Seeing Double: Who do you call?

3 Quick at home checks to see if your double vision equals trouble

The recent news of Senator John McCain’s bout of intermittent double vision along with other serious medical signs prompted a CT scan by his astute physicians. I know many of you are now wondering if your double vision is a sign of a Brain Tumor. Any complaint of double vision should cause concern. Every time a patient enters my office with the chief complaint of recent onset double vision, the hair on the back of my neck stands up!

Presenting with the symptom of Double vision (diplopia) is very unsettling for both the patient and doctor. Double vision is commonly caused by eye misalignment. The misalignment may occur due to an uncorrected refractive error (astigmatism, myopia, or hyperopia). Alternatively, the double vision may be the result of something more menacing, like a muscular or neurological disorder. If you’re experiencing a recent or sudden onset of double vision, you should be concerned and visit your eye doctor soon. However, before you grab your iPhone and dial your doctor in a panic, here are 3 Quick Checks to do at home to help you determine if your double vision equals trouble.

3 Quick checks

  1. Is your double vision in one eye or both?
    • Monocular diplopia (double vision in one eye): the symptoms only disappear when covering the affected eye, one of the images is usually clear, while the other image is washed out. Most of the time monocular double vision is associated with something involving your eyes such as astigmatism, corneal distortion (keratoconus), subluxation of the lens or lens implant, polycoria (multiple openings in the iris), dry eye disease or retinal scarring.
    • Binocular diplopia (double vision in both eyes) occurs because the two eyes are not aligned and not working together. With binocular diplopia, the symptom disappears no matter which eye you cover, both images are usually clear. Binocular diplopia (double vision) is usually associated with systemic or neurological conditions, such as diabetes, cranial nerve palsies, Myasthenia gravis, Graves’ disease or tumors.


  1. Is your Double Vision Constant or Intermittent?
    • Constant diplopia (double vision) refers to double vision continuously throughout the day with no relief. Constant diplopia can be very limiting on daily life activities and very startling. Patients suffering from constant diplopia will see two images either “side by side” or “one on top of each other”. Constant diplopia is usually associated with cranial nerve palsies, thyroid disease, myasthenia gravis and post-surgical eye cases.
    • Intermittent diplopia (double vision) refers to double vision that comes and goes, throughout the day or less often. Intermittent diplopia can be very deceiving. In my opinion, patients with intermittent diplopia are more likely to dismiss it as being tired or secondary to eye strain from computer work and delay visiting their doctor. Intermittent diplopia is usually associated with systemic diseases, such as thyroid disease, myasthenia gravis, or multiple sclerosis.


  1. Are you in overall good systemic and eye health?
    • Many times, recent onset of diplopia has an underlying cause; most cases are associated with a long term systemic health disease. Regular routine visits to your primary care physician will ensure your routine lab testing is up to date. Stay abreast of any changes in your overall physical being and comfort. Be mindful of excessive general fatigue, excessive muscle aching or intolerance to cold or warm settings. Graves’ Disease secondary to a hyperactive thyroid is the most common cause of diplopia in adults. In addition, 43% of patients with the autoimmune disease Myasthenia gravis (MG) will present with variable weakness in eye muscles causing double vision. Lastly, uncontrolled Type 2 Diabetes can affect the eye muscles causing double vision resulting from damages to the nerves coming from the brain to the eye. Annual dilated preventative eye exams will help your eye doctor screen and monitor for eye conditions that could lead to double vision. Annually your eye doctor should screen for irregular corneal disease, eye muscle misalignment, refractive errors and binocular dysfunction. Maintaining a great relationship with both your PCP and eye doctor will help you stay in tune with your overall systemic and eye health.

Any complaint of diplopia should be a cause for concern. Double vision should be treated by first identifying and treating the underlying cause. Not all double vision will stem from a malignant brain tumor. Many cases of diplopia vision will resolve over time and can be treated and monitored by your eye doctor. Other cases of double vision (diplopia) are very complex and will require blood work and CT/MRI scans ordered by your PCP. If you ever experience double vision, stop, review my “3 quick checks”and call your Eye doctor.

Author: drjanelleyoureyecareexpert

Dr. Janelle OD is your expert Optometrist, with more than a decade of experience in eye health and prevention.

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