so have you ever experienced double vision or diplopia as the medical term
where you can be sitting with a friend and all of a sudden they split into two
separate people they could be side by side it could be up and down or even
diagonally and there's gonna be real serious medical issues that could be
causing that well in this video I'm gonna go over five medical causes for
diplopia or double vision let's take a look hello and welcome this to dr. Allen
here from the doctor eye health helping you learn about the eyes and vision
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now having double vision can be very alarming and concerning imagine you are
driving down the road and you can see one car in front of you and all of a
sudden it splits off into two of them and you're not sure which one is
actually real so yes this can be really concerning and frightening and it could
actually be serious medical reasons for causing this now certainly there are
many different causes for double vision and this short list is not every single
possible cause for double vision however I'm just gonna go over the five main
things that I'm thinking about when a person comes into the clinic
experiencing some form of double vision number one strabismus, strabismus is the
medical term for a kind of an eye turn not necessarily a lazy eye
but it's where one eye usually ends up turning inward in some fashion if this
is something that's newly experienced in the brain hasn't adapted to it yet
people can actually see double vision there's actually different types of
strabismus or eye turns you could have somebody with an eye turning inward
which we call an esotropia or possibly an esophoria versus somebody where the
eye kicks outward which we call an exotropia or an exophoria in some cases
now believe it or not many people's eyes naturally do not rest looking straight
ahead even though my eyes are straight right now I actually have an eye that
wants to just kind of wander and drift away especially when I'm very tired we
can call this a decompensating thoria and in fact a lot of people do
experience this again especially when they're tired or
fatigued usually this type of diplopia doesn't last very long it's rather
intermittent meaning it just sort of lasts for maybe a few seconds or a
minute but once you kind of realize it blink your eyes a few times things
suddenly snap back into focus usually in the clinic we can measure for some type
of strabismus or other type of phoria or the alignment of the eyes by doing what
is called a cover test you'll actually see the doctor ask you to focus on a
single object and then they'll cover one eye and go back and forth a few
different times and they're actually looking for eye movement at that time
and the good thing is that if someone does have strabismus there are many
different solutions for it there are prism glasses possibly vision therapy
and in really extreme cases even saw some ice surgeries can help number two
side eye disease now I actually see a lot of people on treatment for some
problem with their thyroid and seems to be coming very very common and I've
actually read a couple of different blog posts out there with people with these
kind of different ideas of why that could be in fact if you're somebody who
has a thyroid problem yourself or if you're maybe in medical care and you
have some sort of ideas of why so many people have issues with their thyroid go
ahead and comment in the section below I'd love to hear what your thoughts are
basically thyroid problems stem from an autoimmune issue where your own immune
cells attack your thyroid but they also can attack the back surface of the eyes
and causes the muscles around the eyes to swell and because the orbit really
doesn't have much place for those muscles to go it actually pushes on the
eyes and causes them to kind of protrude outward and that kind of gives people
this kind of bug-eyed appearance and that's classically known as Graves
disease and in the clinic we actually do measure people's eyes of how their
protruding forward you can use some what's called an exophthalmometry, I
know that's kind of a funny word sounds like all I care terms are made up I've
actually had some friends tell me that I sound like I'm talking from a dr. Seuss
book sometimes but the main issue with having a thyroid disease is that it can
cause these muscles to swell a little bit and it primarily is gonna cause an
issue with vertical double vision so it can cause effect on all the eye muscles
but it usually affects the lower eye muscles first so it actually causes
problems with you kind of looking and your eyes will be kind of staggered in a
way and so you'll see things kind of split vertically but usually if
somebody's experiencing new double vision I start to have at least
some suspicion of thyroid eye disease so we'll order a thyroid panel and make
sure things are doing okay nowadays medical professionals are pretty easy to
catch sigh roid issues and thyroid idd specifically so it usually doesn't get
too really extreme cases however occasionally it still happens and people
will have to go under surgery for orbital decompression basically they do
surgery to open up the orbits so that you can actually have more space for the
eyes and the eye muscles they also do this that the optic nerves don't get
pinched which can ultimately kill the optic nerve and therefore make you blind
and again thankfully we usually catch this pretty easily and with proper
treatment usually I don't have to worry number three Myasthenia Gravis, now if
you've never heard of myasthenia gravis before it's actually another autoimmune
condition where your own immune cells like block the ability for your body to
really utilize acetylcholine which is a neurotransmitter that really speaks
between your muscles and your actual nerve impulses because of this your own
nerve impulses to move your muscles aren't really getting the signal and so
your muscles aren't really working the way they're supposed to and one of the
first signs of myasthenia gravis is typically the loss of control of the eye
muscles and the eyelids so basically all eye doctors are trained to at least
suspect myasthenia gravis whenever somebody has an eyelid droop or are also called a
ptosis additionally we also suspect this for anybody who's having double vision
that is quite variable and usually gets worse toward the end of the day or under
events of extreme fatigue and we can test for this a couple ways in the
clinic we can use medications we can actually do an icepack test we can have
patients try to look up and hold their eyelids looking straight up for a while
and if they are having issues then the muscles get tired really quickly and
then later to start to sink really fast but the biggest concerns for myasthenia gravis
