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How do health-care professionals diagnose the cause of double vision?
A thorough evaluation of double vision begins with a detailed history of the diplopia, including onset (gradual or sudden), duration, frequency (intermittent or constant), and variability with head position or eye gaze, noting any associated symptoms (pain, headache, nausea, and weight loss among others), and a complete history of past and current medical conditions. The physical examination includes measuring the visual acuity in each eye and assessing whether the diplopia is monocular or binocular. Careful examination of the eyes' alignment in various head positions is performed if the diplopia is binocular. A complete eye examination, which may include dilating the eyes, is performed to look for any ocular or orbital abnormalities. Particular attention is paid to the pupils and eyelid position if a neurologic cause is suspected. In some instances, specialized imaging (topography, CT, MRI, etc.) and other tests are needed to further investigate possible causes. When a life- or vision-threatening cause is suspected, time may is of the essence.