Monocular Diplopia: Causes, Diagnosis, and Treatment Options

Q: Monocular Diplopia: Causes, Diagnosis, and Treatment Options

Hello： Possible causes of postoperative vertical diplopia include： 1. <br>Refractive issues： Despite having new glasses prescribed after surgery, there may still be some refractive errors that have not been fully corrected, leading to diplopia. <br>This requires further examinati

Monocular diplopia

Hello, Director: I apologize for taking up your time! I have been wearing glasses for my myopia for 40 years, with each eye approximately -500 degrees.
In early April of this year, I noticed some blurriness in my left eye, and after an examination, my uncorrected vision was 0.4.
The doctor suggested considering cataract surgery with an aspheric monofocal intraocular lens, preserving 200 degrees.
In early June, after the surgery, I had my glasses re-fitted for my left eye and discovered that I was experiencing vertical diplopia (the right eye is fine and does not require surgery).
Although adding a 3-degree prism can correct it, I would like to understand the cause.
After researching, I am considering getting blood tests to check for inflammation of the optic nerve and an MRI of the brain to examine the condition of the ocular blood vessels.
Is this approach correct, or should I wait a while to see if it improves gradually? I apologize for asking so many questions and for taking up your time! Thank you, Director!

morris39, 70~79 year old female. Ask Date: 2024/06/07

Dr. Gao Pilin reply Ophthalmology

Hello: Possible causes of postoperative vertical diplopia include: 1.
Refractive issues: Despite having new glasses prescribed after surgery, there may still be some refractive errors that have not been fully corrected, leading to diplopia.
This requires further examination by an ophthalmologist.
2.
Ocular motility dysfunction: Some patients may experience ocular motility dysfunction after surgery, resulting in diplopia.
This can be further assessed through visual function tests.
3.
Optic nerve or visual pathway issues: Although uncommon, problems with the optic nerve or visual pathways can also cause diplopia.
In such cases, it is reasonable to conduct optic nerve examinations and brain imaging studies (such as MRI) to rule out optic neuritis or other lesions.
Recommendations: 1.
Comprehensive ophthalmic examination: First, it is advisable to visit an ophthalmologist for a detailed assessment of your eye condition, including evaluation of ocular motility, refractive status, and fundus examination.
2.
Neurological evaluation: If the ophthalmic examination shows no significant abnormalities and diplopia persists, it is reasonable to perform blood tests to check for optic nerve inflammation and brain MRI to help rule out other potential neurological issues.
3.
Use of prism glasses: During this period, you may consider continuing to use prism glasses to correct diplopia, which can temporarily improve visual issues and reduce daily inconveniences.
4.
Observation and follow-up: Some cases of postoperative diplopia may gradually improve over time, so you can observe for a period under your physician's guidance and have regular follow-ups to assess changes in vision.
There is no need to worry excessively; I wish you a speedy recovery and a return to normal vision!

Reply Date: 2024/06/07

More Info

Monocular diplopia, or double vision in one eye, can be a perplexing condition that often requires careful evaluation to determine its underlying causes. Given your history of myopia and recent cataract surgery, it’s understandable that you are concerned about the new onset of diplopia, particularly since it has emerged after a significant change in your visual system.

Causes of Monocular Diplopia
Monocular diplopia can arise from several factors, particularly after cataract surgery. Some common causes include:
1. Refractive Errors: Changes in the eye's refractive status post-surgery can lead to diplopia. If the new lens has altered the way light enters your eye, it may result in misalignment of images.

2. Corneal Irregularities: Postoperative changes to the cornea, such as astigmatism or irregularities from the surgery itself, can cause light to scatter, leading to double vision.

3. Lens Positioning: If the intraocular lens (IOL) is not perfectly centered or positioned, it can lead to visual distortions, including diplopia.

4. Neurological Issues: Although less common, issues related to the optic nerve or brain can also manifest as monocular diplopia. This could include inflammation or other neurological conditions.

Diagnosis
To accurately diagnose the cause of your monocular diplopia, a comprehensive evaluation is necessary. This may include:
- Visual Acuity Tests: To assess how well you can see with each eye.

- Refraction Tests: To determine if there are any residual refractive errors that need correction.

- Corneal Topography: To evaluate the shape and curvature of your cornea.

- Optical Coherence Tomography (OCT): To assess the retina and optic nerve for any abnormalities.

- Blood Tests: To check for inflammation or other systemic issues that may affect the optic nerve.

- Magnetic Resonance Imaging (MRI): If there is suspicion of neurological involvement, an MRI can provide detailed images of the brain and eye structures.

Treatment Options
The treatment for monocular diplopia largely depends on the underlying cause:
1. Corrective Lenses: If refractive errors are the issue, updating your prescription or using prism lenses may help alleviate the diplopia.

2. Surgical Intervention: In cases where the IOL is misaligned or if there are significant corneal irregularities, surgical options may be considered to reposition the lens or correct the cornea.

3. Observation: Sometimes, especially shortly after surgery, the visual system may take time to stabilize. In such cases, your ophthalmologist may recommend monitoring your symptoms for a period.

4. Medication: If inflammation of the optic nerve is suspected, corticosteroids or other anti-inflammatory medications may be prescribed.

Conclusion
Given your situation, it is advisable to follow up with your ophthalmologist to discuss your symptoms and the potential need for further testing, such as blood tests and MRI. While it is possible that your diplopia may improve over time as your visual system adjusts, it is crucial to rule out any serious underlying conditions. Your proactive approach to understanding your symptoms is commendable, and ensuring you have a thorough evaluation will help guide appropriate treatment.
If you have further questions or concerns, don’t hesitate to reach out to your healthcare provider for personalized advice and support.

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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!