Binocular diplopia treatment of the cause. Diplopia (double vision) - causes and treatment. Diplopia - causes of eye disease

Diplopia is the so-called double vision. Some people are born with diplopia, but most often this disease is concomitant. Patients with this disease experience significant discomfort, because "double vision" leads to very fatigue eyes from the fact that you have to constantly peer into the individual elements of the picture.

The most important and common cause of diplopia are considered various pathologies central parts of the visual analyzer and muscle imbalance. As a result of the weakening of the functions of the damaged muscles, the eye moves slightly to the side or loses its mobility. Pathological processes in the orbit can also provoke this disease. Paralysis sets in oculomotor muscles, causing a violation of the coordination of the movements of the eyeballs.

There are other contributing factors:

• orbital injury due to eye muscle pinching or fracture bottom wall eye sockets;
• various diseases of the orbit cavity;
• hematomas and neoplasms that limit the movement of the eyeball up to complete immobilization;
• aneurysm carotid artery, accompanied by compression of the oculomotor nerve;
• injury to the oculomotor nerve as a result of damage to the skull;
• neurological diseases: tumors inside the skull or tuberculous meningitis;
• drug or alcohol intoxication;
• diabetes;
• multiple sclerosis;
• consequences of surgical operations for the treatment of retinal detachment, cataracts, strabismus;
• psychoneurosis, bouts of hysteria.

Symptoms of the disease

The main signs of diplopia are:

• bifurcation of objects and objects;
• difficulty in determining the location of objects;
• sudden and often recurring dizziness.

The presence of one or another symptom from the location of the pathological process. For example, if the oblique muscles are affected, then when looking at certain objects, the patient will see them one above the other. With changes in the rectus muscles, the doubling of objects will be parallel. Also, the severity and manifestations of diplopia depend on how far the eye deviated in the opposite direction from the muscle. In order to somehow get rid of double vision, a person with diplopia turns his head in the direction where the focus of the disease is located.

By the way, a patient suffering from diplopia sees two images of the same object as completely different in brightness and contrast.

Types of diplopia

In medicine, there is a division of diplopia into several types:

• binocular diplopia or diplopia in one eye. In this case, the patient views the object with both eyes, but the image is displayed incorrectly on the retina, since there is a deviation of the visual axis in one eye.
• monocular diplopia. Objects are viewed with one eye, but the image passes through two different areas of the retina. The cause of this phenomenon may be clouding of the lens, iridocyclitis, polycoria.
• Paralytic diplopia is a pathology provoked by paralysis eye muscles.
• Crossed diplopia is most difficult for patients to tolerate, since the images are projected crosswise, and it is almost impossible to see anything.

Diagnostics

The primary diagnosis can be established even when visiting an ophthalmologist. A patient who complains of double vision will be diagnosed as “questionable” and will be prescribed additional diagnostic procedures. Firstly, it will be a test control over the patient's vision, whose gaze is directed to a moving light source. The doctor will put the received images on a special map of coordinates and find out which of the eye muscles is defective.

On the this moment there are more modern way definition of the focus of pathology. This procedure is called coordimetry. It is performed using an OK ophthalmocoordimeter.

Also, in the diagnosis of this disease, an ophthalmic cover test is performed. And, of course, the doctor must examine the conjunctiva of the eyeballs, check visual acuity, refraction and color perception.

Treatment

it unpleasant disease causes great discomfort to a person, so the treatment of diplopia should be carried out as early as possible. In addition to drugs that act directly on the eyes, drugs and measures are prescribed to get rid of the underlying disease that caused diplopia. In the treatment of such patients, as a rule, two specialists take part: a neuropathologist and an ophthalmologist.

To reduce the degree of diplopia, prismatic correction is most often used. For this purpose, special glasses are selected individually for each patient, which must be worn. certain period time. One of the most significant disadvantages of such treatment is a decrease in visual acuity. During the period of prismatic correction in a child, it is necessary to develop additional features. Sometimes a doctor may recommend wearing glasses with a displaced lens center. They do a good job of correcting your eyesight.

There is a set of special exercises to improve visual acuity. One of them can be done independently at home. You must sit in front of a white wall at a distance of 1 meter. Before that, a sheet with black stripe. Having chosen a position in which the strip will not double, you need to focus your eyes on this strip and smoothly turn your head in different directions. It is important to try to keep the strip in sight intact as long as possible. This exercise is suitable for those who prefer the treatment of diplopia with folk remedies.

