Why is double in the eyes and what to do?

In obtaining a three-dimensional image of the surrounding objects, both eyes participate simultaneously. Simultaneously with each of them, the central part of the visual analyzer of the brain receives a signal, which, superimposed on each other, merge into a single stereoscopic image. We are accustomed to seeing a single picture and, if it suddenly starts to double, this deprives us of confidence in orientation in space, tires the brain and disrupts the coordination of movements. Doubling in the eyes or diplopia leads to overexertion of the eyes and can cause serious discomfort - dizziness, nausea, heaviness and pain in the eyes and head. The appearance of such a symptom is difficult to ignore, it causes very great inconvenience, because we use our eyes constantly. Even if doubling in the eyes appears occasionally and when looking in a certain direction, this requires diagnosis, since it can indicate the development of a serious pathological process in the body.

Why is it double in the eyes?

Getting a clear visual image depends on the well-coordinated work of several structural elements of the vision system:

• cornea and lens, performing optical functions of conducting, refraction and focusing of light rays;
• muscles that provide fusional movements of the eye;
• the eye nerves that transmit information to the visual analyzer of the brain.

A problem with any of these elements can lead to a mismatch between the location of the beam of light rays from the object on the retina of one eye and the other, the symmetry of the alignment of the visual fields is broken and there will not be fusion of images from the retina of both eyes into one - binocular diplopia will arise. Its cause, basically, is paralysis (paresis) of the external eye muscles. This kind of double vision occurs much more often than monocular diplopia, when the visual object mapping occurs in two places of the retina of one eye (the dispersion of light rays). Doubling does not disappear when you look at an object with one damaged eye. The cause of monocular diplopia is not neurological, but functional damage to the cornea and lens, inflammatory, dystrophic, traumatic (keratitis, iridocyclitis, keratoconus, cataract, astigmatism, lens dislocation), vitreous hemorrhage. Temporary monocular diplopia may occur if the cornea is not moist enough.

Binocular diplopia is a condition where double vision occurs with two open eyes. If one (any) eye is closed - the image ceases to double. The cause of double vision is the deviation of the visual axis in one eye. Doubling of the visible object occurs due to violation of the motor function of one eye, because of which the coordinated movements of the eyeballs become impossible. Motor dysfunction can be caused by depletion of oculomotor muscles, a violation of their innervation, traumatic orbital lesions, massive hemorrhages.

By the mechanism of development, a motor system is formed that is formed against the background of a normally preserved binocular vision as a result of a complete or partial loss of the ability to contract the external ocular musculature, and a sensory one, developed with preserved eye mobility as a result of the dysfunction of fusion of monocular patterns into a single image, symmetry in the patient with strabismus. If it is impossible to distinguish the motor genesis of double vision from the sensory one, a mixed diplopia is distinguished.

The causes of motor diplopia become complete (paralysis) or partial (paresis) inability to contract the muscles involved in the movements of the eyeball, nuclear paralysis as a result of head trauma, neurosurgical interventions, cerebral vascular diseases and infections affecting the brain stem (tetanus, diphtheria, rubella , parotitis). Usually, the function of the nerve is broken, completely. Fewer cases are associated with impaired oculomotor activity, as a rule, its lesions are partial. Dysfunction of the nerve block is even more rare.

In the central part of the field of vision, double vision does not occur, the image begins to double when the look is raised, lowered or transferred to the tip of the nose, which depends on the lesion of the corresponding muscle - the straight lines: upper, lower and inner.

The doubling of the image occurs when the block-shaped nerve is affected. It is always partial, when the patient raises his eyes or looks toward the healthy eye.

The main diffuse lesion of the neuromuscular system, leading to a split image, is myasthenia gravis. Much less often this symptomatology is manifested by myopathy, progressive vaginal paralysis, supernore, multiple sclerosis.

Dysfunction of the thyroid gland (hyperthyroidism, thyrotoxicosis) can lead to peripheral injuries of extraocular muscles (thyreogenic myopathies), accompanied by double vision in the eyes, also - in the aneurysm of the carotid artery, the oculomotor nerve is compressed.

This pathology of vision occurs when traumatic damage to the eye's orbit, if there is a direct damage to the muscle tissue, all oculomotor nerves, or the displacement of the eyeball as a result of a fracture of the lower orbital wall.

