Double Vision (Diplopia): Causes and Treatment

Double vision (diplopia) is when you see two images of one object. Learn about its common causes, symptoms, and treatment options in simple terms.

Double Vision (Diplopia): Causes and Treatment

  • Category

    General

  • Published By

    GetWellGo Team

  • Updated on

    17-Jun-2025

Double Vision Causes

Double vision (or diplopia) perceives two images of an object. It is either monocular (in one eye) or binocular (in both eyes). The etiology varies with the type:

Binocular Double Vision

Happens when both eyes are open and resolves when one eye is shut. Typically results from misalignment of the eyes.

Common Causes:

  • Strabismus (imbalance of muscles of the eye) – such as esotropia or exotropia
  • Cranial nerve palsies (involving nerves III, IV, or VI):
  • Third nerve palsy (ptosis, dilated pupil, eye turned down and out)
  • Fourth nerve palsy (vertical double vision, worse on looking down)
  • Sixth nerve palsy (horizontal double vision, can't move eye outward)
  • Graves' disease (thyroid eye disease) – causes limited eye movement
  • Myasthenia gravis – autoimmune muscle weakness that gets progressively worse with fatigue
  • Brainstem or cerebellar lesions – stroke, tumor, aneurysm, or MS
  • Trauma – orbital fractures affecting eye muscle movement

Monocular Double Vision

Continues in one eye when the other is shut. Most often caused by problems with the cornea, lens, or retina.

Common causes:

  • Astigmatism – abnormal corneal curvature
  • Cataract – lens clouding
  • Dry eye syndrome – interferes with tear film clarity
  • Keratoconus – thinning of the cornea that distorts
  • Lens dislocation (ectopia lentis) – secondary to injury or conditions such as Marfan syndrome
  • Macular degeneration or retinal disease (less common cause)

What is diplopia?

Double vision is the medical condition where an individual perceives two images of one object rather than one. The two images could be side by side, one above the other, or diagonally displaced, and could overlap or definitely be separated.

Types of Diplopia

There are two broad categories:

Binocular Diplopia

  • Present only when both eyes are open
  • Fades when either eye is closed
  • Caused by misalignment of the eyes (the eyes point in two different directions)

Monocular Diplopia

  • Remains in one eye even when the other eye is shut
  • Caused by issues inside the eye itself, rather than misalignment

Double vision in one eye

Double vision in a single eye is referred to as monocular diplopia. It typically indicates the issue lies within the malfunctioning eye itself and is not connected to brain or nerve activity.

Key Features of Monocular Diplopia

  • Remains when the other eye is shut
  • The object is doubled, ghosted, or has two edges
  • Typically painless
  • Blurs can be enhanced with the help of a pinhole or head position change

Double vision symptoms

Double vision (diplopia) presents with a variety of symptoms based on the cause, type (monocular or binocular), and whether it's linked to other neurological or eye disease. 

Fundamental Symptom

Viewing two images of an object:

  • Side by side (horizontal diplopia)
  • One above the other (vertical diplopia)
  • Slanted or overlapping (diagonal diplopia)

Co-occurring Symptoms

Depending on the cause, you might also notice:

Eye-related Symptoms

  • Blurry vision
  • Strain or discomfort in eyes
  • Inability to focus
  • Frequent squinting or closing an eye
  • Eyelid drooping (ptosis)
  • Misaligned eyes (crossed eyes)

Neurological or Systemic Symptoms

  • Headache
  • Dizziness or unsteadiness
  • Numbness or tingling in the face
  • Speech or swallowing difficulty
  • Limbs' weakness
  • Nausea or vomiting
  • Loss of coordination or balance

Visual Clues

  • Worsening symptoms when looking in one direction
  • One image that moves with the eye to be affected
  • Better vision with an eye closed (suggests binocular diplopia)
  • Double vision in one eye only (suggests monocular diplopia)

How to treat double vision?

Treatment of double vision (diplopia) entirely rests on its cause and whether it is monocular (in one eye) or binocular (in two eyes). Listed below is an organized approach to how it is generally treated:

Diplopia treatment options:

Monocular Diplopia Treatment

(Only occurs in one eye, continues even when the other is shut)

Typical Causes & Cures

  • Astigmatism: Glasses or contact lenses to correct
  • Cataract: Surgery to remove the cataract
  • Dry eye: Artificial tears, lubricating gels, punctal plugs
  • Keratoconus: Specialty contact lenses, cross-linking of the cornea, or corneal transplant (in advanced cases)
  • Corneal swelling or scarring: Inflammatory drops, surgery on the cornea (if necessary)
  • Dislocated lens: Lens repositioning or replacement with surgery

Treatment for Binocular Diplopia

(Appears only when both eyes are open, vanishes if either eye is shut)

Common Causes & Treatments

  • Strabismus (misaligned eyes): Glasses containing prisms, vision therapy, or eye muscle surgery
  • Cranial nerve palsies (III, IV, VI): Usually resolves spontaneously, but sometimes needs: Prisms, Patching one eye, Operation

Short-Term Relief of Symptoms

While awaiting complete diagnosis or treatment:

  • Use prism glasses to align the pictures
  • Patch one eye (temporary solution to be comfortable)
  • Don't drive or operate machinery until symptoms have passed
  • Modify lighting to ease strain

Vertical vs horizontal double vision

Vertical and horizontal double vision is two forms of binocular diplopia (double vision with eyes open). How the two pictures are separated in direction gives a hint about the cause.