If a conservative methods treatment fails, the patient is advised to cope with the disease with the help of surgical operation. There are several such opportunities to help the patient. For example, recession of the eye muscles. It consists in moving the affected muscle a little back and sewing the transected tendon to the sclera. It is also possible to resect and shorten the muscle to compensate motor activity second muscle.

In contact with

Diplopia is a pathology of vision, expressed in doubling the images of visible objects, which occurs as a result of a change in the location of the visual axis. Actually, doubling occurs due to the fact that the images are focused instead of the central fovea in a different area, this is due to the deviation of the eyeball.

Diplopia is always a disorder of binocular vision and is fully called binocular diplopia. This defect disappears as soon as one eye is covered. True, sometimes (extremely rare) with eye injuries that are associated with tearing off the root of the iris, forming two false ones, or with subluxation, occurs monocular diplopia. It is characterized by the possibility of seeing with one eye two images of an object at once, and this state does not stop when the other eye is closed.

Causes of diplopia

The development of diplopia is caused various violations central parts of the visual analyzer, as well as pathologies of muscle balance, which arise as a result of a weakening of the functions of the muscles of the eye when it is damaged. This leads to a restriction in the movement of the eyeball or its displacement to the side. In addition, diplopia can be provoked by neurogenic causes or pathological processes, localized directly in .

As a rule, diplopia occurs due to weakening (paresis) or complete paralysis of the oculomotor muscles, which disrupts coordination in the movements of the eyeballs. This loss of mobility occurs due to damage to the muscles responsible for the movement of the eyeball (myasthenia - muscle weakness), as well as damage to the nerves that control these muscles.

However, the causes of diplopia can be:

• pathological processes in the cavity of the orbit, provoking the displacement of the eyeball;
• orbital disorders arising as a result of fractures of the lower wall of the orbit, in which the eye muscle is infringed;
• hematomas and tumor processes that cause restrictions on the movement of the eyeball or its complete immobility;
• aneurysm of the carotid artery, compressing the oculomotor nerve;
• head trauma and oculomotor nerve damage.

Damage to the oculomotor nerves can cause numerous pathologies of a neurological nature (tumor processes inside the skull, tuberculous meningitis etc.). In addition, diplopia is one of the symptoms infectious processes in the brain stem, indicating that the process involves the central nervous system(diphtheria, rubella, mumps, tetanus), or drug and alcohol intoxication. Diplopia also occurs with botulism, thyrotoxicosis, disseminated and diabetes. It can develop against the background of injuries or operations on the brain, as well as due to surgical treatment, with psychoneurosis and states of hysteria.

Symptoms of diplopia

Diplopia manifests itself:

• double vision,
• persistent dizziness,
• difficulties in assessing the location of objects.

Symptoms of diplopia always depend on the location of the pathological process. For example, damage to the rectus muscles entails parallel doubling, and the oblique muscles affected by the disease can cause the "arrangement" of objects one above the other during doubling. With diplopia, there is always a deviation of the eye from the affected muscle in opposite side. The degrees of deviation are very different: sometimes, this is the absence or restriction of the movement of the eyeball towards the affected muscle, it happens and forced position head, with a characteristic turn or inclination towards the affected muscle, which eliminates double vision.

Infectious diseases, meningitis, vascular diseases of the brain, intracranial tumor processes and fractures at the base of the skull give pronounced signs of diplopia characterizing the corresponding condition. For example, with botulism, diplopia is one of the first symptoms, and patients with diphtheria similar condition noted at the height of the disease.

The main task of treating diplopia is to identify and immediately eliminate its causes. The form of emergency care in this case is dictated by the course of the underlying disease. For example, with diphtheria, botulism, meningitis, immediate hospitalization is indicated in the infectious diseases department, with fractures in the skull in the neurosurgical or trauma department. In other cases of diplopia, hospitalization is carried out with a particular severity of the course of the underlying disease or the general condition of the victim.

If diplopia is a consequence of only ophthalmic disease, then treatment is usually carried out in the eye department of a hospital or in a specialized eye center.

Diplopia is a visual impairment in which the image visible object doubled as a result of deviation of the visual axis of the eye. The cause of double vision is the deviation of the eyeball, as a result of which the image is projected not on the central eye fossa, but on another point of the retina.

Causes

Most often, diplopia occurs with paralysis or paresis of one of the oculomotor muscles.

