Skip to main content

Double vision

Opinion statement

When evaluating a patient with a complaint of double vision, it is important to distinguish monocular versus binocular diplopia, which are differentiated by asking the patient to cover each eye separately. In the setting of binocular double vision, one of the two images disappears when either eye is covered, because diplopia is the result of ocular misalignment. On the other hand, monocular double vision resolves when the affected eye is covered, but remains when the opposite eye is occluded. Causes of monocular diplopia include cataract, refractive error, and retinal disease, which can be managed accordingly by an ophthalmologist [1, Class III]. However, an unusual form of monocular double vision can occur in the setting of cortical dysfunction. Cerebral polyopia describes the perception of multiple images and arises from an occipital disturbance. It can occur with migraine headaches and can be accompanied by a homonymous hemianopia. Palinopsia refers to the persistence of an image that is no longer in view (visual perseveration or stroboscopic effect) and results from an occipital lesion as well. The exact mechanism of polyopia and palinopsia are uncertain and both conditions are extremely rare.

The majority of this discussion will focus on binocular double vision and its management. The main treatment objective of binocular diplopia is to restore the largest area of single binocular vision. Ideally, patients would be able to achieve single vision in all fields of gaze, but this is not always possible. The majority of patients are treated with either prism lenses or eye muscle surgery.

This is a preview of subscription content, access via your institution.

References and Recommended Reading

  1. 1.

    Records RE: Monocular diplopia. Surv Ophthalmol 1980, 24:303–306.

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Brazis PW, Lee AG: Binocular vertical diplopia. Mayo Clin Proc 1998, 73:55–66. A review of causes, workup and treatment of binocular vertical diplopia.

    PubMed  CAS  Google Scholar 

  3. 3.

    Brazis PW, Lee AG: Acquired binocular horizontal diplopia. Mayo Clin Proc 1999, 74:907–916. A review of causes, workup and treatment of binocular horizontal diplopia.

    PubMed  CAS  Article  Google Scholar 

  4. 4.

    Flanders M, Sarkis N: Fresnel membrane prisms: clinical experience. Canadian J Ophthalmol 1999, 34:335–340.

    CAS  Google Scholar 

  5. 5.

    Holmes JM, Beck RW, Kip KE, et al.: Botulinum toxin treatment versus conservative management in acute traumatic sixth nerve palsy or paresis. J Am Assoc Pediatr Ophthalmol Strabismus 2000, 4:145–149. Important article.

    Article  CAS  Google Scholar 

  6. 6.

    Dawson EL, Marshman WE, Lee JP: Role of botulinum toxin A in surgically overcorrected exotropia. J Am Assoc Pediatr Ophthalmol Strabismus 1999, 3:269–271.

    Article  CAS  Google Scholar 

  7. 7.

    Rayer SA, Hollick EJ, Lee JP: Botulinum toxin in childhood strabismus. Strabismus 1999, 7:103–111.

    Article  Google Scholar 

  8. 8.

    Hertle RW: Clinical characteristics of surgically treated adult strabismus. J Pediatr Ophthalmol Strabismus 1998, 35:138–145.

    PubMed  CAS  Google Scholar 

  9. 9.

    Wygnanski-Jaffe T, Wysanbeek Y, Bessler E, Spierer A: Strabismus surgery using the adjustable suture technique. J Pediatr Ophthalmol Strabismus 1999, 36:184–188.

    PubMed  CAS  Google Scholar 

  10. 10.

    von Noorden GK: Binocular Vision and Ocular Motility: Theory and Management of Strabismus. St. Louis: Mosby, Inc; 1996.

    Google Scholar 

  11. 11.

    Wright KW: Color Atlas of Ophthalmic Surgery: Strabismus. Philadelphia: Lippincott; 1991.

    Google Scholar 

  12. 12.

    Huang W, Foster JA, Rogachefsky AS: Pharmacology of botulinum toxin. J Am Acad Dermatol 2000, 43:249–259.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Mohan M, Tow S, Fleck BW, Lee JP: Permanent extraocular muscle damage following botulinum toxin injection [letter]. Br J Ophthalmol 1999, 83:1309–1310.

    PubMed  CAS  Google Scholar 

  14. 14.

    Flanders M, Hastings M: Diagnosis and surgical management of strabismus associated with thyroid-related orbitopathy. J Pediatr Ophthalmol Strabismus 1997, 34:333–340.

    PubMed  CAS  Google Scholar 

  15. 15.

    Ruttum MS: Effect of prior orbital decompression on outcome of strabismus surgery in patients with thyroid ophthalmopathy. J Am Assoc Pediatr Ophthalmol Strabismus 2000, 4:102–105.

    Article  CAS  Google Scholar 

  16. 16.

    Astin CL: The use of occluding tinted contact lenses. CLAO Journal 1998, 24:125–127.

    PubMed  CAS  Google Scholar 

  17. 17.

    Birnbaum MH, Soden R, Cohen AH: Efficacy of vision therapy for convergence insufficiency in an adult male population. J Am Optom Assoc 1999, 70:225–232.

    PubMed  CAS  Google Scholar 

Download references

Author information

Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lee, M.S., Volpe, N.J. Double vision. Curr Treat Options Neurol 3, 383–388 (2001). https://doi.org/10.1007/s11940-001-0042-5

Download citation

Keywords

  • Botulinum Toxin
  • Strabismus
  • Strabismus Surgery
  • Medial Rectus
  • Double Vision