Double Vision

If you have diplopia (double vision or ghost images) you should see an Optometrist as soon as possible. A sudden onset of diplopia in children or adults is more of a concern than a longstanding one, but both warrant a visit to the Optometrist to diagnose whether the condition is temporary, or the result of a serious health problem.

Longstanding diplopia can be associated with developmental binocular problems when the ability to use both eyes together never developed properly. Temporary double vision can result from drinking too much alcohol, or fatigue. It can also result from a more serious problem such as:

• Stroke or cerebrovascular accident (leads to temporary or permanent cranial nerve palsy causing misalignment of the eyes)
• Third nerve palsy from diabetes
• Traumatic or acquired brain injury (from sports, car accident, a blow to the head, etc.)
• Orbital fracture and trapped eye muscle
• Multiple Sclerosis

If you have a sudden onset of double vision, and a severe headache, or muscle weakness, call 911 immediately.

The main types of vision problems that cause double vision are:

• Strabismus: (also known as "cross eyed" or "wall eyed"): the inability to align the eyes. One or both eyes may turn in, out, up, or down. It may be constant or intermittent.
• Exophoria (convergence insufficiency) or Esophoria (convergence excess): eyes that have a tendency to drift in or out due to poor eye muscle coordination. This can be developmental or acquired. It can be aggravated by an increased demand on the visual system such as with heavy computer use, desk work, or studying. If the eyes are already working hard to compensate for the tendency to drift apart, prolonged use of the eyes can fatigue the eye muscles resulting in ghost images, images that appear to move, or double vision. The eyes can be held straight, but with excessive effort, and wasted energy. These problems are fairly common, and treatment is very effective.
• Fusional instability: poor sensory ability to fuse the two images from both eyes together to form a single, 3 dimensional image. This may result in ghost images, unstable images, poor depth perception, or intermittent double vision.
• Astigmatism: optical problem resulting from incorrect focus of images on the retina. This can usually be easily corrected by glasses or contact lenses.

Patching

Double vision can cause problems such as visual confusion, clumsiness, impaired balance, and poor 3D vision or depth perception. This diminishes your ability to localize where objects are in space, and can lead to poor eye hand or eye body coordination in sports (such as catching a ball or hitting a ball in baseball, free throws in basketball, tennis), driving (parallel parking), and judging the depth of stairs while walking.

Treatment for Double Vision / Diplopia

If your doctor determines that there is no serious underlying health reason for your double vision, phoria or strabismus, the treatment choices include patching, strabismus surgery and Vision Therapy

Strabismus Surgery

Vision Therapy is a highly effective type of physical therapy that works on eye muscle control and coordination to improve eye muscle alignment non-surgically, and improve efficiency of visual motor input and processing. Vision Therapy consists of weekly office sessions with a therapist, under an Optometrist's prescription and guidance, combined with home therapy to reinforce skills taught, and accelerate treatment. The goal for patients with double vision is to eliminate the diplopia and associated headaches or eyestrain. Vision Therapy also works to improve eye teaming skills, depth perception, eye hand coordination, visual spatial localization, and overall visual efficiency.

Strabismus surgery works by cutting the eye muscles and re-inserting them on the eye in a different position to straighten the eye. The effectiveness of surgery depends on the muscles involved, the direction of the eye turn, and the amount of the eye turn. Vision Therapy is recommended in conjunction with surgery to retrain the brain how to use the eyes together as a team, and how to see 3 dimensional images, etc. This increases the likelihood of success.

Vectograms, an Example of a Vision Therapy Technique For Double Vision

Surgery may decrease the amount of an eye turn cosmetically, but Vision Therapy is still needed to train the eyes to work together, and to stimulate the weaker eye to track, and fixate. Surgery usually requires multiple surgeries unless Vision Therapy is done to train the brain how to use the eyes together. It's like doing knee surgery without going through Physical Therapy: you cannot get a functional cure without doing therapy to improve eye muscle control and coordination.

If you have any questions regarding double vision, please call our office at (323) 954-5800 for an appointment with one of our doctors.