Conditions that can lead to the development of diplopia:

• disorders that occur in the work of the central link of the visual analyzer - diseases affecting the cerebral cortex, pathways optic nerve;
• violations of muscle tone, which ensure the friendly work of the eyeballs, which leads to a displacement of one eye to the side or to a change in its mobility;
• pathological processes in the orbit, which lead to a change in the normal position of the eyeball;
• traumatic lesions eye.

Symptoms of diplopia

The main signs of diplopia are as follows:

• double vision;
• difficulty in determining the location of objects;
• frequent dizziness.

The manifestations of the disease depend on the localization of the pathological process. With the defeat of the oblique muscles, doubling places the image of objects one above the other. If the rectus muscles are affected, parallel doubling appears.

Often, in order to get rid of double vision, the patient turns or tilts his head in the direction of the lesion.

The two images of an object that occur in diplopia usually differ in contrast and brightness. One of them is somewhat shifted vertically and horizontally, located at an angle to the second.

Diagnostics

Diagnosis of diplopia is based on the patient's complaints of double vision. During the examination, the doctor conducts a test control of the patient's vision with his directed gaze at a moving light source, maps the coordinates of the resulting images. This method allows you to determine the affected eye muscle.

AT modern medicine to establish the damaged eye muscle, coordimetry is used, which is carried out using an ophthalmocoordimeter.

Also, in the diagnosis of diplopia, a special cover test is used. It makes it possible to assess the position and state of mobility of the eyelids.

Additionally, the conjunctiva, refraction (refractive power of the eye), color perception, visual acuity are examined.

Types of disease

Diplopia is divided into binocular and monocular. The most common is binocular diplopia. Binocular diplopia can be of different forms:

• sensory;
• motor;
• mixed.

AT rare cases developing monocular diplopia. There are the following forms of monocular diplopia:

• refractive;
• aberrational;
• pupillary;
• retinal.

Patient's actions

Double vision may indicate serious illness therefore, when this symptom appears, it is necessary to consult a doctor (ophthalmologist, neuropathologist).

Treatment of diplopia

Treatment of secondary diplopia of infectious, ophthalmic or neurological etiology involves the treatment of the underlying disease. Treatment of diplopia as the underlying disease is carried out by a neuropathologist or neurosurgeon. In the treatment of diplopia of traumatic origin, an ophthalmologist surgeon takes part, who performs plastic surgery or resection of the eye muscles. Surgery on the eye muscles, as a rule, can be performed only six months after the injury.

Carry out if necessary optical correction diplopia with prism glasses, which can significantly improve visual clarity. Correction, which is 6 prismatic diopters for each eye, is considered to be optimal in the treatment of diplopia. In some cases, it is allowed to wear glasses with even more prismatic compensation.

Functional therapy of diplopia consists in performing a special set of exercises according to Kashchenko in order to restore the abilities of binocular vision, expand the field of view. Also recommended are exercises to merge objects with red glass and the like.

Complications

Diplopia can occur without other common or specific symptoms. Sometimes this disorder accompanied by pain in the eyes, increased fatigue eyes, headache, blurred vision. The appearance of these symptoms may indicate the development of a more serious disorder.

Prevention of diplopia

Prevention of diplopia involves the following activities:

• timely treatment inflammatory diseases nervous system;
• prevention of vascular accidents (level control blood pressure, blood sugar concentration, etc.);
• monitoring hormone levels thyroid gland in blood.

This visual impairment may develop various reasons ophthalmic, neurological, or infectious nature. About what it is diplopia, symptoms, treatment, what are the causes of the disease, and what to do, what exercises for the eyes are suitable - I will tell you about all this today:

What is diplopia of the eyes?

Diplopia is a vision disorder in which double vision occurs due to deviation of the axis of one or the other eye. Objects that a person with diplopia looks at look double. In this case, the focus of the object under consideration is located not in the center of the retinal fossa, but in some other part of it.
There are binocular, monocular, paralytic and cross diplopia.

Diplopia - causes of eye disease

The reasons that contribute to the development of this visual impairment can be different. Let's focus on the main ones:

Dysfunction of the central link of the visual analyzer, pathological processes that develop in the cerebral cortex or the pathways of the optic nerve.

Weakening of the tone of the muscular apparatus, which ensures the coordinated work of the eyeballs, as a result of which the eye shifts from the central axis, or its mobility is limited.

Various pathological conditions eye sockets that change the normal, natural position of the eyeball

Some eye injuries.

Less commonly, pathology occurs due to trauma to the skull, the presence of tumors. The cause may be vascular pathology, for example: aneurysm of the carotid artery, as well as hematomas, suppuration of the soft tissues of the orbit.

