eye disorders
Double Vision
Evaluation of Double Vision
Many causes of double vision can be very serious. The following information can help people know when to see a doctor and what to expect during the evaluation. In people with double vision, certain symptoms and characteristics are cause for concern. They include Any symptoms besides double vision that could represent nervous system dysfunction (for example, weakness or paralysis, numbness, speech or language problems, trouble swallowing or walking, vertigo, headache, incontinence, or clumsiness) Eye pain Bulging of the eye (proptosis) Recent injury to the eye or head Binocular double vision Double vision should always be evaluated by a doctor even if it is temporary. People who have warning signs should be evaluated by a doctor right away, usually in an emergency department. All people who have double vision, even if it has resolved, should see a doctor as soon as convenient, usually within a few days. Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the medical history and physical examination helps suggest a cause of the double vision and any tests that need to be done (see table). Doctors want to know whether double vision involves one or both eyes and whether it is constant or comes and goes. They also ask whether the images are side by side or on top of one another and whether double vision tends to occur only when the person is gazing in a particular direction. Doctors ask about any pain, numbness of the forehead or cheek, facial weakness, Dizziness and Vertigo , and swallowing or speech problems because these symptoms may indicate a The most important part of the physical examination is the eye examination. Doctors check the person's vision. They also carefully look for bulging of one or both eyes and a drooping eyelid and check how the pupils respond to light. They check the eyes' movements by asking the person to follow their finger as it moves up and down and far to the right and to the left. Doctors then use a What Is a Slit Lamp? (an instrument that enables a doctor to examine the eye under high magnification) and Symptoms and examination findings can provide helpful information about which causes are most likely. For example, if double vision comes and goes and there are other symptoms of possible nervous system dysfunction, Myasthenia Gravis and People with double vision in one eye usually are referred to an ophthalmologist (a medical doctor who specializes in the evaluation and treatment—surgical and nonsurgical—of eye disorders). Testing is not needed before the person is referred. The ophthalmologist examines the person's eyes carefully for eye disorders. In people with double vision affecting both eyes, more testing is often needed because many disorders may cause binocular double vision. Tests depend on what doctors find during the history and physical examination. Most people require imaging with magnetic resonance imaging (MRI) or computed tomography (CT) to detect abnormalities of the eye socket (orbit), skull, brain or spinal cord. Imaging may need to be done right away if doctors think an infection, an aneurysm, or a stroke is the cause of double vision. In people with symptoms of Causes (such as bulging of the eyes, eye pain, watering, and an enlarged thyroid gland), thyroid tests (serum thyroxine [T4] and thyroid-stimulating hormone [TSH] levels) are done. Testing for myasthenia gravis and multiple sclerosis may be needed, particularly if double vision comes and goes. Not all people require testing. Some cases of double vision clear up without treatment. If symptoms and examination findings suggest no serious cause, doctors may recommend that the person's eyes be checked regularly for a few weeks to see whether the vision clears up before they recommend any testing. 