The splitting of the seen image can appear as a consequence of surgical intervention to eliminate retinal detachment or to strengthen the sclera of the eyeball with progressive myopia.

Intracerebral neoplasms, diabetes, tuberculous meningitis are risk factors for the appearance of diplopia.

Congenital defects of fusion (fusion) images can also become its cause.

At what disease is double in the eyes and why?

Complaints on a double image arise in patients with different pathological conditions, some of them at first glance are not related to the function of vision.

Dvoenie in the eyes with cervical osteochondrosis arise due to a violation in the vessels supplying the brain regions. A consequence of this is hypoxia and inadequate nutrition of muscle tissues and nerve fibers of the eyes and the visual center. Over time, there are dystrophic changes in the structures of the eye, the mobility of eyeballs is limited, the coordinated work of the eyes is disturbed, which leads to the impossibility of fusions. The visual image can be duplicated in different planes. Binocular diplopia develops in most cases as a result of the convergent, friendly co-stigma acquired at a solid age. Complaints about a double image in osteochondrosis may indicate the development of accommodation disorders, muscle atrophy and / or clouding of the lens, the initial stage of glaucoma.

Violation of the innervation of the eye muscles is one of the symptoms of a stroke. Ischemic processes in the trunk, cerebellum, vertebral-basillar basin of the brain can be accompanied by motor dysfunction of eyeballs. Doubling in the eyes of stroke is more pronounced from the affected muscle.

Hypertension may be accompanied by a bifurcation of the visual image. Many complain of symptoms such as high blood pressure and double in the eyes. Diplopia usually occurs when sharp jumps in blood pressure, in such cases, there is also nausea and headache, impaired coordination of movements, weakness, rapidity of the pulse. These symptoms require examination, as they speak of vascular pathologies and circulatory disorders. They can be harbingers of a stroke.

There are frequent complaints of double vision in the eyes of the VSD (vegetovascular dystonia), in which the control of the body over the vascular tone is disturbed. Failure in the work of the autonomic nervous system can be triggered by a whole bunch of diseases and it is desirable to establish the cause of these symptoms. VSD is a symptomatic complex, not a diagnosis, and it is not worth brushing it off, the consequences can be severe.

Diplomacy is one of the initial symptoms of a severe and as yet incurable disease - multiple sclerosis. This is an autoimmune process of destroying the myelin sheath that protects the nerve fibers, which leads to a partial or complete interruption in the transmission of nerve impulses and simultaneous damage to several parts of the nervous system.

Astigmatism is a fairly common cause of diplopia. In this pathology, as a rule (more than 98%), the cornea is affected, it has an irregular shape, sometimes - the lens of the eye. A defect appears in the optical system of the organ of vision, as a result of which several images (monocular diplopia) are reflected on the retina of the diseased eye. Astigmatism can be innate and acquired. It must be corrected.

It is likely to double in the eyes of diabetes. In this case, small blood vessels are affected, including those that provide blood supply to the retina, and the oculomotor nerves suffer. Most diabetics with experience develop visual pathologies. The cause of double vision in eyes with diabetes can be hemorrhage in the vitreous, cataract, glaucoma.

Closed CCT (4/5 cases of head injury) leads to impaired vision. The causes of this are vascular ruptures in the brain, nerve damage, brain edema, ischemic processes, microtraumas of the skull base, leading to hypoxia, compression of the optic nerve, and transformation of the fundus. Doubling in the eyes is one of the signs of a severe concussion of the brain. With a minor injury, vision can stabilize on its own, however, periodic double vision in the eyes can be observed after a significant period after a head injury.

Doubling in the eyes may indicate the formation of an aneurysm of the carotid artery, a neoplasm or a hematoma.

Diplopia may be permanent or may occur intermittently. For example, there may be double vision in the eyes after sleep, after physical or visual exertion. If this is a one-time situation, then there is nothing to worry about, and if in some situation the image is doubled constantly, then it is necessary to consult a doctor, as this may be a sign of developing pathology.

In general, diplopia after operations is temporary. Doubling in the eyes after laser correction of vision (elimination of myopia), especially in advanced cases, predictable condition. It arises from postoperative disorders of binocular localization of visual images ("fear of confluence"). Vision usually stabilizes after surgery about a month, some patients need a longer period.

