Diplopia - Causes and Signs of Diplopia

Types

Diplopia can be:

• binocular;
• monocular.

There are two forms of the disease:

• horizontal;
• vertical.

Causes

Diplopia can be caused by displacement of the eyeballs in the eye sockets. It is often caused by eye trauma, such as pinching of the eye muscles, caused by a fracture of the walls of the eye sockets. Abnormal positions of the eyeballs are also caused by hematomas of the eye tissues. Another possible cause of diplopia is damage to the oculomotor nerve.

Diplopia can be caused by:

• infectious processes affecting the brain stem due to rubella, mumps, diphtheria or tetanus;
• severe alcohol or drug intoxication;
• pathologies arising in the eye cavities, which lead to displacement of the eyeballs;
• orbital injuries arising as a result of fractures of the lower walls of the eye sockets and pinching of the eye muscles;
• tumor processes and hematomas causing restrictions in the movement of the eyeballs or their complete fixation;
• head injuries resulting from damage to the oculomotor nerve nerve;
• aneurysm of the internal carotid artery, compressing the oculomotor nerve.

Symptoms

Diplopia manifests itself with the following signs:

• double vision;
• difficulty in determining the location of objects;
• frequent dizziness.

Symptoms of the disease depend mainly on where the pathological process is located. If the disease has affected the oblique muscles, then with double vision, the images of objects are located one above the other. If the rectus muscles are affected, then double vision of a parallel nature may appear. Diplopia is characterized by varying degrees of deviation of the eyes in the direction opposite to the affected muscles. As a result, there is a limitation or absence of movement of the eyeballs in the direction of the affected muscles. Very often, to get rid of double vision, a person has to tilt or turn their head towards the affected muscles.

Two identical images of one object that occur with diplopia may differ in contrast and brightness. One of them may shift slightly vertically or horizontally, or be located at a certain angle to the second image.

Diagnostics

Diagnostics of the disease is based on:

• analysis of complaints and history of the disease: how long ago double vision and dizziness appeared; what event provoked the development of these symptoms (headaches, vomiting and nausea, diarrhea, or something else);
• on a neurological examination: the strength of the oculomotor muscles, the presence of strabismus are assessed, diplopia itself (and the plane of its predominance) is identified; search for signs of other neurological pathologies (dizziness, ptosis (drooping) of the upper eyelid, narrowing or dilating of the pupils, absence or reduction of reflexes);
• on the prozerin test: administration of the drug prozerin, which reduces the severity of this disease in myasthenia;
• on the blood test: the glucose level in the blood is measured in order to exclude diabetes mellitus;
• on strabometry: the presence of strabismus is assessed and the angle of deviation in the eyeball is measured;
• computer and magnetic resonance tomography of the head, with the help of which it is possible to study the structure of the brain layer by layer and identify any abnormalities in the structure of the brain (for example, a tumor, hemorrhage, traumatic injury).

In some cases, it is necessary to consult a neurosurgeon.

Treatment

Treatment of diplopia consists of treating the causes that caused it. This can be done in the following ways:

• therapy of the volumetric process in the orbit (puncture of hematomas, removal of tumors);
• treatment of stroke, neuralgia, neuropathy, etc.;
• fight against diseases of infectious or inflammatory origin, while using antibiotics, anti-inflammatory drugs, diuretics;
• treatment of underlying diseases. Since in many cases the work of the optic nerves can be disrupted, a neurologist and ophthalmologist should also participate in the treatment;
• prismatic correction to reduce the disease of diplopia. The patient is made special individual glasses, in which the center of the lens is often shifted. This helps to correct vision. The optimal treatment option is considered to be the use of six prismatic diopters per eye;
• functional therapy, which includes special exercises that expand the field of vision and restore binocular vision;
• surgical treatment.

Prevention

Due to the fact that this disease is characterized by unpredictable development, it is impossible to carry out preventive measures. But you can still avoid diplopia by:

• giving up unhealthy habits (smoking, drinking alcohol);
• maintaining a healthy, active lifestyle: regular walking for at least 2 hours a day, doing physical exercise, following a day and night routine (sleep at night should last at least 8 hours);
• preventive observations by doctors;
• timely contacting doctors if any health problems arise;
• monitoring blood pressure.