is that because you can lose your ability to control your own muscles you
can actually have difficulty swallowing and potentially even breathing and you
could probably guess that not being able to breathe or swallow could be a real
problem doctors also have to be concerned in
this condition for the patient developing a tumor within their thymus
called a thigh moment occurs about 20% of patients begin thankfully for this
condition we can usually identify the patient who's having this issue we can
refer them to a neurologist or a doctor who's more familiar with tree
this type of disease and usually with treatment they do much better for
multiple sclerosis now multiple sclerosis or MS can be a very
frustrating disease not only just for the patient who's actually experiencing
it but also for the doctors ms can attack and affect people in so many
different ways that it's highly variable one person can get it and there are only
mildly affected where another person can develop a really severe form rather
quickly and even at a younger age ms is an autoimmune condition where basically
your own body starts to attack the myelin sheath this is the fatty sheath
that surrounds all the different nerves in your body it's basically kind of like
the rubber wiring around other wires that you see for electronics it actually
helps the propagation of electrical signals down those nerves so this can
affect many different motor abilities in your body and can be very frustrating
and specifically in eye care multiple sclerosis can present in
several different ways in fact it's one of the big things that doctors look for
specifically when a patients coming in with kind of any sort of vision loss or
some sort of visual obscurations they're seeing things a little bit differently
and when we examine the eye everything looks normal this is because ms can
actually cause something called an optic neuritis and this is where there's
swelling and the back of the nerve behind the eye and because it's behind
the eye the doctor really can't see it but we know that with swelling with the
nerve there's these kind of typical symptoms that people will develop people
usually experience some type of blurred vision maybe dimming of lights loss of
color vision they could actually be experiencing pain with eye movements so
when we ask a patient if they're looking left look right are they experiencing a
sharp pain that could be that the optic nerve is swollen and then when you
turning your eye it's pulling on that nerve and you can actually feel it
usually in these cases we order our brain MRI to really identify that it is
MS and it's really important that we do so because the earlier we catch it
really the better the outcomes and treatments are for those patients but
since MS can affect all of your muscles it can actually affect the eye muscles
quite in an extreme manner and just like with other conditions it can be quite
variable and pretty straighting so I doctors like myself can
prescribe glasses with prism in there to help orient kind of how the eye is
seeing and that can sometimes negate the double vision so the person could be
seeing double and then we'll prescribe the prism glasses and it'll shift the
images together so they're seeing single again however if it's highly variable
and one day they're having a better day then the prism glasses we prescribed
when they're having a bad day are no longer gonna work they're gonna almost
over prescribe so it could actually cause double vision so sometimes these
patients will have multiple sets of glasses depending on how good or bad of
a day they're having there's also some prisms that can be kind of stuck on to
glasses lenses kind of like a sticker those ones are pretty nice because you
can just remove them and put them back on depending on really how severe the
double vision is affecting you that day of course for some people the easy
solution is actually just patching over one eye because when you're having
double vision due to two eyes and you patch one eye then all of a sudden
you're just monocular using one eye ultimately MS can be very frustrating
not only just for the doctor again but absolutely for the patient and I do not
wish that disease on anybody and number five that is a brain tumor or mass
lesion I do not like to mention anything like brain tumor to patients actually in
the clinic because it can cause a lot of fear and anxiety but the reality in
medicine and in life these things do happen
and an eye exam is very much a neurological exam in many ways basically
because we're testing so many cranial nerves all at once your cranial nerve
three involves a lot of the eye muscles in q including how the pupil works
Journal of six controls eye muscle screen of four controls your eye muscles
cranial nerve two is your optic nerve and because all of these cranial nerves
originate in deeper parts of the brain they actually have long extensions that
go to the eye so if a tumor or a lesion in your brain is occurring anywhere
along these nerves it can affect to the eye muscles
actually not too long ago I did have a case where a woman came in she had
double vision whenever she was looking off to her left side and just a couple
of weeks before that I had seen it for another reason and everything was normal
so I kind of had this deep sinking feeling that something bad was going on
basically after seeing all that all the different tests and checking her I'm
suls I was able to narrow down that it was criminal of six on her left side
that was affecting her ordered a brain MRI and basically it came back that she
did have really severe hemangioma ultimately at that time things were
starting to turn out for her I honestly haven't kept up with her for a couple of
years so I don't know where she's at I'm really hoping though that things
turned out well for her I think it's important that if you're ever
experiencing any sort of new onset double vision and you haven't had it
address before by your doctor please make an eye examination with your local
eye care physician so that you can get things checked out and make sure that
everything's okay again thankfully with many cases of double vision we can
narrow down the cause we can get correct treatment if needed we can actually
prescribe glasses or have special prisms put into the glasses to basically bring
things back into alignment however if you are being prescribed prism
understand that it can be very difficult and pretty variable depending on how
you're doing that day during testing and how the glasses are made and fit again
if you are having issues with double vision whether you are being treated by
a neck your professional or just experiencing now make sure you talk with
your doctor and see if they can help you out hey thanks for watching if you got
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