From the Guidelines
I strongly recommend immediate evaluation by an ophthalmologist or neuro-ophthalmologist for your diplopia (double vision) and associated symptoms, as described in the adult strabismus preferred practice pattern 1. Based on your description of eyes not tracking together, vertigo, balance issues, and difficulty focusing, you may be experiencing a binocular vision disorder that requires prompt attention. While waiting for your appointment, avoid driving and use caution on stairs. A temporary accommodation for avoiding stairs is reasonable given your documented diplopia from your April 2023 optometry visit. For immediate symptom management, you might try covering one eye with a patch when performing critical tasks, as this can eliminate double vision temporarily. These symptoms could indicate various conditions ranging from cranial nerve dysfunction, such as 6th nerve palsy 1, to more serious neurological issues, which is why specialist evaluation is crucial. The connection between your visual symptoms and balance difficulties occurs because your brain relies heavily on visual input for spatial orientation and coordination. It is also important to consider other potential causes of your symptoms, such as divergence insufficiency 1 or vestibular migraine 1, which can be distinguished from other central causes of vertigo through diagnostic criteria and appropriate investigations. Given the potential for serious underlying conditions, it is essential to prioritize a thorough evaluation by a specialist to determine the cause of your symptoms and develop an appropriate treatment plan. In the meantime, prioritizing your safety and taking steps to manage your symptoms, such as avoiding activities that exacerbate your vertigo and using caution on stairs, is crucial.
From the Research
Diplopia Diagnosis and Management
- Diplopia, or double vision, can be caused by ocular misalignment or strabismus, and can be detected using simple clinical tests 2.
- Patients with diplopia of acute onset should be investigated urgently, and those with a headache or pupillary involvement need to be referred for same-day urgent imaging 2.
- Binocular diplopia is most commonly caused by ocular misalignment or strabismus, and can be managed with prismatic correction 3, 4.
Prism Use in Adult Diplopia
- Prismatic correction can be challenging in adult diplopia, but satisfaction with prismatic correction is achieved in approximately 80% of all adult patients with diplopia when combining the causes 3.
- Patients with vertical diplopia, skew deviation, and fourth nerve palsy have high satisfaction rates with prismatic correction, while patients with thyroid eye disease and orbital blowout fractures have lower satisfaction rates 3.
- Prism glasses can be beneficial in treating diplopia of different etiologies, incomitance, and a wide range of deviations, but can also cause side effects such as headaches, dizziness, and eye strain 5.
Treatment Options
- Patients with diplopia may be prescribed prism glasses to alleviate symptoms, and the success of prism use can depend on the etiology of the diplopia and the type of deviation 4.
- Oblique Fresnel prism can be considered for combined deviation, and high success rates have been seen among patients with decompensated strabismus, sixth and fourth nerve palsy 4.
- The extent of resolution of diplopia is highly correlated with prism satisfaction, improvement in depth perception, driving, and reading 5.