Violation of the visual work of diplopia. Diplopia - what is it? Diplopia - diagnosis and treatment

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 binocular vision and bears the full name of binocular diplopia. This defect disappears as soon as one eye is covered. True, sometimes (very rarely) with eye injuries that are associated with tearing off the root of the iris, forming two false ones, or with subluxation, monocular diplopia occurs. 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 departments visual analyzer, as well as pathologies of muscle balance, which occur as a result of weakening 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, neurogenic causes or pathological processes localized directly in can provoke diplopia.

As a rule, diplopia occurs due to weakening (paresis) or complete paralysis of the oculomotor muscles, which violates coordination in movements 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 disturbances resulting from fractures bottom wall eye sockets, in which the eye muscles are infringed;
• hematomas and tumor processes that cause restrictions on the movement of the eyeball or its complete immobility;
• aneurysm carotid artery compressing the oculomotor nerve;
• head injuries and injuries oculomotor nerve.

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 of infectious processes in the brain stem, indicating that the central nervous system is involved in the process. nervous system(diphtheria, rubella, mumps, tetanus), or drug and alcohol intoxication. Diplopia also occurs with botulism, thyrotoxicosis, disseminated and diabetes mellitus. It can develop against the background of injuries or operations on the brain, as well as due to surgical treatment, with psychoneuroses 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 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, or double vision, is a common disorder. visual function, which is characterized by the formation of two images instead of one when viewing objects. As a rule, this defect does not cause serious discomfort, but if it becomes a constant companion of life, you should pay attention to your health and consult a doctor. In some cases, diplopia acts as a signal serious violations in the body that require timely diagnosis and therapy.

Why double vision?

In a healthy person, when forming an image of surrounding objects, the focus falls on the central point of the eye, due to which a “correct” picture appears. When the visual axis is shifted, projection occurs not to the center of the retina, but to another place - as a result, its “double” appears and the person sees two objects that overlap one another, with a slight deviation.

The causes of diplopia may be external or internal factors that affect the nervous system and structures of the eyeballs:

• weakening of the muscles and nerves that control coordinated eye movements
• ophthalmic disorders: damage to the lens, strabismus, etc.;
• infectious diseases affecting brain structures (tetanus, meningitis, diphtheria);
• neoplasms, hematomas and other pathologies that cause restriction of the mobility of the eyeball, its displacement or fixation;
• facial injuries, as a result of which the eye muscles are infringed or the integrity of one of the walls of the orbit is violated;

• mechanical damage leading to lesions of nerve endings;
• alcoholic or drug intoxication, severe poisoning (eg, botulism);
• an aneurysm of the carotid artery, in which the nerves involved in the movement of the eyes are pinched by a protruding wall;
• some autoimmune and hormonal diseases(diabetes mellitus, thyroid dysfunction, Lyme disease);
• brain surgery, surgical treatment ophthalmic disorders.

In some cases, the defect occurs when there are violations of the functions of the nervous system - neuroses, vegetative dystonia, bouts of hysteria.

For reference: may occur in absolutely healthy people- after serious physical or mental stress, long examination of small objects, etc.

Symptoms of diplopia

The main manifestation of diplopia is the doubling of the image when looking at any objects, and they may differ in characteristics, as well as shift relative to each other. With dysfunction of the oblique muscles, the “pictures” are one above the other, and if the pathological process has touched the rectus muscles, parallel doubling is observed. In addition, the defect can be partial (appears only in a certain part of the field of view) or complete, diagnosed when viewing distant or close objects.

Other signs of pathology include dizziness and the inability to control their movements when trying to pick up an object. Due to the fact that a person sees things in a "double copy", he may miss or miss a thing on the floor.

The remaining signs depend on the cause that caused diplopia. With head injuries, the patient may suffer from nausea and headaches, with infectious diseases- fever general intoxication organism, respiratory manifestations. Diplopia can accompany attacks of certain diseases - for example, VVD or migraine, and disappear after taking sedatives and painkillers.

It should be noted that for some dangerous states that threaten human life (botulism, poisoning methyl alcohol) double vision protrudes the only symptom. The defect can also be observed in stroke (in this case it is accompanied by partial muscle paralysis, speech and coordination disorders), retinal detachment, and also after serious injury heads. If, with the development of diplopia, there is a possibility of serious intoxication or brain damage, you should immediately call the patient an ambulance.

Varieties of diplopia

Diplopia is usually divided into two forms - binocular and monocular. The most commonly diagnosed dysfunction of binocular vision, in which the visual axes, which are parallel in healthy people, shift. Monocular diplopia is diagnosed quite rarely, and the mechanism of its development is to project an image onto two different points of the retina. In addition, there is another type of pathology, the most difficult to correct - double vision, when two images are superimposed on each other.

Binocular and monocular diplopia, in turn, are divided into different types, which are distinguished depending on the causes of occurrence, features and clinical course pathology.