It is important to note that the described violation often occurs as a result of tumor neoplasms, various lesions of the brain stem. More precisely, those of its departments where the nuclei are located cerebral nerves who are responsible for
eye movements.

In addition, various infectious diseases that affect the central nervous system, such as rubella, mumps, diphtheria, tetanus, botulism, as well as intoxications, in particular, drug or alcohol, can become the cause.

Diplopia eyes - symptoms of pathology

Vision healthy person characterized by normal, undistorted vision of the object with both eyes. In the absence of any defects, the brain projects a single picture.

With diplopia, a person looking at one object sees two identical images. In this case, the picture may be clear, or it may have a blurry image. In the second case this violation usually combined with other pathologies of vision. To return the picture to naturalness, to combine two images into one, a person has to close one eye.

About how diplopia is corrected, what is its treatment

For effective correction, normalization of vision, it is necessary to identify the main cause that caused this violation. To do this, you need to contact an ophthalmologist or neuroptologist. The doctor will prescribe an examination, based on the results of which a treatment regimen will be developed.

Prismatic correction will help reduce the symptoms of visual impairment. Glasses or lenses are individually made for each patient. According to indications, glasses can be made, where the center of the lenses is shifted. This contributes to additional vision correction.

However, prismatic correction has another side, namely, a decrease in visual acuity. That is why wearing glasses should definitely be supplemented special exercises aimed at strengthening visual acuity and reducing the symptoms of double objects.

Let's look at some well-known diplopia eye exercises that are easy to do at home:

You will not be overcome by diplopia - exercises will protect!

On a light plain wall, fix a sheet of white paper with a drawn black stripe. Sit in a chair opposite, about a meter away. Look at the strip, the image of which will double. Focus your eyes on it, then slowly, slowly turn your head to one side, then the other, while not losing sight of the black stripe. The main thing is to try to see the image as a whole, not forked, and hold it as long as possible.

This exercise is effective for correcting vision with partial diplopia. With its sensory variety, another exercise will help:

Draw two identical black stripes on two sheets of paper. As in the first option, fasten the sheets next to the wall, sit opposite. Focus on the stripes, trying to merge them into a single image. As you repeat the exercise, hang the sheets with strips further apart, increasing the distance.

Instead of drawn stripes, you can use any objects, such as pencils. Exercise every day, several times a day. Do each for 10-15 minutes.

If the treatment of the disorder, vision correction, exercises are ineffective, the doctor may recommend surgery. During the operation, the recession of the eye muscles (their movement) or resection (their shortening) is performed.

In any case, if there are signs of the described visual impairment, double vision, you should contact a specialist. Be healthy!

What is diplopia

(Greek diploos "double" + ops, opos "eye") - visual impairment, consisting in doubling the image of the object in question as a result of deviation of the visual axis of one eye. The occurrence of doubling is due to the fact that the image of the object in question, when the eyeball deviates, does not fall on the central fossa, but on another part of the retina.

Diplopia is always upset binocular vision. The ghost image disappears when one eye is closed. Rarely (for example, with an injury to the eyeball with a detachment of the root of the iris and the formation of two pupils, as it were, with subluxation of the lens), there may be monocular diplopia - the same object gives two images in one eye. Closing the other eye does not stop the double vision.

Causes of diplopia

Diplopia may be caused by an abnormality in central departments visual analyzer and a violation of muscle balance as a result of a weakening of the function of the affected muscles of the eye, which leads to a deviation or restriction of eye mobility in one direction or another; due to neurogenic causes or a pathological process directly in the orbit.

Most often, diplopia occurs when weakening (paresis) or paralysis of one of the oculomotor muscles, when the coordinated harmonious movements of the eyeballs are disturbed. Such a violation of mobility can occur due to lesions of the muscles themselves that provide movement of the eyeball (ocular form of myasthenia gravis - muscle weakness), or with damage to the nerves that control these muscles (oculomotor nerves).

The causes of diplopia can be pathological processes occurring in the cavity of the orbit and leading to displacement of the eyeball. Image doubling is often observed in case of orbital trauma (in case of a fracture of the lower wall of the orbit with infringement of the eye muscle), with hematomas and tumor processes that cause restrictions in the movement of the eyeball up to its complete fixation. All head injuries can also cause double vision, which is a consequence of damage to the oculomotor nerve. With the development of aneurysms of the internal carotid artery, this nerve can be compressed, which also leads to diplopia.

