Diplopia (double vision)

Diplopia is an ophthalmological disease in which you see two images of the same thing. The condition can affect anyone, but is more common after the age of 60.

What is diplopia and how many types can it be?

Diplopia is when you see two images of the same thing. Can be:

  • Monocular diplopia – less severe and occurs when you see double with one eye open. Then a second image is formed – the “ghost image”.
  • Binocular diplopia – double vision occurs when both eyes are open. The causes are usually more severe, neurological in nature.
  • Horizontal diplopia – the double image forms from top to bottom.
  • Vertical diplopia – the double image is formed from left to right.

Diplopia: Causes

To understand the causes of double vision, it’s important to understand the anatomy of the eye – the structure and role of each component.

Causes of monocular diplopia

The cornea works like a transparent window in your eye, with the main function of focusing light. If your double vision disappears when you cover one eye, but persists when you cover the other eye, you may have corneal damage in the eye with double vision.

O leziune la nivelul corneei poate fi cauzată de:

  • Dryness
  • Keratoconus, when the cornea becomes cone-shaped
  • Infections, such as herpes or shingles
  • Scars

The lens is located behind the pupil and helps focus light on the retina. The most common lens-related problem is cataract, which is almost always corrected by cataract surgery. The disease may be more severe in one eye and may progress differently in the two eyes.

Causes of binocular diplopia

Double vision affecting both eyes may involve:

Eye muscles – These control the movement of the eyeball and maintain the alignment of the eyeballs. If a muscle in one eye is weakened, it will not move in sync with the other eye. Therefore, when you look in one direction (controlled by the weakened muscle), you will see double.

Eye muscle problems can have causes such as:

  • Problems with the nerves that control them.
  • Myasthenia Gravis, an autoimmune disease that stops the nerves from telling the muscles what to do. Early signs include double vision and drooping eyelids.
  • Graves’ disease, a thyroid condition that affects the eye muscles. It can cause vertical diplopia, in which one image is on top of the other.

Nerves – These transmit information from the brain to the eyes. Nerve problems are the main cause of double vision:

  • Multiple sclerosis can affect nerves anywhere in the brain or spinal cord. If it affects the nerves that control the eyes, you may see double.
  • Guillain-Barre Syndrome is a nerve disorder that causes growing weakness. Sometimes the first symptoms appear in the eyes, including double vision.
  • Diabetes can cause nerve damage in the muscles that move the eyes, which can lead to double vision.

Brain – The nerves that control eye movement connect directly to the brain, where images are processed. Many causes of double vision originate in the brain, including:

  • Strokes
  • Aneurysms
  • Increased pressure due to injury, bleeding or infection
  • Tumors
  • Migraines

Diplopia: Symptoms

In addition to double vision, diplopia may be associated with other symptoms such as:

  •  Nausea (feeling sick or vomiting)
  • Dizziness
  • Headaches or discomfort when you move your eyes, in eyebrows or temples
  • Blurred or fuzzy vision in one or both eyes
  • Droopy eyelids
  • One or both eyes not aligning properly (strabismus)
  • Weakness in the eyes (or other parts of the body)


Before you make an appointment with your ophthalmologist, consider the following questions:

  • When did the double vision start?
  • Did you hit your head, fall or faint?
  • Have you been involved in a car accident?
  • Is double vision worse at the end of the day or when you are tired?
  • Have you had any other symptoms besides double vision?
  • Do you tend to tilt your head to one side to focus? You may not realize it, so it might be worth asking a friend or family member.
  • Does double vision only occur when both eyes are open?

It can also help if you try to focus on a non-moving object (phone, lamp, tree, etc.) Ask yourself the following questions about double vision:

  • Are the two images side by side or on top of each other? Are they slightly tilted? Which is higher or lower?
  • Both images are clear, but not aligned? Or, is one blurry and the other clear?
  • Cover one eye, then change. Does the problem disappear when you cover one eye?
  • Imagine you have a clock in your visual field. Move your eyes from 12 o’clock to 6 o’clock and back to 12 o’clock. Is your vision better or worse in any position?
  • Tilt your head right and left. Do any of these positions improve your vision, or make it worse?