Table. Varieties of binocular diplopia.

Table. Varieties monocular diplopia.

For reference: binocular diplopia can be easily distinguished from monocular (in the first case, the defect disappears when one eye is closed), but the rest of the diagnosis and correction should be done by the doctor.

Diplopia in children

AT childhood diplopia is most often the first sign of strabismus, but otherwise the causes of this defect do not differ from those that cause double vision in adults. In addition, in children, the disease often causes complications due to certain difficulties in diagnosis - the child often cannot distinguish the norm from the pathology, as a result of which he has no complaints of double vision. The development of the disease can be recognized by the following signs: children with visual impairments squint their eyes, have poor orientation in space, and their eyeballs may be asymmetric. In the presence of such manifestations, you should consult a doctor as soon as possible in order to identify and eliminate the violation in time.

Diagnosis of diplopia

The main goal of diagnosing diplopia is to identify the cause that caused the defect. First of all, an anamnesis and patient complaints are collected (events preceding double vision, other symptoms, etc.). Next, the patient's vision is monitored: the doctor asks to look at a moving light source, after which a special map of the coordinates of the images obtained is compiled, by which the affected area can be determined.

An important role is played by ophthalmic and neurological tests, which include:

• assessment of muscle tone and the condition of the nerves that control eye movements;
• determination of the features and varieties of diplopia;
• examination of the structures of the eyes, assessment of the main parameters of vision (color perception, refractive power, visual acuity);
• detection comorbidities: constriction or dilation of pupils, deterioration of reflexes, omission upper eyelid, strabismus, etc.

Additional tests include blood sugar tests to rule out diabetes, ultrasound procedure, CT and MRI of the head to detect neoplasms, abscesses, hematomas and other tissue lesions. In some cases, patients need to consult a neurologist, infectious disease specialist, oncologist and other narrow specialists.

Treatment of diplopia

Elimination of double vision caused by an infectious disease, neurological pathology, injury or ophthalmic disorder, is aimed at addressing the root cause of the disorder. Infections such as botulism, meningitis or tetanus require immediate hospitalization of the patient in the infectious diseases department, and in case of head and face injuries - in traumatology or the neurosurgery department. Sometimes (with severe damage to the oculomotor muscles and nerves, retinal detachment, hematomas or tumors), patients need surgical intervention.

If necessary, patients are prescribed optical correction of the defect - wearing special glasses that improve vision characteristics. They are made individually for each patient and have a lens with a displaced middle. The best option for correction is the use of 6 prism diopters for one eye.

With absence dangerous pathologies diplopia can be corrected with the help of special exercises that the doctor should choose. As a rule, they include eye movements up and down, left and right, clockwise, as well as “drawing” diagonals and geometric shapes. Before and after doing the exercises, you need to close your eyes tightly several times and sit for a few minutes in a relaxed state.

Attention: self-medication for diplopia can lead to serious consequences, so if the violation occurred suddenly, accompanied by additional symptoms or does not disappear after a long rest, you should consult your doctor.

Treatment with folk remedies

Alternative recipes for the treatment of diplopia can also be used in the absence of serious illnesses as an adjunct to therapy prescribed by a doctor. Most effective means decoctions and infusions are considered medicinal plants with anti-inflammatory and firming action.

Along with the use of the above means, it is necessary to include carrots in the diet, fatty varieties fish, pumpkin, spinach and other foods that contain substances that are beneficial for eye health.

Prevention of diplopia

To prevent the development of diplopia, the following recommendations should be followed:

• give up bad habits(smoking, alcohol);
• lead active image life, play sports, spend more time outdoors;
• to control blood pressure and sugar levels to prevent diabetes and hypertension;
• while in the sun or doing dangerous work protect your eyes with special goggles;
• when working at a computer, take breaks from time to time and do exercises for the eyes;

• promptly treat infectious and neurological diseases;
• pass preventive examinations at the ophthalmologist.

At first glance, diplopia seems to be a harmless visual impairment, but in some cases it can be a signal of a serious pathology, therefore, if it develops, you should consult a doctor as soon as possible.

Video - How to distinguish astigmatism from diplopia

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.

With diplopia, binocular vision is always upset. 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 can be caused by disorders in the central parts of the 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 limitation 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 with orbital trauma (with 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 to 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). In 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, the eyeball seems to have moved - it squints a little. 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.

Every year the number of patients with eye diseases. This can be influenced by various factors, which may depend on the type of human activity, environment. Diplopia remains a frequently diagnosed ailment. But what it is and how to deal with it, we will consider further.

Disease Definition

Diplopia is an anomaly that leads to impaired visual function. Its essence is that the object that is in front of the eyes doubles. This is due to the deviation of the visual axis of one organ of vision.

The development of an abnormal phenomenon occurs due to the fact that the image of the object in question, when the eyeball is deflected, does not fall on the main fossa, but on another area of ​​the retina.

When doubling the image, there is always a violation of binocular vision.

