See double images - causes and therapy

See double images - causes and therapy

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Double vision - diplopia
Usually, the brain combines the impressions of the right and left eyes into an overall picture. However, those who suffer from diplopia see things twice - either in one eye or in both eyes at the same time.

We differentiate between monocular and binocular double images. Monocular double images arise when the eye's incident light rays in the eye lens and cornea diffract differently. The same object creates two different images on the retina and in the brain.

Binocular double images are more common. This creates a different image in each eye. Some people see pictures shifted sideways, others tilt the picture, others perceive their environment blurry, but see two pictures that overlap.

Patients can no longer correctly estimate distances, which is why they have problems grasping and walking. They find it difficult to do physical work, to condition their movements poorly, and to complain of exhaustion because they make excessive efforts to focus on everyday objects.

The cause of this can be harmless, for example if an eye muscle is strained. Sometimes, however, there is a serious illness behind it - right up to a brain tumor.

What happens when double vision?

There are many reasons for diplopia.

1) In the case of paralysis of the eye muscles, the double images arise because those affected cannot adequately move the eye muscles.

These muscles include the six eye muscles and the eyelid muscle. Three posterior nerves pass information on to these muscles.

Such paralysis occurs when the cranial nerves are damaged. This damage often results from a basic disease, for example from a tumor or an impaired blood flow.

The paralyzed muscles can no longer implement the brain's information.

2) Eye movement disorders

Movement disorders in the eyes result from injuries to the eye socket. If the eye can hardly move in the cave, we see twice.

3) Congenital misregistration of the eye muscles can cause the structure of the muscles to change. Then we see double images, they appear laterally shifted or tilted.

Eye socket disorders

Double images also result from injuries to the orbital walls - mostly through violence. A blow to the eye, which causes a fracture of the cave walls, sometimes pinches the eye muscles. Now the eyeball can move badly. If a nerve is also damaged, the eye muscle also relaxes. A bone fracture has to be operated on.

The eye sockets can also become inflamed, and infection of the paranasal sinuses often spreads to the eye. The movement of the eyes is then restricted in all directions, no matter where the affected person looks, they perceive images twice everywhere. Here antibiotics help effectively.

Inflammation of the orbital socket can easily be confused with non-infectious diseases of the eye muscles or connective tissue, which also trigger the same symptoms. It is not antibiotics that help, but cortisone - and that for a long time.

Cranial nerve disorders

We recognize paralyzed cranial nerves, among other things, by the fact that those affected squint.

The fourth cranial nerve is connected to the upper eye muscle. When no more information reaches the muscle, the eye no longer descends and cannot be rolled inwards. The double images are offset and tilted in height. The images intensify when the head tilts to the affected side or the eyes are directed downwards.

The sixth cranial nerve gives the impulses to the outer eye muscle. If it fails, the eye turns inwards.

The third cranial nerve is responsible for the other four eye muscles. If it fails, the eye slides outwards. Looking up and down is only possible to a limited extent.

These nerve palsies usually result from impaired blood circulation, and this is usually associated with diabetes mellitus. Heavy smoking and high blood pressure can also cause this disorder.

Double vision in the case of paralysis of the fourth cranial nerve usually arises from an injury, i.e. from a traumatic brain injury. As a rule, those affected do not squint and see tilted double images when they look down.

When the sixth cranial nerve is paralyzed, the brain volume usually increases, be it due to a tumor or internal bleeding.

After treating the causative disease, the doctor waits a year for the nerves and muscles to regenerate. Squinting as a result of the paralysis can be treated by an operation that now follows.

Until this operation finally eliminates the malposition, those affected wear glasses with reversing prisms.

People suffering from cranial nerve paralysis suffer from dizziness, their sense of space is disturbed, and they try to compensate for the distorted look by tilting their heads to one side.

Double vision with just one eye

Keratoconus is a rare corneal disorder. Around 40,000 people suffer from this in Germany. The affected cornea bulges out and thins out.

The disease was most common in men in the 20s. The refractive power of the eye changes again and again with them and so their poor eyesight fluctuates. They see “shadows” on letters and they see twice - but only in one eye.

The cause is unknown. Ophthalmologists recognize keratoconus with a corneal topography. They measure the thickness of the cornea and use a slit lamp microscope to examine how the cornea changes.

Double images caused by alcohol

Drunk people see twice. This has little to do with any other poor eyesight. Alcohol does not affect whether someone is short-sighted or far-sighted.

If we have drunk too much, however, the interaction between the brain and the eye is disturbed. The nerve impulses no longer reach the eye system, and where in a sober state a three-dimensional image is created from the impressions of both eyes, two images suddenly dance around. Both eyes have to look in exactly the same direction to merge their images. This is no longer possible after heavy alcohol consumption.


Double vision can be treated as well as the diseases on which it is based.

A prism film on the glasses or a special glasses with prism layers restore the overall picture. The affected eye often has to be covered, but this is only a solution for short-term eye disorders. (Dr. Utz Anhalt)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch


  • Herbert Kaufmann; Wilfried de Decker: Strabismus: 72 tables, Georg Thieme Verlag, 2004
  • Professional association of ophthalmologists in Germany (BVA): cms.augeninfo.de (retrieval: 20.08.2019), double vision with one eye
  • Professional association of orthoptists in Germany: www.orthoptik.de (access: August 18, 2019), treatment options for double images (diplopia) in acquired paralysis of the eye muscles (paresis)
  • Company DUPLICON: www.sehtestbilder.de (accessed: August 18, 2019), double viewing under the influence of alcohol
  • Deutscher Ärzteverlag GmbH: www.aerzteblatt.de (accessed: 17.08.2019), side note: alcohol and double vision
  • Annelie Burk; Reinhard Burk: Checklist ophthalmology, Georg Thieme Verlag, 2014
  • Hedwig J. Kaiser: "Diplopia: From Symptom to Diagnosis", in: Clinical Monthly Bulletins for Ophthalmology, Volume 214 Issue 5, 1999, Thieme Connect
  • Klaus Miehlke: Negotiations of the German Society for Internal Medicine, Springer, 1990

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