2023-06-16 21:00:00
Double vision is a visual disorder in which one object is seen as two. The two images may be close. together or very far apart
Normally, the two eyes are facing the same direction. and rolled in different directions Simultaneously to see a single clear image. If there is an abnormality that inhibits the eye roll, it may be in the muscles, nerves, and the brain stem, causing the two eyes to see differently. and unrelated eye rolls, causing double vision The causes that can be found are tumors, aneurysms, nerve inflammation, ischemia, accidents, muscle weakness, thyroid eruption, muscle slack by age, etc. There are 6 eye muscles on each side, up-down/in-out/counter-clockwise. Controlled by cranial nerves 3, 4 and 6, 3 on each side of the brainstem.
When there are symptoms of diplopia, the important history to help in the differential diagnosis is diplopia when looking with one eye or both eyes, the direction of diplopia. Is there a constant overlap in each direction, time since symptom onset? The duration of the change, with other symptoms such as pain, blurred vision, to distinguish between diplopia when looking with one or both eyes, the patient will have to close one eye at a time and look at If you look at each eye with double vision, it means double vision caused by one eye. The cause may be dry eyes. Uncorrected myopic/long/astigmatism cataracts But if looking with one eye at a time, the double vision disappears, but looking with both eyes and seeing double vision It is caused by one eye being positioned differently, often due to misalignment of the eye muscles. The nature of double images may be seen as a left-right, top-bottom, oblique line.
Causes of dangerous diplopia include: 1. Diploma of blood vessels Diplopia often occurs suddenly within 1 week. Which is caused by the 3rd pair of nerves being pressed in the first place, may be double images, left-right, top-bottom, oblique if the blood vessel is broken Bleeding under the meninges can be fatal, so if symptoms occur, rush to the hospital immediately.
2. Infection, double vision symptoms are increasing in 1-3 weeks, there is often pain behind the eyeballs / head as well. Caused by infections such as sinusitis often posterior tissue
The eyeball is damaged if the infection spreads to the vision, even if treated, vision may not be as clear as before.
3. Tumors like posterior eye cancer Affects nerves 3, 4, or 6, causing pressure in the eye sockets. unable to roll eyes Or there may be a brain tumor that causes high intracranial pressure, causing weakness in the 6th cranial nerve, causing left-right double vision. Often accompanied by brain symptoms such as trembling, trembling hands
Other, more common causes include:
Myasthenia Gravis, a muscle weakness There is often ptosis, which may or may not have double vision. There are often different symptoms during the day, which may be triggered by factors such as being sick.
With some drugs, a confirmed diagnosis relies on a number of laboratory tests. but in some cases, if the symptoms are mild Laboratory abnormalities may not be detected at all, especially if there is weakness only in the eyes. Further examination by placing ice on the eyelids. May help improve neurotransmitters, drooping eyelids look taller or missing images Helps in diagnosing muscle weakness. Some cases may provide treatment and follow-up appointments. In many patients, if the immune system improves, the double vision may disappear.
Nerve ischemia is often caused by an underlying disease. such as poorly controlled high blood pressure, diabetes, hyperlipidemia long smoking Most of the symptoms will start to get better in 1 month and will disappear in about 3 months or more. If it doesn’t get better in 1 month, you need to find out if it’s from other causes such as inflammation, tumors, etc.
look sideways and overlap ->Suspected as the 6th pair of nerves lacking blood, walking, bending over, tilting the neck, if looking up straight and seeing oblique double vision ->Suspected as a lack of blood supply to the 4th nerve, the eyelids are unable to move inward/upper-lower, but the iris is still responding well. The duration is about 1 week -> Usually the 3rd pair of nerves is ischemic.
squinted eyes from long staring Caused by the use of eyes looking at the computer screen too much. Eye strain, double vision will come and go, no matter where you look, double vision will be the same. It’s very late in the evening after working all day. Spasms of the pupil may also occur. The duration is often a long time. treatment by rest reduce computer use and follow-up with an ophthalmologist
The importance of caring for patients with double vision is the correct diagnosis. Because the cause of the symptoms are double vision. There are a lot of things that are life threatening. But many things are not dangerous. The doctor will find a life -threatening cause before the treatment guidelines will be resolved at the first cause. relying on the cooperation of ophthalmologists Physician-neurological surgeon, otolaryngologist, who diagnoses the cause Several methods must be used together, such as blood tests, brain scans, and electrocardiograms. etc., but there are some diseases that may be examined further, nothing can be found, using the method of assuming and monitoring the symptoms mainly In general, it is recommended that patients continue their treatment in the same place. Or if moving to the hospital, should ask for the results of the examination as well Because care for patients with diplopia is important, ongoing follow-up assessment is not recommended for some patients to change physicians. or moving the hospital indefinitely because there may be duplicate checks and exposure to excess radiation
Treatment for double vision depends on the cause, for example: 1. Tumor surgery may be able to cut only some parts and then continue with chemotherapy. To reduce the size of the tumor, blurred vision can be reduced. 2. Taking medicine in patients with double images from muscle weakness 3. give antibiotics Antibiotics if double images are caused by infection, inflammation. corrected by wearing a lens
After completing the treatment according to the cause, if the double vision symptoms persist there is a solution to reduce double images depending on the distance of double images Or the corner of the strabismus, the doctor will choose the treatment method such as 1. Prism glasses 2. Eye muscle surgery 3. Botulinum toxin injections into the eye muscles
The doctor will treat by focusing on making the center of the visual field to be without double images. Usually do not do treatment, but let the patient practice and adapt.
Narrated by
Asst.Prof.Dr.Niphat Euaaree Neuro-Ophthalmology Club
Dr. Techawit Likhitkorn Neuro-Ophthalmology Club
Compiled by Dr. Naphasakorn Sulaimanee, M.D.
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