Diplopia

Astrid Leitner studied veterinary medicine in Vienna. After ten years in veterinary practice and the birth of her daughter, she switched - more by chance - to medical journalism. It quickly became clear that her interest in medical topics and her love of writing were the perfect combination for her. Astrid Leitner lives with daughter, dog and cat in Vienna and Upper Austria.

More about the experts All content is checked by medical journalists.

Diplopia is a common type of visual disorder that causes people to see double vision. In many cases double vision is harmless, but sometimes it can also be due to a serious illness. Read here about the causes of double vision, the symptoms and how diplopia is treated.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. H53

Brief overview

• Causes: tiredness, stress, alcohol, eye diseases, strabismus, injuries, paralysis, certain diseases such as diabetes or multiple sclerosis
• What is diplopia ?: Double vision
• Symptoms: Sudden or insidious double vision, dizziness, disorientation, pain in severe cases
• When to see a doctor ?: If the diplopia does not go away on its own after a short time, a doctor should be consulted immediately.
• Diagnosis: examination by the ophthalmologist and orthoptist
• Treatment: Depending on the cause or underlying disease
• Prevention: Healthy lifestyle (balanced diet, avoidance of nicotine and alcohol, adequate sleep)

Why do I suddenly see everything twice?

When people suddenly see everything twice, the reasons are often harmless. For example, you are very tired or have worked on the screen for a long time. In these cases, the double vision disappears on its own after a period of rest. Migraines, stress or excessive alcohol consumption are also sometimes triggers for temporary double vision.

In other cases it is due to physical illness. They affect the eye itself or occur as a result of another disease. Depending on the cause, the doctor differentiates monocular and binocular double images.

Monocular double images (double image in one eye): Monocular means “only affecting one eye” (Latin “mono-” for single, single, single and Greek “oculus” for eye). A double monocular image persists even if the affected person covers one eye. With this form of double vision, the problem lies in the eyeball, which reacts to light. Normally, the cornea and the lens of the eye together ensure that the light rays entering the eye are bundled and come together on a single point on the retina (macula, point of sharpest vision). If the light hits next to it, those affected see a blurred or distorted image. This is the case with various eye diseases:

• Farsightedness or short-sightedness (e.g. due to missing or incorrect glasses)
• Corneal diseases (e.g. astigmatism)
• Opacities of the lens (cataracts)
• Compression of the nucleus of the lens (cataract)
• Relocation of the lens
• Retinal diseases (e.g. a vascular blockage in one or more vessels that supply blood to the eye)
• Dry eye

Binocular double images (double image on both eyes): Binocular means "concerning both eyes" (Latin "bi-" for two). In binocular diplopia, both eyes jointly produce the double images. Those affected only see this when both eyes are open. If one eye is closed - no matter which one - the double image disappears. Typically, the double images appear shifted or tilted up, down or to the side.

Double vision in both eyes occurs when the eyes are not aligned parallel. As a result, the brain no longer completely merges the visual impressions of both eyes into one image. Binocular double images arise when the eye muscles are not working properly. The reasons for this may be harmless, such as lack of sleep or excessive alcohol consumption, and will go away on their own. But there may also be serious causes.

If the eye muscles no longer function properly, the cause is either in the eye itself or it is caused by diseases outside the eye. The following eye diseases can trigger double binocular vision:

• Squint (strabismus)
• Inflammation of the muscles of the eye
• Diseases of the eye muscles
• Tumor diseases of the eye

Other known triggers for binocular double images are, for example, injuries or damage to the brain:

• Stroke: When a stroke occurs, a blood clot forms, which means that certain areas of the brain are no longer supplied with blood. If nerves that control the eyes are damaged, they develop
• Head injuries (such as a broken eye socket)
• Brain tumor
• Vascular dilation in the brain (brain aneurysm): In an aneurysm, a blood vessel is bulging. If this presses on the nerve of the eye muscle, those affected may see twice.
• Paralysis of the cranial nerves: Triggers can be neurological diseases such as multiple sclerosis, myasthenia gravis or borreliosis.

Diseases that affect the entire body are also sometimes the cause of double vision:

• Endocrine orbitopathy: triggered by a thyroid disease, an inflammatory disease of the eye socket occurs.
• Circulatory problems caused by diabetes or high blood pressure

What are the symptoms of diplopia?

