Double vision in children: What parents should know

Double vision in children: What parents should know

Double vision, medically called diplopia, occurs when a child sees two images of a single object instead of one. This condition can affect one eye (monocular) or both eyes (binocular), and its causes vary from minor vision problems to more serious underlying health issues. While occasional blurred or doubled vision may happen during fatigue or illness, persistent double vision should never be ignored. Early detection is crucial to prevent permanent vision impairment and ensure proper eye development.

Types of double vision in children

  • Monocular Double Vision – This type affects only one eye. It may occur due to:

  • Refractive errors like astigmatism.

  • Cataracts (clouding of the lens)

  • Corneal irregularities
    Even though monocular diplopia is often less serious, it still requires professional evaluation.

  • Binocular Double Vision – This type occurs when both eyes do not work together properly. When one eye is misaligned, the brain receives two different images, resulting in double vision. Binocular diplopia is usually caused by:

  • Strabismus (misalignment of the eyes)

  • Weakness or paralysis of the eye muscles.

  • Neurological conditions affecting eye movement.

Common causes of double vision in children

  • Strabismus (Crossed or Misaligned Eyes)
    Strabismus is one of the most common causes of double vision in children. In this condition, one eye may drift inward, outward, upward, or downward. The misalignment prevents the eyes from focusing on the same object simultaneously, forcing the brain to process two different images. Without treatment, the brain may suppress vision from one eye, leading to amblyopia (lazy eye).

  • Refractive Errors
    Children with uncorrected vision problems like nearsightedness (myopia), farsightedness (hyperopia), or astigmatism may experience double vision. When the eyes strain to focus, the brain may perceive two overlapping images. Regular eye exams are essential to detect and correct these issues with glasses or contact lenses.

  • Eye Muscle Weakness or Paralysis
    Sometimes, one or more of the eye muscles may be weak or paralysed, preventing proper alignment. Conditions like ocular nerve palsy or congenital muscle defects can cause one eye to drift, resulting in double vision. Children may adopt a head tilt to compensate for misalignment.

  • Infections or Inflammation
    Severe eye infections, conjunctivitis (pink eye), or inflammation inside the eye (uveitis) can temporarily affect vision and lead to diplopia. Early treatment of infections is crucial to avoid long-term complications.

  • Head Injury or Trauma
    Blows to the head or face can damage eye muscles or nerves, resulting in double vision. Even mild trauma should be evaluated if diplopia occurs, as it can indicate nerve injury or orbital fractures.

  • Underlying Medical Conditions
    Certain systemic or neurological conditions may contribute to double vision in children, including:

  • Thyroid disorders affecting eye muscles

  • Diabetes causing nerve damage

  • Brain tumors or neurological disorders
     Persistent or new onset double vision always warrants a thorough medical evaluation to rule out serious conditions.

Signs parents should watch for

Parents can often detect double vision in children by observing the following:

  • Tilting or turning the head frequently to see clearly.

  • Covering one eye while reading or watching TV.

  • Complaints of seeing two or overlapping images.

  • Squinting or rubbing the eyes excessively.

  • Misaligned eyes or visible crossing.

  • Difficulty focusing on objects or reading.

Early recognition and intervention can prevent permanent vision problems and improve the child’s quality of life.

Diagnosis and tests

When a child experiences double vision, a prompt and thorough evaluation by a paediatric ophthalmologist is essential to determine the underlying cause and plan appropriate treatment.

The following diagnostic tests may be recommended:

  • Comprehensive Eye Exam
    This is the first and most important step in assessing a child’s vision. The eye specialist will measure visual acuity, check for proper eye alignment, and evaluate overall eye health. The exam may include looking at the front and back of the eye, testing eye movement, and assessing how the eyes work together.

  • Cover Test
    The cover test helps the doctor identify misalignment of the eyes. One eye is covered at a time while the child focuses on an object, and the doctor observes how the uncovered eye moves. This test can detect conditions like strabismus, which is a common cause of double vision in children.

  • Refraction Test
    This test determines if refractive errors—such as nearsightedness, farsightedness, or astigmatism—are contributing to double vision. Corrective lenses can often resolve double vision caused by these errors.

  • Neurological Evaluation
    If the eye specialist suspects that double vision may be related to nerve or brain issues, a neurological assessment may be recommended. This evaluation can help identify conditions affecting eye muscles, cranial nerves, or brain function.

