Diplopia: Causes, Symptoms, Treatment and Cost

Diplopia, sometimes referred to as double vision, is a disorder in which an individual sees two images of a single thing instead of just one image.

• Monocular Diplopia: Monocular diplopia occurs when the distortion of one eye prevents both eyes from focusing on the same point simultaneously. This type of diplopia is caused by irregularities in the eye itself such as astigmatism, corneal aberrations or lens defects.
• Binocular Diplopia: Binocular diplopia occurs when there’s a misalignment between both eyes, causing them to focus on different points at once—meaning they are not accurately targeting one single point when looking at an object. This type of double vision can be caused by strabismus (crossed eyes) or extra ocular muscle spasms affecting only one eye at time (heterotropia).
• Physiological Diplopia: Physiological diplopia occurs when there is no visible abnormality in either eye but our brain cannot correctly interpret an overlapping image from both eyes into one that makes sense meaning that two distinct and separate images are seen simultaneously instead of just one; also known as ‘physiological blur’.

• Impaired eye coordination, misalignment of eyes, or damage to the area of the brain responsible for controlling eye movement can all cause diplopia.
• Abnormalities in the cornea, lens or retina may also cause diplopia in some individuals.
• Diseases such as thyroid eye disease, stroke or multiple sclerosis may lead to diplopia as well due to changes in the nervous system associated with these conditions.
• Uncorrected refractive errors such as near-sightedness, astigmatism and far-sightedness can also cause double vision in some cases if not treated properly with eyeglasses or corrective lenses.

Common symptoms include:

• Double vision
• Eyestrain
• Headaches
• An inability to focus on one image or track movement.
• More severe cases may cause nausea and loss of balance as well.

• Get regular check-ups with an ophthalmologist.
• Wear prescribed glasses or contact lenses, if needed.
• Manage existing medical conditions like diabetes and high blood pressure to prevent diplopia risk factors.
• Avoid activities that may put strain on the eyes, such as extended computer use or reading in dim light.
• When participating in activities or performing sports that might potentially cause eye damage, it is important to wear protective eyewear.

• Cover Test: This test is used to identify the eye that is causing diplopia and to assess the amount of deviation present. The patient will be instructed to concentrate on an item in the distance while the attending physician will alternately cover each eye with a hand or a card.
• Prism Test: This test is used to measure the amount of deviation and determine which direction the eyes are deviating in. The doctor will ask the patient to look through a prism while looking at an object at a distance.
• Hirschberg Test: This test is used to assess whether or not a patient has strabismus, which can cause diplopia. The physician will examine each cornea by shining a light into each eye and seeing how the light reflects off each cornea. If one eye is deviating, this test can help diagnose it.
• Hess-Lester Test: This test is used to assess how well both eyes can align and focus on an object together when both eyes are open at the same time. The patient will be asked to look at an object in different directions, such as looking up and down or left and right, while keeping both eyes open.
• Worth Four Dot Test: The four dot test is an ocular motility and perception test commonly used to diagnose diplopia (double vision). During the test, a patient is asked to look at four dots that are placed at the center of a sheet of paper. The patient must be able to distinguish all four dots without any double vision or overlapping images. If the patient cannot correctly identify each dot, or sees two overlapping images, then double vision is likely present and should be further evaluated.

• Suppression or censorship of the double vision in one or both eyes.
• Unreliable eye teaming.
• Loss of depth perception.
• Headaches, eye strain
• Uncomfortable with reading and other everyday tasks requiring close vision.
• Social and psychological impacts such as embarrassment while communicating with others.

• Abhyanga: Abhyanga is an Ayurvedic massage therapy that helps to reduce stress and improve the flow of energy throughout the body. This type of massage can be used to help with diplopia, as it can help reduce stress and tension in the eyes, neck, and head that may be causing the diplopia.
• Nasya: Nasya is a nasal treatment in which herbal oils are administered through the nostrils. This helps to clear up clogged energy channels in the head and neck, which may have been the underlying cause of diplopia.
• Shirodhara: Shirodhara is a kind of Ayurvedic treatment in which heated oil is poured over the forehead while other parts of the head and neck are massaged. This therapy helps to relax the mind and body, which can help reduce any tension or stress that may be causing diplopia.
• Trataka: Trataka is a form of meditation in which one focuses their gaze on a single point without blinking for an extended period of time. This practice helps to strengthen eye muscles, improve focus, and reduce strain on the eyes which may help ease symptoms of diplopia.

• Foods high in antioxidants such as dark-colored berries and leafy greens help protect the eyes from further damage caused by free radicals.
• It is important to consume foods that contain omega-3 fatty acids since they are necessary for maintaining healthy eyes. Foods such as fatty fish (e.g., salmon, tuna), walnuts, flaxseeds, and chia seeds are good sources of omega-3 fatty acids.
• Vitamin A is important for vision health and can be found in foods such as carrots, sweet potatoes, pumpkins, spinach, kale, cantaloupe and mangoes.
• Zinc helps protect the eyes from damage caused by ultraviolet rays so include foods such as oysters, beef chuck roast, cashews or pumpkin seeds in your diet to get enough zinc.