Anyone who perceives one and the same object out of focus or twice, i.e. (slightly) horizontally, vertically or diagonally shifted, sees twice. Double vision occurs suddenly (acute diplopia) or insidiously, in the distance or in the vicinity or only when looking to the side.

Additional complaints such as pain when moving the eyes or protruding eyes are an alarm signal. In this case, it is advisable to consult an ophthalmologist to clarify the symptoms. The same applies to drooping or swollen eyelids or visible squint.

The following symptoms indicate serious causes and give the doctor initial clues as to the reason for the visual impairment:

• Eye movement disorders
• Hanging of the upper eyelid
• Eyelid swelling
• Visible squint
• Protruding eyes
• Pain when moving the eyes

Diplopia “only” affects the eyes, but seeing double vision has far-reaching effects on the everyday life of those affected: Those who cannot see clearly (anymore) are more likely to get injured. For apparently inexplicable reasons, those affected fall more often or injure themselves.

Possible effects of diplopia include:

• Heights, depths and distances are no longer correctly assessed. (Risk of injury!)
• Affected people grasp the wrong way or bump into each other.
• Unsteady walking, especially when climbing stairs
• Difficulty reading
• dizziness
• headache
• See blurred

See an ophthalmologist immediately if you notice any of the above symptoms!

What is diplopia?

Diplopia is a type of visual disorder that causes people to see double vision. They perceive a viewed object as two objects displaced against each other.

It is normal for the eyes to see two images of the same object. The reason for this is the different position of the eyes. The eye relief means that you are looking at an object from two different angles. The brain combines both images into one. This makes spatial vision possible: the image seen appears three-dimensional. This process is also known as "binocular vision".

With double vision, the coordination of the eyes is disturbed. The two images are no longer completely merged, but instead appear shifted next to or on top of each other. The causes of diplopia are varied, they can be harmless, but they can also be an indication of a serious illness.

Double vision makes it difficult for those affected to see the environment correctly: heights, depths and distances are misjudged. Affected people suddenly have difficulty orienting themselves, reach past objects or have problems walking. If diplopia occurs, an ophthalmologist should be seen. He clarifies whether it is a harmless, temporary visual impairment or whether it is a serious illness.

If you see twice, you are not allowed to drive the car yourself! Have someone you trust bring you to the doctor or, if necessary, to the emergency room!

When to the doctor

Double vision is a common visual disorder that often goes away on its own after a short time. In some cases, diplopia is a serious illness. It is therefore always advisable to see an ophthalmologist if the double vision persists for a long time.

Please consult a doctor immediately if you have any of these symptoms:

• You have pain in your eyes.
• One eye or both eyes protrude.
• You recently had a head injury.
• The double images do not disappear even after covering one eye (binocular double vision).

• Accompanying symptoms such as weakness, paralysis of the face, problems speaking, swallowing, walking, dizziness, headache, incontinence occur.

Double vision should always be examined by an ophthalmologist, even if they go away on their own. If they occur suddenly and there are other symptoms such as pain or paralysis, it is an emergency!

What does the doctor?

The first point of contact for double vision is the ophthalmologist and, if necessary, the orthoptist. While the ophthalmologist examines the visual abilities, the orthoptist deals with the position of the eyes, the mobility of the eyes and their interaction.

Examination at the ophthalmologist

For the diagnosis, the ophthalmologist first inquires about the symptoms in order to find clues about possible causes. He will ask the following questions:

• How long have you been seeing double vision?
• Do you have pain?
• Do you currently see double vision?
• Was there a trigger? (Injury, surgery, new glasses)
• Did the double vision appear suddenly or do they develop slowly?
• Do the double vision disappear when you cover one eye?
• Are the double images always there or only temporarily?
• Do the double images appear horizontally, vertically, diagonally or tilted?
• Do the double images change with the direction of gaze or the posture of the head?
• Do the pictures change during the day?
• Do other symptoms such as headache, eye pain, eye movement pain, eye reddening, hearing impairment, sensory disturbance, dizziness and / or unsteady gait occur?
• Have you been diagnosed with any other condition such as diabetes or multiple sclerosis?
• Did you squint as a child?

