosis, lesions in regions of the brain that control eye alignment may result in diplopia that varies over time. Guillain-Barré syndrome can produce diplopia from restricted eye movement due to nerve damage. Migraine headaches can cause a sudden but temporary eye misalignment. Diseases such as myasthenia gravis can interfere with the communication between the nerves and the eye muscles to cause diplopia. And the eye muscles themselves can be damaged or compressed by conditions such as Graves' disease (often associated with thyroid disease), orbital inflammations, vascular disease (as seen with diabetes and high blood pressure), and others. Following traumatic fracture of the orbital bones, muscles and orbital tissue may be trapped in the fracture, leading to restriction of eye movement in certain directions of gaze. Sometimes the cause is relatively harmless, such as when the eye muscles or neurologic signals to the muscles weaken with fatigue or illness. Inability to align the eyes when focusing on a near object (convergence insufficiency) is a common benign cause of intermittent binocular diplopia that can often be treated with prism glasses.

Medically Reviewed by a Doctor on 5/26/2016

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