If a visual image is double after cataract surgery, this may be a sign of displacement of the intraocular lens. In such cases, you need to see a doctor as soon as possible. Time is important for correcting this complication. With late treatment, for example, after three months, the correction becomes more complicated. In general, in occasion of any postoperative complications it is necessary to address to the doctor as soon as possible. Perhaps nothing terrible has happened, and we just need to wait. And may need a corrective procedure, the sooner it is carried out, until the lens has not healed, the easier it will be to recover.

When after an impact in the eye the image is doubled, it can talk about traumatic damage to the cornea, muscles or nerves, fracture of the lower orbital wall. After trauma of the eye, you should always see an ophthalmologist.

Diplopia can be temporary and arise as a consequence of taking certain drugs that affect the brain, for example, anticonvulsants, barbiturates, anesthetics. Doubles in the eyes after anesthesia, as it affects blood circulation and metabolic processes in the brain.

People who spend a lot of time in front of the monitor, there is an overwork of vision and from the computer double in the eyes. This is typical for the "dry eye" syndrome. To prevent unpleasant symptoms, you must follow the rules of working with the computer.

Temporary diplopia can be caused by alcohol, food or drug intoxication, observed in severe infectious diseases, with an overdose of Botox (pricks against wrinkles).

When doubles twice in the eyes in the dark, it is necessary to undergo a survey. This condition can be caused by a deficiency of vitamin A. Its leading symptom is the so-called "night blindness" - poor vision in the dark and is accompanied by dry eyes and their inflammation.

If double in the eyes when walking, it is also necessary to be examined. Initially, many of the symptoms manifest themselves during exercise and disappear at rest. Walking is not such a big load and if in the process of moving there is a double vision in your eyes, this is a serious bell.

Neurogenic diplopia is a functional impairment of vision and is, in the opinion of specialists, the most difficult to explain pathology variant. They occur with meningoencephalitis, endocrine diseases, hysterical disorders, asthenopia.

The risk factors for diplopia are numerous, some of them require immediate treatment, so if the dyslexia occurs intermittently, it is necessary to visit the doctor, because the result of inactivity can be a neglected disease.

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Pathogenesis

The basis of the mechanism of development of monocular diplopia is the dispersion of light rays due to congenital or acquired defects of the cornea and lens, as a result of which several images of the visual object appear on the retina of one eye.

The pathogenesis of binocular double vision of a motor-type visual image is a paralytic strabismus acquired for various reasons, already mentioned. In this case, the light beam enters the foveal zone of the healthy and the peripheral part of the retina of the eye with limited mobility. The very ability to normally see two eyes with motor diplopia, usually, is not violated. When paresis (muscle paralysis) of the binocular fusion of the images can be achieved by compensating the action of the paralyzed muscle by turning the head towards it, as a result of which the image in the mowing eye falls into the central fossa of the retina (fovea).

The mechanism of development of binocular sensory diplopia consists in the impossibility of fusion of two images, while light rays enter the fovea of the retina of both eyes. The location of the images is symmetrical in all parts of the field of vision, the mobility of the eyes is preserved, but the fusion does not occur because of the congenital or later emergent insufficiency of the apparatus, the merging image (fusional), the narrowing of the amplitude of the fusion. Sensory-type douching can manifest itself during the formation of strabismus, when the symmetry of the position of the eyes only begins to be disturbed, and the light flux from the visual image falls into the affected eye not in the fovea, but next to it, and the images do not merge. Provided that strabismus develops in childhood, a mechanism works that suppresses the image not falling into the central fossa, and double vision is not observed. In adults, the suppression mechanism is weakened, so when the strabismus develops, the dispersion of light rays is stronger and persists for a longer time.

In the pathogenesis of mixed diplopia, both factors work: both functional difficulty with fusions and muscle failure.

The image, depending on which particular muscles or nerves are affected, can be doubled both along the vertical axis and horizontally.

Dvoenie in the eyes on the vertical occurs with lesions of oblique muscles, oculomotor or block nerve.

