Sudden double vision is never normal
If an adult suddenly starts seeing double, it should always be checked promptly. Some causes are urgent.
When to go to hospital now
Part 06 · 01Go to an emergency department, or call 000, if double vision comes with: a drooping eyelid or one pupil larger than the other; a sudden or severe headache, or eye pain; weakness, numbness, slurred speech or a drooping face; or a recent head injury.
Otherwise, call us on 08 6288 4218 or see your GP the same day. Please don’t wait for an online booking.
If the double vision goes away when you cover either eye, it’s coming from the eyes not lining up. Covering one eye can make you comfortable until you’re seen. Don’t drive while seeing double.
A common cause
Part 06 · 02In older adults and people with diabetes or high blood pressure, a common cause is reduced blood supply to one of the nerves that control eye movement.
A nerve stops working for a while
One of the nerves to the eye muscles stops working properly.
Over a few months
Many cases improve over a few months.
Why we check promptly
That’s why prompt assessment matters.
Cranial nerve palsies at a glance
For optometristsLimited abduction
The most common microvascular palsy in diabetic and elderly patients. Horizontal diplopia, worse at distance and toward the affected side.
Vertical or oblique diplopia
Worse looking down and in. Compensatory head tilt away from the affected side.
Ptosis, eye down and out
Limited elevation, depression and adduction. Microvascular cases are typically pupil-sparing.
Microvascular palsies usually recover within about three months.
Red flags: urgent same-day referral
For optometristsPupil involved
Dilated or poorly reactive pupil with a third nerve palsy: rule out aneurysm. Emergency department, same day.
Pain
Significant pain or headache.
More than one nerve
More than one cranial nerve involved, or other neurological signs.
Atypical patient
Young patient without vascular risk factors.
No recovery
No improvement within three months.
Key takeaways
Part 06- 01New double vision in an adult needs same-day assessment.
- 02A droopy lid, unequal pupils, headache or other neurological signs mean emergency department now.
- 03Microvascular palsies often recover within about three months, but they’re a diagnosis of exclusion.
Seeing double? Call us today
For sudden double vision, call rather than book online. With warning signs, go to an emergency department.
General health information only, not personal advice. Everyone’s eyes are different. An optometrist or doctor should examine you before any treatment is decided.