Expert evaluation of seeing double
Double Vision (Diplopia) Evaluation in Los Angeles
Double vision can be alarming and may indicate a neurological or eye muscle problem. We specialize in diagnosing the underlying cause and providing targeted treatment to restore alignment and comfort. If you're experiencing double vision in Los Angeles, early evaluation is important.
What is Double Vision (Diplopia)?
Double vision (diplopia) means seeing two images of a single object. It can be binocular (present only when both eyes are open, disappearing when either eye is closed) or monocular (persisting even when one eye is closed). Binocular double vision indicates a misalignment of the eyes and may point to neurological, muscular, or orbital causes that require prompt evaluation. Monocular double vision is usually caused by an optical problem within the eye itself, such as cataracts or corneal irregularity. Determining which type you have is the critical first step in finding the cause and the right treatment.
Symptoms of Double Vision (Diplopia)
- Seeing two images side-by-side, one above the other, or at an angle
- Symptoms that worsen when tired or at the end of the day
- Double vision worse in a particular direction of gaze
- Eye strain or headaches from trying to compensate
- Closing one eye improves vision
- Difficulty reading, driving, or navigating stairs
- Nausea or dizziness from visual confusion
- Head tilting or turning to reduce the double image
Common Causes of Double Vision (Diplopia)
- Cranial nerve palsy (third, fourth, or sixth nerve)
- Myasthenia gravis — fluctuating weakness of the eye muscles
- Thyroid eye disease (Graves' orbitopathy)
- Strabismus — eye misalignment from various causes
- Prior eye surgery (retinal, cataract, or orbital surgery)
- Stroke or brain-related conditions
- Orbital fracture or trauma
- Convergence insufficiency
- Decompensating childhood strabismus
How We Evaluate Double Vision (Diplopia)
Evaluation includes a detailed cover test to determine if the double vision is monocular or binocular, a comprehensive motility examination to identify which eye muscles or nerves are affected, and precise prism measurements to quantify the misalignment. Depending on the suspected cause, we may order MRI of the brain and orbits, CT angiography, blood work (thyroid function, inflammatory markers, acetylcholine receptor antibodies for myasthenia gravis), or other targeted tests.
Treatment Options
Treatment targets the underlying cause. If a systemic condition such as myasthenia gravis or thyroid eye disease is identified, treating that condition often improves the double vision. Prism glasses can immediately reduce or eliminate double vision by optically realigning the images. For stable misalignments that don't resolve, Dr. Ghiam can perform strabismus surgery to permanently restore single vision.
- Prism glasses — immediately reduce or eliminate double vision
- Treatment of the underlying cause (thyroid disease, myasthenia gravis, etc.)
- Strabismus surgery for stable misalignments that don't resolve
- Eye patching for temporary relief
- Botulinum toxin injection in select cases
- Observation if the cause is expected to improve (microvascular palsy)
Why Choose Dr. Ghiam for Double Vision (Diplopia)
- Fellowship-trained neuro-ophthalmologist — the ideal specialist for double vision
- Expertise in both the neurological workup and the surgical treatment
- Systematic approach to identify the cause, including rare and complex diagnoses
- On-site prism fitting for immediate relief
- Adult strabismus surgery expertise for cases requiring surgical correction
Double vision has a wide range of causes — some benign, some life-threatening. A neuro-ophthalmologist is uniquely trained to sort through these possibilities systematically, identify red flags that require urgent workup, and connect the eye findings to broader neurological diagnoses. Dr. Ghiam's combined expertise in neuro-ophthalmology and strabismus surgery means he can manage your care from diagnosis through surgical correction if needed.
Get Expert Help for Double Vision (Diplopia)
If you are experiencing double vision, early evaluation is important — some causes require urgent attention. Call our Los Angeles office or schedule an appointment online today.