Are you seeing double? Double vision, also known as diplopia, is a visual disturbance where the eyes do not work together, causing one image to be perceived as two! Read on to find out who is affected by double vision, why it occurs, what the visual symptoms of double vision are, and what treatment options are available…
What is double vision?
Double vision (diplopia) occurs when the two visual axes of your eyes cannot align on the same point, leading the brain to receive two different images instead of one clear image. You will see two images of the same object, either side-by-side (horizontally) or one above the other (vertically). This feels both uncomfortable and disruptive and can challenge your daily life.
Who is affected by double vision?
Double vision can affect people of all ages, but some groups may be more vulnerable than others. Older people may be at higher risk, as the condition is often associated with eye diseases and neurological problems that are more common with age. However, double vision can also affect younger people, especially if they have vision problems, suffer from migraines, are stressed, are sleep-deprived, or have excessive screen time.
Why does double vision occur?
Double vision can arise for various reasons. Some are less serious, occurring only briefly due to, for example, lack of sleep or alcohol consumption. Other causes can be congenital or due to challenges in the eye, in the area around the eye, or in the nervous system. Look out for the 9 most common causes of double vision:
- Lack of sleep
- Long periods of concentration
- Increased screen time
- Fatigue or exhaustion
- Squint
- Stress or traumatic experiences
- Migraine or concussion
- Alcohol consumption
- Uncorrected refractive errors such as farsightedness or nearsightedness: Double vision can also be a sign that you need glasses – or have the wrong prescription in your glasses or contact lenses. If your vision corrections are incorrect, you force your eyes to work harder to focus. This can often be solved with a pair of reading glasses in the correct strength if you are farsighted.
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Sudden double vision can be caused by an acute serious condition such as a blood clot, a tumor, an aneurysm, or pressure in the brain. If you experience sudden double vision, it requires prompt treatment, and you should therefore contact your doctor.
What is monocular double vision?
Monocular diplopia occurs when double vision is experienced in only one eye. If you cover one eye and double vision persists, it is likely monocular. Causes of monocular double vision can be:
Keratoconus: Breaks in the corneal structures, where the cornea bulges forward like a cone, can cause double vision as it impairs image formation.
Uncorrected refractive errors: Astigmatism, also known as irregularities in the curvature of the cornea or lens, can cause visual disturbances and double vision if not corrected with the proper spectacle lenses or contact lenses.
Cataracts: A problem in the eye itself, such as cataracts, can cause monocular double vision, as the lens in the eye becomes cloudy and creates double images.
Age-related macular degeneration: Wear and tear on the retina's macula, where sharp vision is formed, can affect image formation and cause double vision.
What is binocular double vision?
Binocular diplopia occurs when double vision is experienced in both eyes. If you cover one eye, the double vision disappears. Binocular double vision is often caused by problems with the muscles that control the eyes or problems with nerve pathways connecting the brain and the eyes. Causes of binocular double vision can be:
Strabismus (squint): If the eyes do not work together and point in different directions, double vision can occur.
Nerve damage: Damage to the cranial nerves that control eye movements can lead to double vision.
Neurological diseases: Diseases such as multiple sclerosis (MS), myasthenia gravis, and stroke can affect muscles and nerves and cause binocular double vision.
How does double vision affect everyday life?
Double vision can make it difficult to read, watch TV, drive, and perform everyday routines such as walking, cooking, or working on a screen. Some people with double vision may experience discomfort, headaches, or nausea. In the long run, it can disrupt balance and coordination as the brain constantly struggles to compensate for the double vision. For some people, it can lead to social isolation and reduced quality of life.
What are the symptoms of double vision?
The symptoms of double vision vary depending on the cause of why you see double, but the 6 most common symptoms are:
- Seeing two images of the same object – either horizontally, vertically, or diagonally.
- Problems with judging distances.
- Pain in and around the eyes – especially when moving them.
- Headache and tired eyes as the eyes try to compensate.
- Blurred vision, dizziness, and balance problems.
- Nausea – especially if the double vision is intense and prolonged.
- Droopy eyelids.
What are the typical treatment options for double vision?
Treatment for double vision depends on the cause, so it is important to find out why you are seeing double. Contact your ophthalmologist or optician for a thorough eye examination to determine the cause of your double vision. The typical treatment options are:
Glasses or contact lenses: In some cases, glasses or contact lenses can help with double vision, especially if it is caused by astigmatism in the eye.
Eye exercises: In cases of binocular double vision, eye exercises, often with the help of an orthoptist, can help strengthen the eye muscles and thus reduce double vision.
Surgery: In certain cases, surgical intervention may be necessary, especially if double vision is due to strabismus (squint) or other problems with the eyes or muscles.
Treatment of underlying disease: If double vision is caused by a disease such as multiple sclerosis or diabetes, treating the disease can often help alleviate the double vision.
Botox: For some, Botox injections into the eye muscles can help reduce double vision by temporarily paralyzing certain muscles and adjusting the eye's position.
Eye patch: A simple solution can be to cover one eye with an eye patch to temporarily eliminate double vision, although this reduces depth perception.
How is double vision diagnosed?
To diagnose the cause of double vision, an ophthalmologist will perform a thorough eye examination and ask about the symptoms you are experiencing. The examination will include a test of your visual acuity, measurement of eye alignment, and a slit lamp examination to view the front and back of the eye. The examination may also include:
Imaging diagnostics: CT or MRI scans can help identify other problems affecting the eye muscles and nerves.
Blood tests: To detect diseases such as diabetes or thyroid problems that can cause double vision.
What is the impact of double vision?
Double vision can have a significant psychological impact on an individual, as it can lead to frustration, stress, and isolation, especially if it affects the ability to participate in social events. Persistent double vision can create anxiety about falling or make it difficult to concentrate at work. People with double vision may develop depression, especially if treatment options are limited or ineffective. It can therefore be important to receive support, both medical and psychological, to manage the situation of double vision.
How common is double vision?
Double vision is not among the most common vision problems, but it is nevertheless often seen – especially in older people or those with neurological and autoimmune diseases. The exact statistics vary depending on region and demographics, but researchers estimate that a large proportion of the population will experience double vision at some point in their lives, albeit briefly.
What future treatment options are under development?
The good news is that research into new treatments for double vision is constantly evolving. New technologies such as virtual reality (VR) training, where patients train their eye muscles through specially designed VR glasses. There is also development in lenses with prisms, called prism lenses. They are used to avoid double vision caused by incorrect muscle balance, such as strabismus. Prism glasses help to shift the image of the object either horizontally or vertically depending on the direction of the prism and the strength of the lens.
When should you seek help?
You should seek help if sudden double vision occurs or if it worsens over time. Double vision can be a sign of a serious condition such as a blood clot, a tumor, an aneurysm, or pressure in the brain. If you experience sudden double vision, it requires prompt treatment, and you should therefore contact your doctor.