This phenomenon disappears if a person closes one eye. Very rarely, monocular diplopia may occur. This pathological phenomenon implies that the same object gives two pictures in one eye. If you cover the second organ of vision, then this phenomenon does not disappear.

Causes

The incorrect location of the eyeball in the orbit can provoke the development of the disease. This can be influenced various injuries- infringement of the muscles of the visual organ, resulting from a fracture of the wall of the orbit. Wrong position eyeball is another reason for the development of hematoma of the eye tissues.

Damage to the oculomotor nerve can also affect the pathological process. This can lead to:

• local expansion of the carotid artery;
• tumors concentrated inside the skull;
• meningitis of tuberculous origin.

Diplopia can also be affected by various infectious processes formed against the background of the following pathologies:

• rubella;
• mumps;
• diphtheria;
• tetanus.

Severe intoxication that has arisen against the background of alcohol or medication can provoke diplopia.

Image ghosting can be the result of such pathological conditions:

• botulism;
• thyrotoxicosis;
• multiple sclerosis;
• bouts of hysteria.

Diplopia may occur against the background of operations on the organs of vision, used for , and .

Symptoms

Diplopia can be recognized by the following symptoms:

• difficulty in determining the location of objects;
• regular dizziness.

The symptomatology of the pathological process is determined taking into account the place of its localization.

If the lesion was inflicted on the oblique muscles, then doubling involves the image of objects one after another. When the rectus muscles are damaged, parallel doubling occurs.

Two images of an object that are formed during pathology may differ in brightness and contrast. One of them can move vertically and horizontally, be at a certain angle to the second object.

Often, to get rid of double vision, a person simply needs to turn or tilt his head in the direction of the lesion.

Possible Complications

Diplopia refers to those pathologies that can occur without a general or specific clinical picture. If you start the disease and do not start treatment, then such complications arise:

• fatigue of the organs of vision;
• Pain in the eyes;
• headache;
• blurry vision.

If you find these symptoms, you should immediately visit a doctor, as this indicates the development of a more serious pathological process.

Treatment

To get rid of the pathology, the patient must visit a doctor on time. He is based diagnostic study be able to diagnose and prescribe effective scheme therapy.

Use of glasses

The treatment of diplopia is based on prismatic correction. The essence of this technique is that the patient must wear special glasses. They allow you to optically eliminate the effect of ghosting. The disadvantages of this method include a decrease in visual acuity while wearing glasses. So when prescribing them to children, additional attention should be paid to maintaining normal vision.

Prismatic correction in the treatment of diplopia

Surgical method

Can be used to correct pathology operational path. Surgical treatment is prescribed only after other methods of therapy have not given the desired result. Two methods can be used for this purpose:

1. Recession eye muscle. During the operation, the eye muscle moves back, but the cut fascia is fixed to the sclera.
2. Muscle resection. The purpose of this operation is to shorten the length of the muscle in order to compensate for the work of the affected one.

Folk remedies

For the treatment of pathology can be used folk remedies. But this can be done provided that the reason for its development lies in the muscles, and not in the structure of the eyeball itself.

Self-medication is not worth it, as you need to know exactly what led to the bifurcation. Otherwise, there is a risk total loss vision.

To alleviate the condition, the following methods can be used:

1. Lavender tincture. Take 50 g of dry leaves, 30 g of valerian root and 1 liter of white wine. After mixing the components, they must be infused for 3 days. Then take the filtered preparation in 20 ml.
2. Purchase flower pollen at the pharmacy. Take 10 ml 2 times a day. The duration of treatment will be 30 days.
3. Take equal amounts of viburnum and rosehip berries. For 20 g of the mixture there are 200 ml of water. Simmer on fire for 10 minutes, cool and take 100 ml 2 times a day.
4. Take 50 g of eyebright, add 2 cups of boiling water. Insist 4-5 hours. The filtered infusion is taken 10 ml 3 times a day.
5. Take 30 g of blueberry leaves, add 200 ml of boiling water. Filter the infusion and take 10 ml 3 times a day.
6. Take 20 g of calendula flowers, add 2 cups of hot water. Infuse for 2 hours, filter and take throughout the day.
7. You can just add a few mint leaves to your tea.

treat diplopia non-traditional means it is possible, but only the probability of successful treatment is low. They are best used in combination with other therapies.

Prevention

To prevent the development of diplopia, it is worth following simple recommendations:

1. Treat in a timely manner inflammatory diseases nervous system.
2. Avoid the development of vascular accidents. To do this, it is necessary to measure the level of blood pressure, the concentration of sugar in the blood.
3. Monitor hormone levels thyroid gland in blood.

Video

conclusions

Diplopia is dangerous disease, which, if not properly treated, can lead to complete loss of vision. The treatment of pathology must be approached responsibly. Only experienced specialist be able to accurately diagnose and select the best option therapy, based on the stage of the pathology, its type and characteristics of the patient's body.