  • Imaging Tests (MRI or CT Scan)
    In rare cases, if structural abnormalities or serious medical conditions are suspected, imaging tests like MRI or CT scans may be conducted. These tests provide detailed images of the eyes, brain, and surrounding structures to detect any underlying causes of diplopia.

Treatment options

The treatment for double vision in children depends on the specific cause and severity of the condition. Common approaches include:

  • Glasses or Contact Lenses
Glasses or Contact Lenses

Correcting refractive errors with glasses or contact lenses can often eliminate double vision caused by the eyes straining to focus.

  • Prism Lenses
Prism Lenses

Prism lenses are special lenses that bend light entering the eyes, helping the eyes to align properly and reducing the perception of double images.

  • Vision Therapy
Vision Therapy

Vision therapy involves a series of eye exercises designed to improve coordination, focusing ability, and eye alignment. This therapy can be especially useful for children with mild strabismus or binocular vision problems.

  • Surgery
Surgery

In cases of significant eye misalignment or severe eye muscle disorders, surgical intervention may be necessary. Strabismus surgery helps align the eyes, improving vision and reducing double images.

Prompt and appropriate treatment is crucial to prevent amblyopia (lazy eye) and other long-term complications, ensuring healthy visual development.

Practical tips for parents

Parents play a key role in supporting children with double vision. Here are some practical steps:

  • Schedule Regular Eye Check-Ups – Routine eye exams can help detect vision problems early, even before your child reports symptoms. Early intervention improves treatment outcomes.

  • Observe Head and Eye Behavior – Watch for unusual head tilts, squinting, or covering one eye. These behaviors may indicate that your child is compensating for double vision.

  • Ensure Proper Lighting – Good lighting while reading, studying, or doing homework reduces eye strain and helps children focus better.

  • Limit Screen Time – Prolonged use of digital devices can worsen eye strain. Encourage breaks using the 20-20-20 rule: every 20 minutes, look at an object 20 feet (6 metres) away for 20 seconds.

  • Seek Immediate Medical Attention if Needed – If double vision appears suddenly, or is accompanied by headaches, nausea, eye pain, or other neurological symptoms, seek prompt medical evaluation. Sudden onset diplopia can sometimes indicate a more serious problem.

Conclusion

Double vision in children does not have to affect their long-term vision — but early detection and timely treatment are essential. At Clarity Eye Surgeons, we are dedicated to helping parents in Canberra and surrounding areas ensure their children’s eyes develop healthily through expert diagnosis, personalised treatment, and compassionate care.

Book a paediatric eye examination today and take the first step toward protecting your child’s vision.

Author bio

Dr Parth Shah is a director and principal ophthalmologist in Canberra at Clarity Eye Surgeons. With extensive training and experience, he is renowned for his expertise in the field. Dr Shah is dedicated not only to performing successful surgeries but also to patient education. His compassionate approach, combined with technical proficiency, has earned him the trust and gratitude of countless patients. He is a true advocate for eye health and a trusted name in the Canberra ophthalmology community.

FAQs

Sometimes mild or temporary double vision may improve on its own, especially if caused by fatigue or minor eye strain. However, persistent double vision rarely resolves without professional evaluation, and early intervention is important to prevent long-term complications.

Not always. Double vision can result from minor issues like uncorrected refractive errors, but it can also indicate more serious conditions such as eye muscle disorders or neurological problems. Prompt and proper assessment by a paediatric ophthalmologist is essential.

Children should have their first comprehensive eye exam by age 3–4. If double vision is noticed at any age, an immediate eye evaluation is recommended regardless of routine check-ups.

Yes. Poor posture, excessive reading, or improper screen habits can strain the eyes and exacerbate underlying vision problems. Encouraging good ergonomics and breaks can help reduce symptoms.


Warning signs include sudden onset of double vision, headaches, nausea, vomiting, eye pain, drooping eyelids, or changes in balance or coordination. These require urgent medical evaluation.

Severe sinus infections or allergies can occasionally cause temporary blurred or double vision due to swelling around the eyes, but this is usually short-lived and resolves once the underlying condition is treated.

Yes. Persistent double vision can make reading, writing, and concentrating difficult, leading to frustration and academic challenges. Early treatment helps prevent learning difficulties.

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