Informational - Differentiating Between Monocular and Binocular Diplopia

An explanation by Dr. Aleksic.
Dr. Zoran Aleksic FCS (SA) Ophth, is an eye surgeon and Ophthalmologist specialising in cataract and laser refractive surgery (Lasik / PRK laser refractive surgery for short sightedness, far sightedness and astigmatism). Dr. Aleksic’s treatment centre is located in Sea Point in Cape Town.
Dr. Zoran Aleksic and his team have long been recognised both in South Africa and the rest of the continent for providing high quality eye care with a full spectrum of treatments, from prescribing glasses and contact lenses to complex and delicate eye surgery using the latest technological equipment, all in a relaxed and professional environment.
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Transcript:
We often get referrals in ophthalmology from optometrist, GPS or from friends saying that they're sending a patient with a double vision. Well, double vision is quite a broad definition. We would actually like to know: is this double vision proper double vision where you see two clear objects, or is it double vision with one eye or is it just blurred vision. And what we
would like to do is the following: differentiate these three.
It is extremely important that patients’ visual acuity gets tested with their best correction. Is that contact lens that they are wearing? Is that TV driving glasses, not reading, driving glasses. So we are going to put the best optical correction in front of them and ask them to look at the visual acuity chart. At that stage we'll ask the patient to cover one eye and look at the time. Now, the patient may say with the best correction that they see that largest letter or any target that we showed as a double image. Usually they would say it's ghosted image, that means one is reasonably clear and the other one in the background is like a shadow of a letter. That is monocular diplopia that means in one eye we see two images and that is often if we are not optically well corrected we have some media problems like a corneal problems or cataract forming that will potentially split our image.
There are generally saying three major areas where you need to think of when somebody comes: the cornea, a lens change, cataract (most common) or retina, macula problem. So those are the three things that you think of if somebody best corrected covered one eye
looks at the target and sees two target: monocular diplopia three most common causes, think cornea, lens, retina.
Then we will do the same thing with the other and patient sees single
or double. If they're seeing single with one and double with the other, you should have three: diplopia here so you should have triple image not double. If you see with one eye clear, let's say cover your left eye again, that should be clear. Now cover your right eye again that is clear. Open both let's double so each eye sees single image, both eyes open double image. That's a classic example of binocular diplopia so you can have a perfectly clear image in one perfectly clear image and the other and see 2 images.
It's very important to differentiate when somebody complains of double and from practical clinical experience most of the double vision complaints are Uni-ocular diplopia.

[@skny1]

Thank You Dr. Aleksic for making it simple to understand :)

[@lindseynguyen926]

Thanks for this clear explanation! Studying for my neuro exam and my textbook was as clear as mud.

[@feyehudson1]

Thank you finally you explained it perfectly. I understand now🙂

[@dk3250]

Thank you for the beautiful and clear explanation. Any recommended exercises for binocular diplopia? Thank you

[@merlinsamuelkutty9114]

Well explained

[@billybobdog3815]

I was spat at which went into my left eye this was at work which I washed out 10 days later my left eye was itching and was like something was in my eye I had MRI scan all clear I have vertical ghosting now in my left eye only never had a problem with my sight until now it's very frustrating

[@Sho-mh4pe]

that was great thank you!

[@elyasuaral]

hello DR i have monocular double vision in my both eyes what can i do? will it be fixed after laser surgery to eliminate using glasses?

[@bhupendrasingharora6183]

How are you now

[@elyasuaral]

@@bhupendrasingharora6183 i still have doublevision

[@naturehub782]

Any test conducted on u or any cause u find

[@elyasuaral]

@@naturehub782 yes they did all the tests but there is no way to fix it yet

[@virpalsingh8017]

Having diplopia with left eye...while looking side wise nd down wards..please suggest remedy. ..thanking you in anticipation

[@ivanjovanovic5693]

Pozdrav za kolegu iz Zaječara!!!

[@mechtechmechanical1571]

I have single vision in one eye and double vision in the other eye this has been like this since I had an operation when I was a child and now my eye glides out to the right. Would prism glasses help.

[@inkroude2]

I'm seeing triple ghost images in monicular in each eyes.. the optic neurologist was baffled they checked my optic nerve it was fine..it's cause some weird vertigo.

[@nimishsawant7734]

Was it resolved?

[@inkroude2]

@@nimishsawant7734 it hasn't been

[@Bhavaniputra]

@@inkroude2 is your problem fixed??

[@unnwnlyer7372]

@smiley Yooo were the same, both of my eyes see 3 images at once and its binocular as well. Is yours good now?

[@americanbobtail1]

Sounds like palinopsia. Check out palinopsia and visual snow syndrome.

[@Oj12323]

My eyes will randomly go crossed eyed now and then some times 3 times a day some times 3 times a month does anyone know what it might be

[@there_was_a_2453]

It started for me the same 4 years ago or so, it also appeared when I drank alcohol, and now I basically have crossed eyes all the time specially focusing on objects which are far away. I can't even focus peoples eye's which is pretty annoying and looks probably weird (specially because you're not used to it because you had good vision before). I don't know if you work in front of a screen a lot, but I do and I'm confident this is the issue (low light, working many hours without breaks). There are exercises for your eyes (which basically train your eye moving muscles), also staring in the open from time to time helps. It sounds silly and stupid but do these, because your eyes will get used to it otherwise which makes it harder to get rid of it. Trust me

[@anasutic]

Zdravo doktore, imam duplu sliku na jednom oku zbog padanja kapka. Imam Myastenia gravis. Da li smem da pojacam terapiju na nekoliko dana? Koristim Sandimun neoral. Ako mozete javite mi. Pozdrav

[@brigittescott2438]

I see shadow double in both eyes it used to be 1 eye

[@elizabethrogers77]

A cracking explanation of the mechanics of double vision commonly found in 58% of display screen operators in the workplace suffering computer vision syndrome (CVS) or Screen Fatigue that, if not mitigated by optimising your screen ergonomics, will predictably result in visual repetitive stress injuries (RSI's) now classified as a Global Pandemic in DSE operators by the WHO under the heading of Asthenopia. Score you screen risk today at: www.screenfatigue.me.uk

[@ehabrrmobdie4814]

no empathy with the pt.

[@Sho-mh4pe]

he is teaching you, not the pt you dont know about the whole interview

[@dhruvkumar3612]

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