Horizontal Double Vision

What it looks like: Two pictures appear side by side

Worsens when glancing left or right

Common Causes

  • Sixth cranial nerve (abducens) palsy: Pares the lateral rectus muscle; eye can't turn outward normally
  • Strabismus (esotropia or exotropia): Inward or outward misalignment of the eyes
  • Graves' eye disease: Tightness of muscles restricts side-to-side movement of the eyes
  • Myasthenia gravis: Weakening of eye muscles, which include muscles that move eyes laterally
  • Head trauma: May damage nerves or muscles responsible for horizontal movement

Vertical Double Vision

What it looks like: One image is seen above the other

Worsens with looking up or down, or with head tilt

Common Causes

  • Fourth cranial nerve (trochlear) palsy: Involves the superior oblique muscle; difficulty looking downward, particularly when reading or going down stairs
  • Thyroid eye disease: Tightness of the inferior rectus restricts upward gaze
  • Orbital floor fracture: Bypasses eye muscle, limiting upward movement
  • Brainstem lesions or stroke: May impact vertical gaze centers or nerves
  • Myasthenia gravis: Also results in vertical misalignment in fluctuating patterns

Diplopia neurological causes

Neurological Causes of Diplopia (Double Vision)

AIFF non-neurological causes, double vision is usually caused by neurological causes that involve:

  • Cranial nerves (III, IV, VI) that control eye movements
  • Brainstem, cerebellum, or neuromuscular junction pathology
  • Occasionally central causes such as stroke, tumor, or demyelination

Important Neurological Causes of Diplopia

AIFF Nerve Palsies

  • Each of them is responsible for controlling eye muscles, and injury leads to eye misalignment.

Myasthenia Gravis

  • Autoimmune illness of the neuromuscular junction
  • Causes fluctuating muscle weakness, frequently in the eye muscles
  • Diplopia is worse with fatigue and better with rest

Multiple Sclerosis (MS)

  • A demyelinating illness that may affect:
  • Brainstem centers responsible for coordinating eye movements (e.g., internuclear ophthalmoplegia)
  • Cranial nerves
  • May result in periodic or fixed diplopia

Brainstem Stroke or Lesions

  • Involves cranial nerve nuclei, centers of gaze, or pathways of coordination

Also may result in:

  • Facial numbness/weakness
  • Balance difficulty
  • Slurred speech
  • Tumors (e.g., Meningioma, Schwannoma, Pituitary Adenoma)
  • May compress optic chiasm or cranial nerves
  • Gradual onset diplopia, sometimes with other visual or neurologic deficits

Increased Intracranial Pressure (ICP)

  • Can stretch 6th cranial nerve, resulting in horizontal diplopia
  • Usually with headache, vomiting, or papilledema

Wernicke's Encephalopathy

  • Secondary to thiamine deficiency (usually in alcohol use disorder)
  • Classic triad: ophthalmoplegia (dysfunction in eye movements), ataxia, confusion

Double vision after stroke

Double vision following stroke is a recognized and possibly dangerous complication. It typically occurs due to injury to eye movement and coordination-controlling areas of the brain, especially the brainstem, which contains nuclei for cranial nerves responsible for eye movement.

Why Stroke Produces Double Vision?

Stroke can interfere with:

  • Cranial nerves III, IV, or VI (eye muscle-controlling nerves)
  • Brainstem gaze centers
  • Visual processing pathways in occipital or parietal lobes

This results in defective eye coordination so that each eye now tends to move in a different direction, leading to binocular diplopia or double vision that is abolished by shutting one eye.

Why Choose GetWellGo for Double Vision Treatment?

GetWellGo is regarded as a leading supplier of healthcare services. We help our foreign clients choose the best treatment locations that suit their needs both financially and medically.

We offer:

  • Complete transparency
  • Fair costs.
  • 24 hour availability.
  • Medical E-visas
  • Online consultation from recognized Indian experts.
  • Assistance in selecting India's top hospitals for double vision treatment.
  • Expert ophthalmologist with a strong track record of success
  • Assistance during and after the course of treatment.
  • Language Support
  • Travel and Accommodation Services
  • Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
  • Local SIM Cards
  • Currency Exchange
  • Arranging Patient’s local food

 

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