Diplopia: Treatment Options and Causes Explained

Treatment for Diplopia (Double Vision)

Hello Dr.
Liang, I would like to ask you about whether individuals with diplopia can wear contact lenses to address the issue of mismatched focal distances between old glasses and the current condition of both eyes.
What type of surgery could improve the current diplopia? Does your hospital perform such surgeries? I have noticed that after taking a shower, the symptoms of diplopia temporarily disappear; what could be the reason for this? Is it related to hyperthyroidism affecting the extraocular muscles? Can physical therapy or massage help improve this condition? Thank you.
Below is my medical history:
One morning in 2016, while driving out of a parking lot, I turned my head left and right to observe the road conditions, and suddenly experienced diplopia.
After nearly a year without improvement, I noticed that my eyes were becoming more protruded.
In 2017, I sought medical attention and was diagnosed with hyperthyroidism causing exophthalmos and associated diplopia (binocular diplopia).
After a five-day hospitalization and high-dose steroid treatment, I continued to take medication for hyperthyroidism for over a year.
My thyroid levels returned to normal, but my left eye still protrudes slightly (five months post-treatment, I developed herpes zoster).
The diplopia situation improved slightly; initially, I experienced horizontal double vision, with the left image lower than the right, approximately at a 45-degree angle below the right image.
Currently, the two images are almost at the same horizontal level, with the left image slightly lower than the right.

Over the past year, I have noticed that after taking a shower (including washing my hair), the diplopia temporarily disappears for about 1-2 minutes, and the pupils are aligned correctly, but the diplopia returns shortly after.
Reflecting back, I recall that about 20 years ago, I often felt that the eyelashes or eyelids of my left eye easily touched the lens (which is still the case now), but I always thought it was due to a misaligned frame.
The glasses I currently wear were prescribed before the onset of my condition, with a prescription of -8.50 for the left eye and -9.50 for the right eye, both with astigmatism of -0.75.
I have been wearing progressive lenses for my myopia and presbyopia.
In the three years prior to the onset of my condition, I had five new pairs of glasses fitted, with each refraction showing about a 1.00 diopter change.
Currently, I am unable to undergo refraction for new glasses.

Mr. Zhong, 60~69 year old female. Ask Date: 2021/06/07

Dr. Liang Ce reply Ophthalmology

It is recommended that you discuss the above situation further with your attending physician to determine if any additional examinations are necessary.
Thank you, and wishing you good health!

Reply Date: 2021/06/07

More Info

Diplopia, or double vision, can be a complex condition with various underlying causes and treatment options. It is essential to understand the nature of your diplopia, its causes, and the potential treatments available to manage or alleviate the symptoms.

Causes of Diplopia
In your case, the diplopia appears to be associated with hyperthyroidism (甲亢), which can lead to Graves' disease, a condition that often results in thyroid eye disease (TED). This condition can cause inflammation and swelling of the eye muscles, leading to misalignment of the eyes and resulting in diplopia. The fact that you experienced a sudden onset of diplopia while driving and have noticed changes in your eye position over time suggests that there may be a muscular or neurological component to your condition.

Treatment Options
1. Eyewear Adjustments: While wearing contact lenses may help with comfort and aesthetics, they may not necessarily correct the underlying issue of misalignment. However, specialized prisms can be incorporated into glasses to help align the images seen by each eye, potentially alleviating the diplopia.

2. Surgical Options: Surgical intervention may be considered if the diplopia is persistent and significantly impacts your quality of life. Strabismus surgery, which involves adjusting the eye muscles, can help realign the eyes and reduce or eliminate diplopia. It is crucial to consult with an ophthalmologist or a specialist in ocular motility to determine if you are a suitable candidate for this type of surgery.

3. Physical Therapy and Rehabilitation: While physical therapy and eye exercises may not directly resolve diplopia, they can help improve coordination and strengthen the eye muscles. Some patients find relief through vision therapy, which may include exercises designed to improve eye alignment and coordination.

4. Medical Management: Since your diplopia is related to hyperthyroidism, managing the underlying thyroid condition is crucial. This may involve antithyroid medications, radioactive iodine treatment, or even surgery to remove part of the thyroid gland, depending on the severity of your hyperthyroidism.

Temporary Relief and Symptoms
You mentioned that your diplopia temporarily resolves after showering. This phenomenon could be due to changes in muscle tension or relaxation during the warm water exposure, which may temporarily alleviate the muscle imbalance causing the diplopia. However, this is not a long-term solution, and the underlying issue needs to be addressed.

Monitoring and Follow-Up
Given the complexity of your condition, it is essential to have regular follow-ups with your healthcare provider. They can monitor your thyroid levels, assess the progression of your eye symptoms, and adjust your treatment plan as necessary. If you are experiencing significant discomfort or changes in your vision, do not hesitate to seek immediate medical attention.

Conclusion
In summary, diplopia can be a challenging condition, especially when associated with underlying health issues like hyperthyroidism. While contact lenses may provide some comfort, they may not resolve the diplopia. Surgical options, medical management of thyroid conditions, and possibly vision therapy could be beneficial. It is crucial to work closely with your healthcare providers to develop a comprehensive treatment plan tailored to your specific needs.

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