Eye Movements
Recent-onset or persistent double vision.
Warning signs: if double vision starts suddenly with a severe headache, a drooping eyelid, a dilated pupil, weakness, speech changes or balance problems, seek emergency medical care immediately. Do not wait for a WhatsApp message, email reply or routine appointment.
Diplopia means seeing two images of a single object. It is important to distinguish binocular diplopia—which disappears when either eye is closed and usually involves eye alignment or neurological control of eye movements—from monocular diplopia, which persists when viewing with one eye alone and generally has an ocular rather than a neurological cause.
Binocular diplopia may be caused by palsy of the cranial nerves that control eye movement (III, IV or VI), thyroid eye disease, myasthenia gravis, or other neurological or systemic conditions. Identifying the cause is necessary both to guide treatment and to rule out conditions requiring more urgent attention.
The evaluation considers the specific pattern of double vision (which direction of gaze brings it on or makes it worse) and examines eye movements. Depending on the findings, further testing or coordination with other specialties may be needed.
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General references