During the ophthalmological examination, the doctor will carry out a full eye examination. This involves:

  • A sensorimotor examination, which measures the alignment of the eyes in all directions
  • An alternative coverage test that measures eye movement when focused on an object.

If eye misalignment is unusual, the specialist will perform further ophthalmological investigations.

To determine the cause of double vision, the doctor may ask:

  • Blood tests
  • Eye motility testing (helps the doctor determine eye movement limitations that may be caused by neurological conditions or other diseases)
  • Imaging investigations (MRI, CT)

Diplopia treatment

The ophthalmological treatment of diplopia differs, depending on the cause.

  • If double vision is caused by weak eye muscles, or if a muscle is compressed due to an injury, ophthalmological surgery is recommended.
  • Medicines can treat Myasthenia Gravis.
  • Surgery and medicines can treat Graves’ disease.
  • Medicines and insulin can keep blood sugar levels under control in cases of diabetes.
  • Eye patches or glasses with prisms can relieve the effects.

Almost 70% of cases are treated with medicines or surgery. There are also situations when diplopia disappears on its own.

How to prevent diplopia?

There are no specific ways to prevent double vision, but eye care and regular ophthalmological examinations are essential to detect vision problems early. Follow these tips to take care of your eyes:

  • Don’t smoke.
  • Take breaks from screens throughout the day.
  • Wear computer glasses.
  • Wear appropriate safety glasses if you participate in sports or activities that require it.

Go for annual control. The Dr. Holhoș ophthalmology network is present in Cluj-Napoca, Sibiu, Alba-Iulia, Turda and Mediaș, with top specialists and state-of-the-art technology.

Text medically reviewed by Dr. Teodor Holhoș, Ophthalmic Surgeon
Written by Dr. Holhos Team

Nystagmus is the eye condition where the eyes make repetitive and uncontrollable movements. Discover other symptoms and treatment options.

Color vision deficiency, also known as dyschromatopsia, is a general term referring to various vision disorders characterized by a deficiency in color perception.

“Flying flies” are most often harmless and represent a normal stage in the aging process. Find out what the causes are and how you can reduce the symptoms.

Ocular allergies occur as a reaction of the body to an allergen, causing inflammation and itching in the eyes. The most common ocular allergies are seasonal.

Ophthalmic migraine is most common in the 40s. It manifests itself in visual impairment and even temporary blindness.

Keratitis, also known as “corneal ulcer”, is an inflammation of the cornea. If detected early, the ophthalmological disorder is easy to treat and heals quickly.

Diplopia is an ophthalmological disease in which you see two images of the same thing. The condition can affect anyone, but is more common after the age of 60.

Xanthelasma is a member of the xanthomas family and represents fatty deposits in the skin cells around the eyes. It is visible as yellow, harmless bumps.

Colorblind people perceive colors differently from most people. Most of the time, this ophthalmological disorder makes it difficult to distinguish between certain colors.

Epiphora is an ophthalmological disorder manifested by excessive tearing of the eyes. Most of the time, it is not severe and disappears on its own. However, if you are experiencing this and the problem persists, we recommend that you make an appointment for an ophthalmological examination. Treatment can be different, depending on the cause of the epiphora.

If you notice a yellow spot on the white of your eye, you are most likely dealing with pinguecula. The ophthalmological disorder is not severe, but the symptoms can be uncomfortable. Find out how to treat pinguecula and, more importantly, how you can prevent it.

Entropion is the ophthalmological disorder in which the eyelid of the eye turns inwards. It is different from ectropion, where the eyelid turns outwards. It most often occurs in older people and usually only affects the lower eyelid.

It is possible that you may also be experiencing ocular toxoplasmosis without knowing it. This retinal disorder is extremely common in our century and is manifested by eye discomfort and blurred vision.