Doubling in the eyes horizontally occurs with weakness of the lateral or medial rectus muscle and occurs when the oculomotor or defective nerve is affected, as well as by the internuclear ophthalmoplegia.

Statistics

According to different studies, the ideal balance of the muscles that provides the correct position of the eyes is quite rare, only in 20-30% of the population. In others, the visual axis of one eye deviates periodically in any direction. This, the so-called, hidden strabismus. It can be assumed that even with quite innocent unfavorable conditions (visual tension, severe fatigue, medication intake, incorrectly selected glasses and others), the majority of the population may have a temporary double vision.

Among the people who turned for help in occasion of double vision, 75% had binocular diplopia, the rest - monocular. The first kind of double vision is considered a more disturbing sign, as it causes a violation of the innervation of the ocular musculature or its weakness, which may indicate the presence of neuromuscular pathologies and systemic diseases that cause them.

Symptoms

The first signs of diplopia, as a rule, people notice immediately. They cause very great discomfort. They are manifested in different ways. Some patients complain of a sudden and constant double vision in the eyes, in others, the image is twofold from time to time or in some direction of view, with the turns and slopes of the head.

The pictures are also different - they are layered, placed side by side or one under the other.

Diplomacy is almost always accompanied by other symptoms. When a person doubles in the eyes and dizzy, nausea comes to the throat, such signs can talk about a jump in blood pressure, concussion and spine trauma. Such symptoms, appearing from time to time, can speak about the presence of vegetative dystonia, osteochondrosis of the cervical region, chronic ischemia of cerebral vessels, heart muscle diseases and anemia, various toxic effects. The appearance of such signs may precede a stroke or a heart attack.

If to these manifestations, pain or tinnitus, a decrease in hearing and excision from the auditory canal is added, this condition can be observed with an average otitis. If the deterioration of the hearing progresses, the patient weak and vomits, then - with Meniere's disease.

Dizziness, nausea and diplopia may be present with a symptomatic complex of about 80 different diseases, therefore, to determine the cause of such symptoms, do not delay, you need to visit a doctor.

It happens that the objects that are at a close distance are seen well, but it is double in the eyes of the far away. The most likely cause of such symptoms is a disruption in the ability of the eye's optical system to provide a qualitative image of objects located at different distances (i.e., accommodation). Such disorders affect people who spend a lot of time at the computer, forced to longly focus on the closely located small icons or objects. A vague double image of objects in the distance, often signals a developing short-sightedness.

Doubling in the eyes and headache also requires specialist advice. Similar ailments are observed with a migraine attack, vegetovascular dystonia, neurosis, hypertension. Sharp pain that occurs simultaneously with a double image before the eyes, is observed with spasm of cerebral vessels, transient ischemic attacks, stroke, and also - with influenza, encephalitis and meningitis. Periodic pain and bifurcation of the visual image may follow the bruise of the head, be the symptoms of a developing neoplasm of the brain or an aneurysm of the carotid artery. These are alarming symptoms, possible with a variety of pathologies and requiring examination.

When the image is doubled in one eye, monocular diplopia is diagnosed. To see this, it is necessary to look in turn with each eye, closing the next one. Thus, it is possible to detect double vision in the left, right eye, or both at once, just with eyes not looking at the same time, but separately, and they see a bifurcate image. Such a sign with a high probability of talking about the pathologies of the cornea, which appeared from various causes - inflammation, trauma, operations, at least - its dryness. Problems with the lens of the eye - dislocation, dislocation, turbidity, development of cataracts. In the latter case, double vision occurs when reading. Congenital anomalies - columba, polycoria, acquired - pterygium, haljazion, dermoid cyst, traumatism can lead to double vision in one eye.

When a person complains that his eye hurts and the image of the visual object is twofold, he may have: iridocyclitis, glaucoma, inflammation of the optic nerve, cornea, conjunctiva, skin of the eyelids. Ingestion into the eye of the foreign body, xerophthalmia and migraine can be accompanied by the same symptoms. Pain and double vision in the eye after an injury are grounds for an urgent examination.

Complaints of weakness, which is doubled in the eyes, certainly better sounded in the doctor's office. It is more likely that these symptoms are caused by common diseases: osteochondrosis, vegetovascular dystonia, endocrine pathologies, multiple sclerosis, infectious diseases. Weakness and diplopia may indicate hypertension and vascular accident, heart damage and intoxication. After a bruise of the victim's head, too, the doubling of the visual image and weakness may be disturbing.

