Closing One Eye to Improve Vision: Evaluation and Management
If closing one eye improves your vision, you should promptly consult an ophthalmologist for a comprehensive eye examination, as this may indicate underlying conditions such as strabismus, binocular retinal diplopia, or angle closure that require proper diagnosis and treatment. 1
Understanding Why Closing One Eye Helps Vision
When closing one eye improves vision, several underlying conditions may be present:
Possible Diagnoses
Binocular Diplopia (Double Vision): Closing one eye eliminates double vision by removing conflicting visual input 1
Strabismus (Misalignment of Eyes): Closing the deviating eye can improve visual clarity by eliminating visual confusion 1
Binocular Retinal Diplopia: Caused by retinal distortion where images don't properly align between eyes; closing one eye eliminates the conflicting images 1
Angle Closure: In some cases, narrowed anterior chamber angles can cause visual disturbances that temporarily improve when closing one eye 1
Diagnostic Approach
A comprehensive eye examination should include:
Complete history: Document onset, frequency, and specific circumstances when closing one eye improves vision 1
Visual acuity testing: Measure vision in each eye separately and together 1
Binocular alignment assessment: Evaluate at distance and near in primary gaze and different positions of gaze 1
Extraocular muscle function testing: Check for limitations in eye movements 1
Sensory testing: Evaluate fusion and stereoacuity 1
Gonioscopy: Examine the anterior chamber angle to rule out angle closure 1
Slit-lamp biomicroscopy: Assess anterior segment structures 1
Management Strategies
Management depends on the underlying cause:
For Strabismus:
Prismatic correction: May help align images and reduce need to close one eye 1
Strabismus surgery: Consider if significant misalignment is present 1
Vision therapy: May help in some cases of binocular dysfunction 1
For Binocular Retinal Diplopia:
Fogging techniques: Applying Bangerter foils or Scotch Satin tape to spectacle lens can create a central scotoma that eliminates foveal conflict 1
Prism correction: May reduce symptoms in some cases, especially when combined with fogging 1
Occlusive contact lenses: Can be used to block vision in the problematic eye 1
For Angle Closure:
Laser peripheral iridotomy (LPI): If angle closure is suspected, LPI may be indicated 1
Medical therapy: May be needed to control intraocular pressure 1
Important Considerations and Pitfalls
Don't delay evaluation: Early diagnosis and treatment are essential, particularly for conditions like angle closure that can lead to permanent vision loss 1
Beware of self-treatment: Consistently closing one eye as a compensatory mechanism can lead to amblyopia (lazy eye) in children and should not be used as a long-term solution 1
Rule out serious conditions: Closing one eye to improve vision may mask serious underlying conditions like increased intracranial pressure that require prompt attention 1
Consider quality of life impact: Strabismus and other conditions requiring eye closure can negatively affect quality of life, social interactions, and psychological well-being 1
Test for superimposition: If superimposition of foveal images using prism or synoptophore doesn't resolve diplopia, strabismus surgery is unlikely to be successful 1
Follow-up Recommendations
Regular monitoring: Follow-up intervals should be determined based on the diagnosed condition and its severity 1
Repeat testing: Special attention should be given to repeat examinations to determine if the condition is stable or progressing 1
Patient education: Explain that some conditions may require lifelong management and monitoring 1