Ectropion is the ophthalmic disorder in which the eyelid and eyelashes pull away from the cornea, and reorient outwards.

One of the most common types of headache is headache of ocular origin. It occurs as a result of an ophthalmological disorder.

Blepharitis is an ophthalmological disorder that manifests itself by inflammation of the eyelids. At the base of the eyelids, the patient notices small crusts formed by solidified oil particles or bacteria that collect in the crease at the corner of the eye.

Uveitis is an ophthalmological disorder of the uveal tract, manifested by changes in vision and eye pain.

Among the most common ophthalmological disorders is hordeolum. This is popularly known as an “stye” and is an infection of the eyelids.

The drooping eyelid is known in medical terms as “palpebral ptosis”. It manifests itself by narrowing the visual slit of one or both eyes, creating aesthetic and functional discomfort.

Amblyopia is a vision problem, popularly known as “lazy eye”. This disorder can occur in one or both eyes, and studies show that around 3% of the population suffer from this eye disease.

The sensation of “dry eyes” or “tired eyes” is known in medical terms as “dry keratoconjunctivitis” or “xerophthalmia”, and refers to a dysfunction of the tear film.

Strabismus, also known as “crossed-eyes” or “crossed vision”, is an ophthalmological disorder in which the visual axis of the eyes is not aligned. This causes one eye to deviate when it needs to look at a fixed point.

Conjunctivitis is one of the most common ophthalmological disorders. It can occur in adults, children and babies.

Chalazion is manifested by inflammation of the upper or lower eyelid. It is one of the most common ophthalmological disorders, and occurs when the secretion of sebaceous glands in the eye is blocked.

Macular degeneration involves deterioration of the macula and therefore of the quality of central vision. This disease does not affect peripheral vision and therefore cannot lead to complete blindness.

Hypermetropia affects the ability to see nearby objects. You may be able to see distant objects clearly, but closer objects, even words in a book, are usually out of focus. Hypermetropia occurs when the eye does not focus light properly on the retina (the light-sensitive layer at the back of the eye).

Myopia is a disorder that falls into the category of refractive errors (along with astigmatism and hypermetropia). In common terms, myopia manifests itself as blurred distance vision, while near vision is not a problem.

Astigmatism, like myopia and hypermetropia, is a refractive error. In general terms, the disorder manifests itself in blurred, fuzzy vision, regardless of the distance to objects, surfaces.

Presbyopia is an age-related disorder characterized by decreased near vision. It usually appears around the age of 40.

Cataract is a common ophthalmological disorder that causes progressive loss of vision through loss of lens transparency. Studies show that about 50% of the population loses their vision due to this disorder.

See all

You can make an appointment quickly via the form on the right, or directly over the phone. Our colleagues at the reception desk will be happy to provide you with the availability and information you need to make an appointment. Filling in the form does not represent the registration or confirmation of an appointment, but submitting an appointment request. You will be contacted by our team to check the availability of doctors and make an appointment.


Important note regarding patient consultations and surgery appointments

A patient who cancels a consultation or surgery appointment once, at least one day prior to the scheduled appointment, has the right to a second appointment under the same conditions.
If the patient cancels the second consultation and/or surgery appointment, a new appointment can be made only if the patient accepts to pay for both the consultation and the surgery in advance. This can be done either by payment order or in cash at the clinic reception.
A patient who does not show up for their consultation or surgery, who does not cancel the appointment in due time, or does not answer the clinic’s calls, may request a second appointment only if they pay for the consultation/surgery in advance. 
Patients requesting an appointment for retinal surgeries or laser Prk/Femtolasik/Smile Pro must pay 30% of the cost of the surgery in advance. The appointment will be scheduled only after receiving the advance payment. If the patient is unable to attend the scheduled consultation or surgery, and cancels the intervention at least 48 hours beforehand, they will be refunded in full. If the patient does not show up and does not cancel or contact the clinic at least 48 hours in advance, the advance paid is considered to be lost as damages and will no longer be refunded.