Damage to the oculomotor nerves responsible for image doubling may be based on various diseases neurological nature (intracranial tumor processes, tuberculous meningitis, etc.). Diplopia is a symptom of damage to the brain stem caused by an infection when the central nervous system is affected (rubella, mumps, tetanus), as well as alcohol or drug intoxication.

Diplopia can also be a symptom of botulism (mimics the symptoms eye shape myasthenia gravis), (with swelling of the oculomotor muscles, their movement is difficult), multiple sclerosis, as well as . Moreover, damage to the oculomotor nerves in diabetes is secondary and resolves on its own, but relapses are frequent. Diplopia can occur after trauma and operations on the brain, operations for strabismus, retinal detachment, cataracts, with psychoneurosis and hysterical attacks.

Diplopia can be a symptom of the following diseases:

Symptoms of diplopia

Symptoms of diplopia are double vision, dizziness, difficulty in assessing the location of objects. When one eye is closed, these phenomena disappear. The nature of diplopia depends on the localization of the process. With damage to the rectus muscles, parallel doubling is noted, with damage to the oblique muscles, objects during doubling can "locate" one above the other. Deviation of the eye in the direction opposite to the affected muscle can be expressed in varying degrees. The movement of the eyeball towards the affected muscle is absent or limited.

There may be a forced position of the head - turning or tilting it towards the affected muscle (in this case, doubling disappears). At infectious diseases, meningitis, intracranial tumor processes, vascular diseases brain, fractures of the base of the skull, diplopia is combined with a clear severe symptoms characteristic of the respective state. In patients with diphtheria, diplopia develops at the height of the disease, and with botulism it can be one of its early symptoms.

Treatment of diplopia

Treatment of diplopia consists in identifying and eliminating its cause. Urgent care determined by the nature and course of the underlying disease. Urgent hospitalization necessary for diphtheria, meningitis, botulism (in the infectious diseases department), with fractures of the base of the skull (in the neurosurgical or trauma department). In other cases, indications for hospitalization are determined by the course of the underlying disease and the general condition of the patient.

Questions and answers on the topic "Diplopia"

Question:After an accident, it kind of mows down the image in the brain. Neither MRI, nor CT scan, nor the ophthalmologist said anything about the damage. It's been 1.5 months already.

Question:Hello I was in an accident on a motorcycle hit occipital part I lay my head for 2 days in an artificial coma, after which, when I woke up, I noticed that I had double vision only when I looked down with both eyes, looking straight and up, everything was fine, when one eye was closed, when looking down, double vision disappeared, but the right eye did not see clearly and dizziness began blurry , Please tell me which doctor to go to and is there a way to train the eyes to reduce Lower Diplopia? Ophthalmologists say everything is fine, everything is whole, and so on. Thank you.

Answer: You need to see a neurologist. After what happened to you, a period of rehabilitation is necessary under the supervision of a number of specialists.

Question:Hello. Brother was sick, botulism moderate, two months have passed - still double vision, weakness, dizziness, when to wait for recovery.

Answer: As a rule, patients need half a year - it depends on general condition health.

Question:Hello. The thing is, I've had the same double vision for two years now. Also, when looking up, only double vision is obtained by rotating the image of one of the eyes by 20-30 degrees. Twice addressed to ophthalmologists, Nothing. Both eyes, individually, are normal. What can you advise?

Answer: Hello. Diplopia - doubling. There can be several reasons for diplopia, especially at your age. This and latent strabismus, which manifests itself when the eyeball moves, and the reasons uneven movement eyes (which gives double vision) can also be several: this is a trauma to the head and orbit, these are the consequences of a violation cerebral circulation, these are neurological diseases, etc. There is double vision associated with the pathology of the cornea, lens (astigmatism), pathology vitreous body, pathological changes on the fundus (and first of all, age-related macular degeneration).

Question:Hello, I am 48 years old, after blepharoplasty and forehead endoscopy, there is a bifurcation of the image from the horizon line and below. More than a month has passed, vision is not restored, lacrimation, heaviness, pain, especially in the left eye, eyeball as if moved - slightly mows. Separately, there is no bifurcation, but the left eye sees worse - there is no clarity. I think it's diplopia? Before problems vision was not. Often before surgery long time I had a tic in my left eye. I had a head injury for a long time. Treatment required? Who to contact?

Answer: Hello. A full-time consultation with an ophthalmologist is necessary, then, according to his testimony, a neuropathologist and a plastic surgeon.