Vertical Diplopia Symptoms, Causes, Treatment

Generally Vertical diplopia is characterized as “an indication that there is a misalignment between the two eyes of a person which may lead to the double vision”.

Normally when a person looks at any object two separate images generate by each of the eye and later on combined by the brain into one single image of this particular image. This whole process takes even less than a second to make any object visual to human eye. When the brains fails to combine these two separate images of any object into a single image then the double vision is experienced. It usually happens because the two images that are generated by each of the eye are not similar enough which on joining may not produce a single image.

Diplopia is considered the first symptom of the disease among other signs and symptoms. And characterized by the concurrent visual perception of two images of single object that may be misaligned with each other in any of the positions i.e. horizontally, vertically, diagonally (both horizontally and vertically), or rotationally.

On diagnosis, the double vision may appear monocular in which one or both eyes sees multiple images while testing them individually. But sometimes it may appear binocular which is characterized by the experience of double vision only when the both eyes are open and individually these see a single image separately.

In this condition, both of the eyes stays completely functional but may fail to generate the exact images of any specified objects due to the impaired function of the extraocular muscles.There can be any problem with these muscles including; mechanical problems, disorders of the neuromuscular junction, disorders of the 3, 4 and 6th cranial nerves, and may be the disorders caused by the ingestion of toxins.

Vertical Diplopia Symptoms, Causes, Treatment

Vertical Diplopia Symptoms

There is a defined list of the signs and symptoms which may appear in any person leading to the easy diagnosis of the disease. This list may include;

  • Misalignment of one or both of the eyes characterized as ‘wandering eye’ or ‘cross-eye’.
  • Pain is experienced on the movement of the eyes.
  • Radiating pain around the eyes in area of temples and eyebrows.
  • Frequent headache.
  • Fatigue may aid the variability of double vision.
  • Weakness of eyes or any other associated body portion.
  • Weary eyelids.
  • Sometimes the images may appear overlapped or neighboring to each other. Both of these conditions may lead to the blurred vision or dizziness.
  • Double vision may appear continual or variable which is explained by the irregularities of the eye’s surface which may causes the variation in the double vision on blinking.
  • Direction of the gaze or change in the lying position of head may cause variation in the binocular diplopia.

Vertical Diplopia Causes

Commonly trochlear nerve palsy is considered as a most contributing cause to the vertical diplopia. But there are many other ophthalmologic, infectious, autoimmune, neurological, and neoplasticcauses which may contribute to the development of the disease. These may include;

  • Abscess
  • Anisometropia
  • Antipsychotics(haloperidol, fluphenazine, chlorpromazine)
  • Atypical parkinsonisms, especially multiple system atrophyand progressive supranuclear palsy
  • Botulism
  • Brain tumor
  • Cannabis
  • Cancer
  • Damage to third, fourth, or sixthcranial nerves, which control eye mobilization
  • Cataract
  • Diabetes
  • Drunkenness
  • Fluoroquinoloneantibiotics[6]
  • Graves disease
  • Guillain–Barré syndrome
  • Lasik complications
  • Keratoconus
  • Lyme disease
  • Migraine headaches
  • Multiple sclerosis
  • Myasthenia gravis
  • Opioids
  • Orbital myositis
  • Trauma
  • Salicylism
  • Sinusitis
  • Strabismus
  • Wernicke’s syndrome
  • Increased intracranial pressure (compressing the sixth cranial nerve results in diplopia)

Vertical Diplopia Vertical Diplopia Treatment

The choice of treatment option is dependent upon the correct identification of the underlying cause. To achieve better and quality outcomes from the treatment requires the proper knowledge of the underlying cause which is leading to the disease.

Treatment option may include;

  • Eye exercises
  • Wearing eye patch on alternative eyes
  • Prism corrections
  • Use of the botulinum toxins
  • In extreme condition surgery is may suggested

Other than the achievement of better outcomes, causative agent or source is needed to be addressed accurately in order to choose the proper treatment approach for the specified condition. For example;

  • Glasses and contact lenses are suggested for the diplopia emerging from refractive errors including; myopia, hyperopia and astigmatism.
  • A wide range of treatment techniques is made available for treating dry eyes, including; artificial tears, anti-inflammatory drops, punctal plugs, warm compresses etc.
  • Surgery is suggested for the treatment of cataracts and after this the posterior opacification is treated with the use of laser.
  • Binocular diplopia is required to report on immediate basis as it is followed by the deadly conditions particularly; aneurysms, head trauma, stroke and other neurological conditions. This can be diagnosed by the identification of associated symptoms such as; headache, nausea, dizziness, loss of balance etc.

In many patients, double vision may diminish with the proper treatment of the underlying disorder.

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