Monocular Diplopia: Causes and Solutions for Eye Issues

Q: Monocular Diplopia: Causes and Solutions for Eye Issues

Hello Rusa： 1. Monocular diplopia is likely caused by astigmatism. Binocular diplopia is related to strabismus. 2. This is the situation seen with astigmatism. Therefore, astigmatism is the most probable cause of diplopia. The prescription for glasses is q

Both eyes have issues with monocular diplopia?

Hello, Doctor Gao.
My symptoms are as follows: I have congenital intermittent exotropia, as well as myopia (approximately 300 degrees) and astigmatism (both of which are acquired).
In recent years, I have developed floaters in both eyes, but these do not affect my daily life, so I haven't paid much attention to them.
However, in the past year, I have experienced diplopia.
After confirming that I have diplopia, I got a new pair of glasses, so I can confirm that the prescription is correct.

1.
I experience diplopia when viewing with both eyes and with each eye individually, and the degree of diplopia differs between my eyes (the left eye is more severe).
Therefore, I suspect that I have monocular diplopia in both eyes.

2.
I see diplopia (double vision) with both bright and non-bright objects, but it is particularly pronounced with bright objects.
The visual experience is similar to this: https://m.imgur.com/vNNgeKK?r3.

3.
I consulted two hospitals, both of which suggested that my condition might be caused by dry eyes.
The first hospital speculated that due to my strabismus, I may be exerting more effort to see near objects than the average person, leading to eye fatigue.
The second hospital performed dilation and examined my eyes with a flashlight, indicating that my cataracts, macula, and retina appeared normal.
They speculated that my diplopia might be due to fatigue and dry eyes.
However, my diplopia has been present since the moment I wake up, and even after a good night's sleep, the issue persists.
Additionally, after using eye drops (such as Refresh and artificial tears) for a month, there has been no improvement in my symptoms.
Therefore, I am concerned that the cause of my diplopia may not be dry eyes and fatigue, but rather some unknown reason.

Furthermore, someone suggested that I could get a pair of glasses with a lower prescription, stating that my current glasses prescription is quite strong (around 1.2), which is sufficient for distance vision but may cause strain when looking at near objects (due to my strabismus).
Do you think that getting a pair of glasses specifically for near vision could help alleviate my eye fatigue?

Rusa, 20~29 year old female. Ask Date: 2021/11/17

Dr. Gao Pilin reply Ophthalmology

Hello Rusa: 1.
Monocular diplopia is likely caused by astigmatism.
Binocular diplopia is related to strabismus.
2.
This is the situation seen with astigmatism.
Therefore, astigmatism is the most probable cause of diplopia.
The prescription for glasses is quite strong, and focusing on near objects requires more effort, so getting a pair of glasses specifically for reading or near work can help reduce fatigue.

Reply Date: 2021/11/17

More Info

Monocular diplopia, or double vision in one eye, can be a perplexing and concerning symptom. Your description of having congenital exotropia, myopia, astigmatism, and the recent onset of diplopia suggests a complex interplay of factors affecting your vision. Let's delve into the potential causes and solutions for your condition.

Understanding Monocular Diplopia
Monocular diplopia can arise from several underlying issues, particularly in the context of your existing eye conditions. Here are some common causes:
1. Refractive Errors: As you mentioned, you have myopia and astigmatism. These refractive errors can lead to blurred or double vision, especially if the prescription is not optimized for your specific needs. If your current glasses are too strong for near vision, it could exacerbate your symptoms.

2. Dry Eye Syndrome: Dry eyes can significantly impact visual clarity and comfort. Symptoms of dry eyes include irritation, redness, and fluctuating vision, which can contribute to the perception of double vision. If your eyes are not adequately lubricated, it can lead to instability in your visual system.

3. Strabismus: Your congenital exotropia may also play a role in your diplopia. Strabismus can cause misalignment of the eyes, leading to double vision. The brain may struggle to fuse the images from both eyes, especially if one eye is more affected than the other.

4. Fatigue and Eye Strain: Prolonged periods of focusing, especially on near objects, can lead to eye strain and fatigue, which may worsen your symptoms. This is particularly relevant given your history of using your eyes extensively for reading or studying.

5. Corneal Irregularities: Conditions affecting the cornea, such as keratoconus or other corneal deformities, can also lead to monocular diplopia. If the shape of the cornea is irregular, it can distort the light entering the eye, resulting in double vision.

Potential Solutions
1. Optical Correction: Given your concerns about your current glasses, it may be beneficial to consult with an optometrist or ophthalmologist to reassess your prescription. A pair of glasses optimized for near vision could help reduce strain and improve clarity. This is particularly important if you find that your current prescription is too strong for close work.

2. Artificial Tears: If dry eyes are contributing to your symptoms, using preservative-free artificial tears can help maintain moisture and comfort. Regular use of these drops may alleviate some of the visual disturbances caused by dryness.

3. Vision Therapy: Depending on the severity of your strabismus and diplopia, vision therapy may be an option. This type of therapy involves exercises designed to improve coordination and alignment of the eyes, potentially reducing or eliminating double vision.

4. Regular Eye Exams: Continuous monitoring of your eye health is crucial, especially given your history of eye conditions. Regular visits to your eye care provider can help identify any changes or complications early on.

5. Lifestyle Adjustments: Reducing screen time, taking regular breaks during prolonged near work, and ensuring proper lighting can help minimize eye strain. Additionally, practicing good eye hygiene and managing allergies (if applicable) can contribute to overall eye health.

Conclusion
Your experience with monocular diplopia is multifaceted, influenced by your existing eye conditions and possibly exacerbated by environmental factors. While dry eyes and fatigue are likely contributors, it is essential to rule out other potential causes through comprehensive eye examinations. Adjusting your optical correction and implementing strategies to manage dry eyes and eye strain can significantly improve your symptoms. If your diplopia persists or worsens, further evaluation by a specialist may be necessary to explore additional treatment options. Always prioritize open communication with your eye care provider to ensure you receive the most appropriate care for your unique situation.

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