Some Causes of Double Vision When Both Eyes Are Open
Cause |
Common Features* |
Diagnosis† |
Disorders that affect control of eye muscles by the nervous system‡ |
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Certain strokes or transient ischemic attacks |
Often in older people and in people with risk factors for these disorders (such as high blood pressure, atherosclerosis, and diabetes) Sometimes slurred speech, weakness, and/or difficulty walking |
MRI or CT |
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A mass that presses on a nerve, such as a bulge in an artery (aneurysm) or a tumor |
Often pain (sudden if caused by an aneurysm) and often other symptoms of nervous system dysfunction (such as muscle weakness, loss of coordination, and abnormal sensations in the skin) |
MRI or CT of the brain (done immediately) |
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Inflammation or infection of the eye or surrounding structures (for example, abscess, sinusitis, and, rarely, with a blood clot in the cavernous sinus at the base of the skull) |
Constant pain Sometimes fever, chills, fatigue, loss of sensation in the face, and/or bulging eyes |
CT or MRI |
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Usually periods of relatively good health alternating with episodes of worsening symptoms Weakness that comes and goes from day to day Abnormal sensations such as tingling, numbness, pain, burning, and itching Clumsiness Loss of strength or dexterity in a leg or hand, which may become stiff As the disorder progresses, shakiness, partial or complete paralysis, and involuntary muscle contractions (spasticity), sometimes causing painful cramps Slowed, slurred speech Problems with urination and/or bowel function |
MRI of the brain and spinal cord |
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Double vision that comes and goes Difficulty speaking or swallowing Weakness Muscles that weaken when they are used repeatedly |
Strength testing after a drug that relieves symptoms of myasthenia gravis is injected (edrophonium test) |
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History of long-term alcohol abuse Clumsiness, poor coordination, and confusion |
A doctor's examination |
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Disorders that block eye motion |
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Graves disease (thickening of muscles and tissues around the eye—called infiltrative ophthalmopathy—that occurs most often in people who also have an overactive thyroid gland and rarely occurs in people with a normal thyroid gland) |
Bulging of the eyes, often eye pain or irritation, watering, sensitivity to light, an enlarged thyroid gland (goiter), and thickened skin on the shins |
Blood tests to evaluate thyroid function |
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Injury, such as a fracture of the eye socket (orbit) or a collection of blood (hematoma) |
Pain In people who have obviously had a recent eye injury |
CT or MRI |
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Tumors (near the base of the skull, the sinuses, or the eye socket, called orbital tumors) |
Often pain unrelated to eye movement, bulging of one eye, and sometimes other symptoms of nervous system dysfunction |
MRI or CT |
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*Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. † Although a doctor's examination is always done, it is only mentioned in this column if the diagnosis can be made only by the doctor's examination, without any testing. ‡ Whether pain is present varies by cause. CT = computed tomography; ECG = electrocardiography; MRI = magnetic resonance imaging. |
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