Monocular Diplopia: Causes and Solutions for Right Eye Issues

Q: Monocular Diplopia: Causes and Solutions for Right Eye Issues

Hello, Nantou conscript： Common causes of monocular diplopia include refractive errors, especially astigmatism, corneal disorders, cataracts, lens dislocation, iris atrophy, and vitreoretinal diseases. <br>Based on your description, it is likely due to previous corneal inflammati

Monocular diplopia in the right eye?

Hello, doctor! After I entered military service at Chenggong Ridge around March, I noticed that at night, when looking at lights or light sources (like the moon or streetlights), they appeared to scatter, and I experienced photophobia.
At that time, I consulted a doctor who diagnosed me with corneal abrasion and inflammation, and advised me to use eye drops and rest.
After using the eye drops for over a month, the doctor said my eyes had healed.
However, I then realized that while my eyes no longer felt uncomfortable or sensitive to light, I began to see double images when looking at text on my phone or lights at night, specifically right above the text or light source.

I conducted a cover test and found that only my right eye exhibited this issue.
During the day, while I do not see double images, distant objects appear unclear, almost as if my eyes are unable to focus properly.
The vision test indicated that my eyesight had not significantly changed, but during the test, the doctor asked me to identify gaps, and I needed to wait a moment before I could see them.
Although I could eventually see the gaps, everything still felt blurry.
Interestingly, my right eye was identified as my dominant eye, so I would expect distant vision to be clearer than with my left eye.
Due to these issues, I have visited two ophthalmologists at Chung Shan Medical University and an eye clinic in Taichung.
Both doctors performed corneal topography, macular examinations, and retinal assessments, all of which showed no problems.
They were also unclear about the cause of my symptoms.
I even had my glasses prescription updated, but both my previous and current glasses still present issues, suggesting that it may not be a problem with the glasses.
However, I find that wearing contact lenses provides clearer vision compared to glasses, even though I still experience some double vision.
It feels like I can see further and more clearly with contacts.

Thank you for your assistance, doctor! My prescription is +8.50 for the right eye and +7.75 for the left eye, and I also have floaters in my right eye.

Nantou Yirnan, 20~29 year old female. Ask Date: 2021/05/28

Dr. Gao Pilin reply Ophthalmology

Hello, Nantou conscript: Common causes of monocular diplopia include refractive errors, especially astigmatism, corneal disorders, cataracts, lens dislocation, iris atrophy, and vitreoretinal diseases.
Based on your description, it is likely due to previous corneal inflammation that has resulted in corneal scarring.
Sometimes, even very small or irregular scars can cause diplopia, but they may not be easily detectable upon examination.
Online responses can only serve as a reference; it is essential to seek medical attention at a healthcare facility if necessary.
I hope to have the opportunity to assist you.
Gao Pilin

Reply Date: 2021/05/28

More Info

Monocular diplopia, or double vision in one eye, can be a perplexing and concerning symptom, especially when it arises after an eye injury or condition such as corneal abrasion. Your experience of seeing halos or ghosting around lights, particularly at night, and the subsequent development of double vision in your right eye, suggests that there may be underlying issues that need to be addressed.

Firstly, it is important to understand that monocular diplopia can arise from various causes, including refractive errors, corneal irregularities, lens opacities, or retinal issues. Given your history of corneal abrasion and inflammation, it is possible that the cornea has not fully healed or that there are residual effects from the initial injury. Corneal irregularities can lead to light scattering, which may cause the visual distortions you are experiencing.

The fact that your vision is clearer with contact lenses compared to glasses suggests that the glasses prescription might not be optimal for your current eye condition. Contact lenses can provide a more stable and uniform surface for light to enter the eye, which may help reduce the ghosting effect. However, it is crucial to ensure that the contact lenses are fitted properly and that they are not contributing to any additional irritation or dryness.

You mentioned that both ophthalmologists you consulted performed thorough examinations, including checks of the cornea, macula, and retina, and found no significant issues. This is reassuring, but it does not completely rule out the possibility of subtle corneal irregularities or other factors that could be contributing to your symptoms. It may be beneficial to seek a consultation with a specialist in corneal diseases or a neuro-ophthalmologist, who can provide a more in-depth evaluation of your condition.

In addition to the potential corneal issues, it is also important to consider the role of dry eye syndrome, especially since you have experienced discomfort and visual disturbances after prolonged use of digital devices. Dry eyes can exacerbate visual symptoms and may contribute to the feeling of blurred or double vision. Using artificial tears or lubricating eye drops can help alleviate dryness and improve overall comfort.

Another aspect to consider is the possibility of a refractive error that may not have been fully corrected with your current glasses. If you have not already done so, it may be worthwhile to undergo a comprehensive refraction test to ensure that your prescription is accurate and that any astigmatism or other refractive errors are adequately addressed.

In summary, while your symptoms of monocular diplopia and visual disturbances can be distressing, they may be manageable with the right approach. Here are some steps you can take:
1. Consult a Specialist: If you haven't already, consider seeing a corneal specialist or a neuro-ophthalmologist for a more detailed evaluation of your symptoms.

2. Re-evaluate Your Prescription: Ensure that your glasses prescription is accurate and consider the possibility of needing a different prescription for different activities (e.g., reading vs. distance).

3. Consider Contact Lenses: If you find that contact lenses provide clearer vision, discuss with your eye care provider about the best options for your needs.

4. Manage Dry Eye Symptoms: Use lubricating eye drops to alleviate dryness and improve comfort, especially during prolonged screen time.

5. Monitor Your Symptoms: Keep a log of your symptoms, noting when they occur and any potential triggers, which can help your eye care provider in diagnosing the issue.

By taking these steps, you can work towards finding a solution to your visual disturbances and improving your overall eye health.

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