Types and Causes
Double Vision (diplopia)
Double Vision (diplopia): Double vision refers to seeing two images of one object. This can occur all the time (constant) or sometimes (intermittent). There are two main types of double vision: that caused by one eye alone (monocular) and that caused by the combination of both eyes (binocular).
You can determine which type of double vision you have, by looking at an object and covering one eye. If the double goes away when you cover one eye, but continues when you cover the other, then you have one eye or monocular type. If the double goes away when you cover either eye, you have the two eyes or binocular type. The photo at left shows horizontal (side by side) double vision. One image is usually more faded or ghost-like than the other.
You should see your general ophthalmologist, eye MD, if you have the monocular type. You should see an adult strabismus specialist, if you have the binocular type. Adult strabismus specialists usually also treat children, so don’t be surprised to see kids in the waiting room. You are in the right place.
An adult strabismus specialist will help you determine the cause of your double vision and can offer either glasses with a special type of lens called a prism, exercises to help realign the eyes, or sometimes surgery to improve the double vision.
Causes of binocular double vision
There are many causes, but the most common reasons are break down of a pre-existing or childhood misalignment or the changes that occur to the structures around the eye as we age. Sometimes, hitting your head, a virus, stroke or brain mass can cause damage to a nerve which moves one of the eyes. This results in a particular pattern of double vision. A different pattern of double vision emerges if thyroid disease, or other autoimmune diseases are causing the diplopia. Your adult strabismus specialist will determine if you have a pattern of double vision that requires more investigation, including imaging of the eyes and brain. You may also be referred to a neuro-ophthalmologist to help determine the cause.
This is a special type of lens that can be ground into your glasses or placed in a film which clings to one lens of your glasses. The prism bends light to move objects and can help you superimpose the images again.
If the eyes do not point in the same direction, whether double vision exists or not, some people feel an embarrassment or self-conscious about the alignment. Often times, eye muscle surgery can be performed to re-align the eyes. You should discuss this with your adult strabismus specialist to see if it is right for you. Enhancing your quality of life by re-aligning the eyes may be the right treatment.
Eye Muscle Surgery
There is no age limit for eye muscle surgery. You should discuss the goals and expectations of surgery thoroughly with your strabismus specialist. The goals of surgery may be to improve the alignment of the eyes, restore binocularity, improve depth perception, increase the peripheral vision, increase the range of single vision, improve head posture, or reduce nystagmus.
In most instances, the surgery is done under general anesthesia, but does not require an overnight hospital stay. For your particular situation, you should rely on the advice of your strabismus specialist. In general, there is usually no bandaging of the eyes following surgery. Most patients are expected to recover and return to work in 3-5 days following surgery, but individual cases vary. Mild discomfort, headache, some nausea, and redness of the operated eye are common in the immediate postoperative period. It would be unexpected to have worsening pain, decreased vision, or worsening redness during the postoperative time. These symptoms may be a sign of infection and you should alert your strabismus specialist immediately if they occur.
Although the alignment changes immediately following surgery, there is a healing period when the alignment can change that lasts 4-6 weeks following surgery. Follow up appointments with your strabismus specialist during this time period will help chart your progress. Sometimes, eye muscle surgery needs to be repeated to fine tune the alignment, or due to over- or under-correction from the initial surgery. For more detailed information, refer to the preoperative and postoperative instructions page and discuss with your strabismus specialist.