Diplopia from Nerve Palsy

Overview

When your eyes work appropriately together and your brain processes information correctly, you see single images of what is in front of you. However, conditions that disturb or block the nerves and muscles responsible for controlling the movement of your eyes can interfere with the process of seeing clearly. As a result, you can develop diplopia, also known as double vision.

Types

  • Binocular diplopia can be diagnosed when eyes do not align with one another. It can be caused by a number of conditions, including artery or thyroid disease, diabetes, multiple sclerosis and stroke.
  • Monocular diplopia is double vision in only one eye. It can be caused by abnormality in the eye, such as astigmatism or cataract, dry eye, fluid in the eye, inconsistencies in the iris or lens, or macular degeneration.

Symptoms

  • Double vision (side by side, one on top of the other or both)
  • Problems moving the eyes
  • Blurry vision
  • Droopy eyelid

Prevention

Because diplopia can occur with stroke or diabetes, it’s important to follow a healthy lifestyle. Your risk of diabetes complications and stroke may be reduced by eating a healthy diet and exercising regularly.

Risk Factors

  • Diabetes
  • High blood pressure
  • Older age
  • Smoking

Diagnosis

  • Medical history and symptom review. Your provider will review your health history, lifestyle, previous injuries and symptoms. Some specific clues that may offer answers include whether you have diabetes or recently experienced head trauma.
  • Eye examination. Your doctor will perform a series of tests, including examining the structures inside your eyes with a tool called a slit lamp; looking through a prism so that your doctor can use light to measure misalignment in the eyes; and having you look in different directions to detect muscle weakness in the eyes.
  • Neurological examination. Your doctor may ask you whether you feel pain or numbness around your eyes, weakness in the face or if you have trouble speaking or swallowing. He may also look for drooping of your eyelids.
  • Imaging. MRI, CT or angiograms may be performed to detect abnormalities in the brain, eye sockets and spinal cord that may cause double vision. These include an aneurysm, inflammation of the nerves or a tumor.
  • Blood work. Testing your blood can help your doctor find underlying diseases that may cause double vision. These conditions include Graves’ disease, Lyme disease and multiple sclerosis.

Treatment

Diplopia from nerve palsy will typically resolve itself within six to 12 weeks. However, you can address the double vision with:

  • Conservative management. Covering one eye with a patch or wearing prism glasses can help merge images.
  • Medications. Over-the-counter anti-inflammatory medications can help if you experience any pain related to your diplopia. 
  • Surgery. When eye muscles don’t recover, ocular surgery may be recommended.

Follow-up Care

  • Your doctor will continue with eye examinations as you adjust to your eye patch or prism glasses.
  • If you have surgery, you will be prescribed antibiotics and steroid drops to use for several days or a few weeks.