• High cholesterol foods: Avoid saturated fats such as red meat, whole milk, cheese, and other animal-based products; instead opt for healthier sources of omega-3 fatty acids such as fish, nuts and seeds.
• High sodium foods: Limit your intake of processed and canned food items that are high in sodium. These include soy sauce, ketchup, and pickled items.
• Refined carbohydrates: Minimize the consumption of white breads, cakes and pastries made from refined flour as these provide little nutritional value.
• Fried food items: Fried foods should also be avoided whenever possible to reduce calorie intake and fat consumption.
• Sugary beverages: Sugary drinks like soda can lead to weight gain so these should be limited or avoided altogether if possible.

• Eye exercises: Specialized eye exercises can help reduce diplopia.
• Botox injections: Botox injections may help reduce muscle spasms that lead to diplopia by temporarily relaxing the muscles around the eyes.
• Strabismus surgery: This type of surgery involves altering the shape and size of one or more of the extraocular muscles in order to improve eye alignment. It can be performed through a variety of techniques such as suturing, recessing, advancing or resecting the muscles around the eye to correct any imbalance in muscle function or strength.
• Orthoptic exercises: These exercises can help strengthen weakened eye muscles and improve visual field coordination in order to correct diplopia or double vision. The exercises involve focusing on objects placed at varying distances from the eyes, then tracking them with both eyes open at all times.
• Refractive lens exchange surgery: Also known as clear lens exchange, this type of surgery may help reduce Coincident Diplopia which is caused by misalignment due to an underlying refractive error such as nearsightedness or astigmatism. During this procedure, damaged lenses are removed and replaced with intraocular lenses that are stronger than regular corrective lenses might be able to provide.

A person experiencing diplopia (aka double vision) should consult an optometrist or ophthalmologist.

They will perform a full eye exam to check visual acuity and to observe how the eyes focus and move together.

• Acetazolamide for diplopia: Acetazolamide is an anticonvulsant medication that is sometimes used to treat diplopia, or double vision. The medication is effective because it lowers the activity level of some nerve cells in the brain that are responsible for the occurrence of double vision.
• Cyclopentolatefor diplopia: It works by temporarily paralyzing the muscles of the eye, causing the two images seen by each eye to become more aligned and reduce double vision. It is usually administered as an eye drop and can take several hours to take effect.
• Atropine for diplopia: Atropine is sometimes used to treat diplopia (double vision). In order for it to be effective, it will temporarily paralyse the eye muscles, which are the ones that control eye movement. This allows the two eyes to become better aligned, resulting in a single clear vision.
• Pilocarpine for diplopia: It works by stimulating the muscles of the eye, which helps to reduce the double vision and improve overall vision. It is typically administered in eye drops or gel form and may need to be taken multiple times a day for best results.
• Botulinum toxin type A for diplopia: In order to treat the muscle that is producing the double vision, Botox is injected into that muscle. It works by temporarily weakening the muscle, which helps to reduce or eliminate the double vision. It can take several days to weeks for the effects of Botox to take effect and the effects typically last about three months.

In many cases, diplopia can be reversed within weeks or months with glasses or appropriate pen direction exercises.

People may need physical therapy or surgery to correct misalignment of the eyes and eliminate diplopia permanently.

However, this type of treatment may take up to one year for full recovery in some cases.

It is not always the case that treatments for diplopia will provide lasting benefits.

Treatments may be used to reduce double vision and improve vision quality, but in some cases it can temporarily reduce the symptoms while the underlying cause remains.

• To ensure the success of treatment, it is important to follow post-treatment guidelines for Diplopia.
• Be careful to maintain frequent checkups with your primary care physician and to take any medicines or treatments that have been given to you.
• Wear any protective eyewear as recommended by your physician, such as prismatic glasses or special lenses.
• Do eye exercises and other exercises suggested by your doctor, to maintain comfortable vision and optimize visual motor coordination if necessary.
• Avoid activities that could cause further strain on the eyes and increase risk of additional complications.
• Educate yourself on any potential symptoms that may require additional medical attention, such as double vision or changes in pupil size / shape / color not caused by medication side effects or contact lenses use etc.

Keep regular appointments with your eye care professional to monitor progress and ensure the best outcome possible from treatment efforts, managing potential long-term impacts that might occur due to Diplopia associated complications.

Generally, treatments may range from Rs. 1000 - Rs. 10,000 or more depending on which procedure the patient undergoes.

Diplopia treatment can cause a range of side effects including:

• Eye strain
• Headaches
• Double vision in one or both eyes.
• Reduced vision.
• Eye-drops may cause dryness, burning or stinging of the eyes, blurred vision or other general irritation.
• Surgery carries the risk of infection and creating long-term issues with eye muscles due to scarring and damage.
• In rare cases, brain tumors resulting in double vision have been known to occur after surgery for diplopia treatments.

You should see a doctor in your area if you have any Diplopia-related issues because they can lead to complications like 'nausea, vertigo, eye strain, sensitivity to light or sound, or even brain tumour,' for which treatment regimens can last anywhere from a few months to years, depending on the severity of the condition.