Sudden Double Vision

Sudden double vision can be quite concerning, both for a patient and a doctor. If you are a patient it is very difficult and downright dangerous to drive to an office to have your vision checked.

As a doctor the question becomes what has caused the double vision. The majority of double vision is binocular (both eyed) therefore it goes away if an eye is covered.

Possible causes of binocular double vision include:

Trauma – this is generally fairly apparent, the patient may have been struck or been in a car accident.
Stroke – damage in the brain can cause difficulty controlling eye muscles
Aneurysm – a expanding blood vessel can compress an area which controls an eye muscle
Tumor – can be either in the brain or compressing the muscle themselves
Myasthenia Gravis – a muscle disorder which causes generalized weakness but it often affects muscles intermittently
Grave’s Disease – an autoimmune disorder which can cause tightening of the muscles
Microvascular disease – including high blood pressure and diabetes can cause temporary damage to a muscle
Decompensated phoria – essentially this means someone has a latent eye turn which they are no longer able to compensate for

Assuming there is no history of trauma, the more dangerous disorder need to be ruled out. This usually requires a neurological evaluation and often an MRI. In the meantime we can treat the double vision with prism.

Fresnel prism is form of prism that can be attached to a pair of glasses. It is cut in the shape of the lenses with scissors and then sticks to the front surface. It is a fantastic option with new double vision because the amount of prism can be quickly and cheaply adapted as the alignment changes. It does however cause a fair bit of blurriness out of the eye it is placed over.

If the dangerous disorders are ruled out, the likely culprit is a docompensated phoria. Options for treating the double vision include vision therapy or prism, after several months surgery is also possible. If prism is used, having it embedded into glasses provides the best clarity.

“Dodge”

William Dodge Perry, OD

Falls Church VA