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What is Diplopia? Why is it important to understand diplopia

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Author : Dr Deepak Garg

Diplopia, also commonly known as double vision. Diplopia means  a condition in which an individual sees two images of a single object. It usually occurs when the eyes are not correctly aligned, or there is an issue with the muscles controlling eye movements. Understanding diplopia is crucial, as it can be a symptom of a severe underlying medical condition, such as a brain tumour or stroke. By recognizing and seeking treatment for diplopia, patients can prevent potential complications and improve their quality of life. In this blog, we’ll explain diplopia and its causes in-depth and share tips for managing and treating this condition.

What are the types of diplopia?

There are two types of diplopia – binocular and monocular – each with unique causes and symptoms.

1. Binocular diplopia is the most common type of double vision and occurs when both eyes are open. This type of diplopia is typically caused by an issue with the muscles that control eye movement. Symptoms of binocular diplopia include seeing two horizontally or vertically displaced images, and double vision disappears when one eye is closed.

Binocular diplopia are of two types

  1. Comitant binocular diplopia occurs when the distance between the two images remains the same regardless of the direction of gaze.
  2. Incomitant binocular diplopia occurs when the distance between the two images changes depending on the direction of the gaze.

2. Monocular diplopia, on the other hand, occurs when double vision is present in only one eye, even when the other eye is closed. This type of diplopia is typically caused by issues with the eye itself, such as a cataract or astigmatism. Symptoms of monocular diplopia include seeing two images vertically or horizontally displaced from each other or overlapping. 

There are three subtypes of monocular diplopia

  1. Physiological monocular diplopia is normal when looking at specific patterns, such as a striped shirt.
  2. Pathological monocular diplopia is caused by an underlying health condition or eye disorder, such as a cataract or retinal detachment.
  3. Artificial monocular diplopia occurs when the individual intentionally induces double vision, such as looking through a pair of binoculars with one eye.

What are double vision or diplopia causes?

The reason for double vision or diplopia can vary from minor issues to more severe underlying medical conditions. Understanding the root cause of diplopia is essential in determining the appropriate treatment options.

Binocular Diplopia

  1. Strabismus or squint
  2. Cranial nerve palsy – These could be the 3rd Nerve palsy, 4th Nerve palsy or the 6th nerve palsy. These are usually of sudden onset and could occur because of the following
    1. Hypertension
    2. Diabetes
    3. Brain tumour
    4. Brain aneurysm
    5. Stroke
    6. infection
  3. Injury to the Extraocular muscle – Because of an eye trauma
  4. Road traffic accident resulting in injury to the eye socket or facial trauma or head injury
  5. Thyroid eye disease – autoimmune condition
  6. Other neurological diseases
    1. Guillain-Barre Syndrome – rare autoimmune disease
    2. Myasthenia Gravis – a condition that affects the neuromuscular junctions and muscles don’t function well
  7. Convergence Insufficiency – May lead to diplopia sometimes
  8. Nystagmus

Monocular diplopia

  1. Astigmatism
  2. Dislocated lens
  3. Dislocated IOL – After a cataract surgery
  4. Polycoria – Multiple Pupils 

Symptoms of Diplopia

Apart from seeing double following symptoms may occur

  1. Eye strain
  2. Headaches
  3. Patients tripping and falling – lack of depth perception
  4. Glare
  5. Difficulty in seeing in dim light
  6. Difficulty reading 
  7. Difficulty concentrating
  8. Blurred vision

What are the investigations in diplopia ?

The following are done depending on the what positive findings are found

  1. Detailed eye examination
  2. Strabismus examination
  3. Diplopia charting
  4. Binocular function test or depth perception – Titmus fly test
  5. Physical exam of the face and orbits
  6. Eye muscle movements examination
  7. MRI or magnetic resonance imaging or brain and/or orbits
  8. Blood tests – Needed for certain neurological conditions and for blood sugar
  9. Visual field test – to test the field of vision

What are the options for diplopia treatment?

Treatment options for diplopia depend on the underlying cause of the condition.

Treatment for squint or strabismus

  1. Eye glasses to treat high plus power
  2. Eye exercises
  3. Prism Glasses used for eye misalignment
  4. Eye cover or eye patch – Used when we expect the squint to recover on its own in a few months. Usually in cranial nerve palsies caused due to diabetes or hypertension.
  5. Squint or strabismus surgery
  6. Prism adaptation test – Here prisms are placed on the glasses so that the child or the adult feels what it would be like after the surgery. If the patient is comfortable then we go ahead with the surgery. 
  7. Botox Injections in the muscle to realign the eyes.
  8. Vision therapy may work in some situations


Diplopia can be caused by various underlying medical conditions, from minor issues to more severe disorders. Understanding the root cause of diplopia is essential in determining the appropriate treatment options. The top five causes of diplopia include problems with the muscles controlling eye movements, underlying health conditions such as diabetes or high blood pressure, cranial nerve damage, thyroid eye disease, and severe underlying medical conditions such as brain tumours or stroke. If you are experiencing double vision, seeking medical attention to determine the underlying cause and receive appropriate treatment is essential.Is Double vision troubling you? Trust Eye Solutions, the Complete Eye hospital in Mumbai, with our expert doctors at Kemps Corner. Get treated today and book your appointment now!

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