He then examines both eyes in detail - regardless of whether the double vision occurs in only one or both eyes. The doctor checks the eyesight, the mobility of the eyes and the reaction of the pupils to light. At the same time, he pays attention to changes such as protruding eyes or sagging eyelids.

He then examines the inside of the eye. The doctor uses a so-called slit lamp for this. The device consists of lighting and a microscope that shows the inside of the eye enlarged. He uses it to check the inside of the eye for changes that could be the cause of the diplopia.

By covering one eye at a time, the ophthalmologist can also determine whether double vision affects only one eye or both eyes. From this he gains further clues in the search for the cause of diplopia.

Examination at the orthoptist

If the doctor determines binocular diplopia, what is known as an orthoptic examination usually follows. Orthoptics is a specialty in ophthalmology that deals specifically with movement disorders of the eyes. The orthoptist checks whether those affected are cross-eyed, see three-dimensionally and whether both eyes interact properly. After the examination, the orthoptist will discuss the next steps with the patient and the ophthalmologist.

Further investigations

Since diplopia can have many causes, further examinations are often necessary for a reliable diagnosis. This includes imaging methods such as magnetic resonance or computer tomography. They make changes in eye level, skull or brain visible.

If another disease is suspected, the ophthalmologist will consult the appropriate specialist. Recurring double vision in combination with neurological complaints are, for example, a possible indication of neurological diseases such as multiple sclerosis or myasthenia gravis. In these cases, the doctor will refer the patient to a neurologist for further clarification.

If there is any suspicion that the diplopia is due to diabetes (diabetes mellitus) or another general disease (circulatory disorder), he will refer you to an internist. As soon as all examinations are completed, the doctor discusses the findings with the patient and initiates the appropriate treatment for the patient.

treatment

How diplopia is treated depends on the specific cause. With the treatment of the underlying disease, the double vision usually also disappears.

Treatment of double monucular vision

In the case of double monocular images, there is usually an eye disease that the ophthalmologist treats accordingly:

Ametropia: The doctor compensates for nearsightedness or farsightedness with appropriately adapted glasses or contact lenses.

Curvature of the cornea: With a laser treatment, the doctor changes the cornea in such a way that the retina creates a sharp image again. Visual acuity is restored and the double images disappear.

Cataracts: If the lens is cloudy, those affected see "like through a veil". During cataract surgery, the doctor replaces the lens with an artificial lens.

Dry eye: If the eyes do not produce enough tear fluid, they may become inflamed and double vision may occur. Then the doctor will prescribe eye drops to replace tears.

Treatment of binocular double vision

Treatment of the underlying disease

In binocular double images, it is not the eye itself that is affected, but diplopia is the result of another disease. Depending on the cause, the doctor will begin the appropriate therapy. If the treatment is successful, the double vision will also improve.

If the diplopia is caused by other diseases such as migraines or multiple sclerosis, the doctor treats them with special medication. The same applies to circulatory disorders or thyroid diseases. The better the condition is under control, the less effects it will have on vision.

Double vision that occurs suddenly and accompanied by paralysis or pain is an alarm signal. In these cases, the cause is to be clarified and treated by a doctor as soon as possible.

If the double vision does not disappear despite correct treatment, special glasses are used. These are coated with foils that bundle the incident light beam in such a way that the person concerned only sees one picture. Alternatively, eye patches or eye patches can be used to alleviate the symptoms.

Eye exercises

In addition to medical treatment, there are eye exercises to help you see better again.

• Focus on a specific goal such as a photo.
• Hold the picture an arm's length away at eye level.
• Try to see only one picture for as long as possible.
• Move the photo towards your nose slowly and evenly.
• As soon as the single image becomes two images, stop and go back to the position where you last saw an image.
• Start the exercise again.

Can you prevent diplopia?

Diplopia can have many causes. The options for preventing double vision are correspondingly diverse.

Since diplopia is often triggered by other underlying diseases such as diabetes or high blood pressure, a healthy lifestyle is a top priority for prevention. A balanced diet, adequate sleep and little stress do not reliably prevent double vision, but they do minimize the risk. The same applies to accidents. Appropriate measures (protective goggles, wearing a helmet) protect against head and eye injuries.

Another common trigger is strabismus. In order to avoid squinting, it is important to correct existing ametropia in good time. If the doctor prescribes visual aids such as glasses or contact lenses, it is advisable to wear them as prescribed.

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