Diplopia is a vision alteration consisting in the perception of double vision. This vision disturbance can be horizontal, vertical or oblique depending on how the images appear (to the side, above or diagonal to the object). In addition, it can affect both eyes (binocular) or only one eye (monocular).
Double vision can have different types and can be produced by several causes, some of them more serious than others. Strabismus, uncorrected refractive problems, cataracts, retinal diseases or some muscular and neurological alterations are some of the causes that can lead to double vision. Therefore, when the first symptoms appear, it is necessary to go for an urgent check-up.
Diplopia can be classified into:
Causes of diploplia are classified depending on the type of double vision.
Monocular double vision: In this case it is usually caused by eye structural causes, and in very few cases it is related to neurological alterations. Some of its causes may be:
In all these eye structure alteration cases, once the alteration is corrected, double vision disappears.
Binocular double vision: In case of binocular double vision, a neurological alteration or eye muscle problems may be at the root of the problem. Some of its causes may be:
Double vision or diplopia may occur at any point in life. Children may suffer from diseases leading to double vision, and, in case of strabismus, when the disease is being consolidated, during acute moments when there is a rapid decompensation, episodes of double vision may occur. Nevertheless, eye deviations caused by strabismus, especially in young ages, are usually compensated by our brain over time, and double vision is not consolidated. In case there has been a deviation from childhood, when the child reaches the adult age, he usually won’t experience.
Diplopia is a symptom reported by the patient, which is usually quite striking and causes a lot of visual discomfort, so the patient comes to the consultation saying that they “see double”.
In consultation, in order to carry out a diagnosis and determine why does the patient see double, we perform a comprehensive eye exam, including:
A patient should go immediately to an emergency room in order to determine the cause.
If it is due to a decompensated strabismus, there will be enough time to perform an examination. However, it is important to rule out any neurological cause requiring urgent performing of studies and even hospital admissions in order to determine the cause of such double vision. Therefore, it is always recommended in case of acute double vision to go immediately an eye emergency room.
Treatment will depend on the cause of the diplopia. In case of monocular diplopia, which produces structural alterations of the eye, if these alterations can be corrected we will be able to solve the problem of double vision. However, in the case of binocular diplopia, if it persists, there are three therapeutic options:
Surgery that is carried out in case of eye misalignment is the same surgery performed in case of strabismus It consists of adjusting the muscles in order to correctly align the eyes. It is an outpatient surgery which usually does not require the patient’s admission. In most cases, the patient goes back home the same day of surgery. Procedure is performed under topical anesthesia effects with some kind of sedation. In some very specific cases, it may be performed under the effects of general anesthesia.
After a strabismus surgery, the recovery time is relatively short. Usually, patients may resume their daily tasks (job, studies…) within the first week after the surgery, depending on the complexity of the case. It is, however, recommended for patients to avoid going to the beach or swimming pool, as well as to not perform any sports contact during approximately the first 10 to 20 days.
During the postoperative period there may be some discomfort, such as a foreign body sensation or something rubbing inside the eye, but the evolution is usually favorable and in a few weeks it disappears completely.
The patient will need to follow a treatment with eye drops during the first month and to attend the required control visits.Usually, a control visit is scheduled 24 hours after surgery. Then, contingent upon the evolution, we carry out another control visit after a week. Finally, one month after surgery we are already able to determine the more or less definite surgery outcome and the impact it’s had on double vision.
Amblyopia or lazy eye is a vision alteration caused by an asymmetry in the position of the eyes. It usually develops at a very early age and is the leading cause of childhood vision loss.
Neuro-ophthalmology treats diseases that, without being properly of the eyes, manifest themselves with alterations of vision, eye movement or pupils. The patient sees badly but the cause is in the brain, optic nerve or elsewhere in the body.
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