Sometimes the complaint sounds like this: "I see each eye well, two-fold." These are symptoms of binocular diplopia. The object of vision is twofold only when a person looks simultaneously with both eyes. It is worth closing any of them, and doubling stops. Most diplopia of this type is caused by the paralyzing of the muscles and are considered alarming symptoms of serious disorders.

Judging by the number of questions that double in the eyes during pregnancy, this condition is not uncommon. It, most likely, is connected with an overstrain of an extraocular musculature, a xerophthalmia. If a woman in the near future does not injure her eyes and head, you can do exercises that provide relaxation of the eye of the eye, reduce the visual load. But it must be remembered that there are many pathologies, one of the signs of which is diplopia. Therefore, if the gymnastics for the eyes turned out to be ineffective, you should consult a doctor with this problem.

Any pathological causes can cause double vision in the eyes of the child. But children's ophthalmologists often meet with physiological diplopia, when objects that are visible with lateral vision are duplicated, but not those that are in the line of sight.

In addition, diplopia often occurs in the process of the functional treatment of strabismus in pediatric practice. Moreover, the child (in contrast to the adult), the appearance of diplopia is considered a favorable prognosis, indicating the possibility of restoring normal vision.

To suggest what causes diplopia, other associated symptoms help.

Dvoyenie and so-called flies in the eyes appear in short-sighted people at a distance and are a symptom of destructive changes in the vitreous.

In addition, flickering flies often accompanies migraine, sudden pressure drops, spasms of the eye and cerebral vessels, thus can manifest multiple sclerosis, infectious and inflammatory diseases and other diseases leading to vasospasms, violations of muscle innervation and fluctuations in blood pressure.

Reddening of the eyes and a double image in front of them are typical for the inflammatory processes of the eyelids and structural elements of the eye of various origins - infectious, allergic, traumatic, common infectious diseases (acute respiratory viral infection, influenza), computer visual syndrome and other increased loads on the organs of vision and the organism in general.

Occasional darkening in the eyes, accompanying diplopia, can speak about the presence of anemia, hypotension, migraine, vegetovascular dystonia, cervical osteochondrosis. With sclerotic changes in the cerebral vessels, attacks occur, during which darkens in the eyes.

In the symptom complex of glaucoma there is diplopia, clouding of eyes, veils and flies, which can also be interpreted as "darkening in the eyes". In addition, often the pain in the eyes and their hyperemia, the narrowing of the angle of vision, a significant decrease in the quality of vision in the dark.

Sand in the eyes and double vision occurs most often with dry eye syndrome. When foreign body enters such symptoms are usually felt in one eye.

The sensation that sand hit the eye occurs with a variety of eye diseases, with common diseases that cause enlargement and inflammation of the vessels in the eyes. Diagnosis of the disease can only be a specialist, so if such symptoms occur frequently or worried constantly, you should not hesitate to see a doctor.

Doubling in the eyes rarely occurs without accompanying symptoms. He is accompanied by dizziness and nausea, impaired coordination of movements, headache, discomfort in the eyes. Diplomacy causes a lot of inconvenience to the patient, affecting all areas of life. The duplication of the image can be observed in all directions of view (complete) or in some one (partial). The image can be divided at different distances, close or far, or maybe on any. One of the images is sharper and brighter than the other, they can layer or be near. There are many options. The patient, as doctors say, can always tell at exactly the moment when double vision began, even if the appearance of a symptom is not associated with trauma.

Diagnostics

When a patient seeks a doctor with a complaint about double vision in the eyes, during the interview and examination they establish the form of double vision and previous events - injuries, diseases, infections. The condition of the conjunctiva and the eyeball of both eyes, the reaction to pupillary light and their symmetry, the ophthalmoscope, the vessels, the retina and the optic nerve disk are studied visually, the standard ophthalmologic diagnosis is performed (checking visual acuity, color perception and refraction using instruments autorefekeratometer, oroprotor). The latent strabismus is diagnosed by co-ordination and provoking doubling. If the patient wears glasses or contact lenses, then their influence on the quality of vision is taken into account.

