Double vision

Abstract

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. 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.

Monocular diplopia‐associated migraine‐like headache induced by nicotine withdrawal

“…To distinguish monocular versus binocular diplopia, the first step is to ask 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 . However, in our case, double vision resolved when the right eye was covered, but remained when the left eye was shielded, which clearly demonstrated the two images were viewed by single right eye (monocular diplopia).…”

Rare presentation of cryptococcal meningitis in an immunocompetent patient

“…With monocular, the diplopia remains when either eye is covered, which is the result of ocular misalignment such as astigmatism. With binocular, the diplopia resolves with shielding one eye which is the result of a possible neurological process as the eyes do not coordinate in sync 9. Our patient demonstrated signs of binocular diplopia, which further narrowed our differential.…”

Diplopia as the Sole Manifestation of Hyperthyroidism

“…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 [ 3 ]. Binocular vertical diplopia may be due to supranuclear processes, ocular motor nerve dysfunction, neuromuscular junction disease, diseases of eye muscle, mechanical processes causing vertical eye misalignment, and even retinal disease [ 4 ].…”