During the examination, the position of eyelids and eyeballs, their symmetry and mobility in all directions (up-down, right-left, diagonals) are evaluated. If visual violations are not determined, a variety of tests are performed depending on the technical equipment of the institution: "cover-test" (eye test with cover), color testing with a straight and turned head position, make Haab tests and other tests depending on the alleged lesion. The main purpose of the diagnosis is to determine the nature and organ of damage that caused the diplopia. Often, modern computerized instrumental diagnostics is used, which makes it possible to diagnose fairly quickly. In ophthalmology, computerized accomodography, ultrasound examination of the eyeball and computer coherent tomography are used, which allows to study almost all the structures of the eye.

Laboratory investigations are carried out - in the inflammatory processes, a clinical blood test, a bacterioscopic examination of a conjunctival smear, a lacrimal fluid, an allergy test, a suspected diabetes mellitus, a glucose concentration in the blood, hyperthyroidism - thyroid hormone tests, other necessary procedures for discretion of the doctor.

The patient may need an advisory opinion of other physicians: neurologist, endocrinologist, oncologist, psychiatrist, additional studies of brain structures - tomography, ultrasound.

After the examination and diagnostic studies, differential diagnosis is carried out according to their data. Organic pathologies of the eyes are excluded or confirmed: myopia, strabismus, congenital defects of the cornea and lens, columba (when the pupil "enters" on part of the missing iris), dystrophic corneal anomalies (protrusion, flattening, clouding) and retina acquired - retinal dystrophy, cornea, lens, macular degeneration (ischemic processes in the retina caused by vascular insufficiency), inflammatory diseases of the eye, in particular, keratitis (inflammation of the cornea), lens dislocation, glaucoma, t avmaticheskie organic lesions, postoperative complications - scars, "merging fear" and others.

If organic pathologies are excluded, dry eye syndrome or damage to the eye muscles and / or nerves caused by common diseases - hypertension, diabetes, multiple sclerosis, cerebral artery aneurysm, thyrotoxicosis, which are confirmed by appropriate studies, is often diagnosed.

[2], [3], [4]

Consequences and complications

Ignore the appearance of such a symptom as double vision in the eyes is not recommended, because in addition to visual fatigue and dry eyes, it can be a sign of the development of serious diseases, even incurable as glaucoma or multiple sclerosis, however, early diagnosis of which and timely started maintenance therapy enables the patient to lead full life.

Diplomacy causes great inconvenience to people not only in the workplace, but also in everyday life, up to loss of ability to work and habitual daily skills. Often patients screw up one eye or wear a bandage on the eye to eliminate discomfort.

And if doubling in the eyes is included in the complex of symptoms of serious diseases (glaucoma, hypertension, neoplasms) or is a harbinger of a stroke, the lack of timely diagnosis and treatment can result in loss of sight, disability and even death of the patient.

[5], [6], [7], [8]

Prevention

A good effect on preventing loss of visual acuity and the appearance of eye diseases is given by exercises to train the eye muscles. By observing the hygiene of work and letting our eyes rest, we are already reducing the likelihood of visual disorders.

Active lifestyle, lack of bad habits, walking outdoors, proper nutrition - the use of a variety of products, including - rich in vitamins A, E, C, minerals, lutein, will allow us not only to maintain eyesight, but, in general, to remain more healthy - not to suffer from hypertension, nervous and endocrine diseases, hysterical psychoses.

And if the disease is still there, also - and in case of injuries, contact a doctor, diagnose in time, not allowing the development of complications.

Forecast

Lack of treatment for binocular pathology, basically, leads to the fact that the patient adjusts to choose the main image and abstract from the other. Adaptation occurs rather in patients with a large angle of strabismus: the further the images are spaced apart from each other, the easier it is for the patient to adjust and compensate for doubling, for example, by turning the head. However, self-rehabilitation is delayed for years. Modern ophthalmology has a variety of techniques aimed at restoring fusional ability and normalizing the vision.

With monocular diplopia, one must be treated, since this form of the disease is often caused by severe vision pathologies that can lead to complete blindness.

However, timely access to a doctor, diagnosis and treatment allows, in the main, to get rid of this painful visual defect.

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