Evaluation of Physical Exercises as a Non-Surgical Treatment Modality for Patients with Diplopia

Abstract

Background: Diplopia, commonly known as double vision, is the perception of two images of a single object. It may occur due to ocular misalignment, extraocular muscle weakness, trauma, refractive errors, or systemic conditions affecting ocular motility. Binocular diplopia is usually related to misalignment of the visual axes and often improves when one eye is covered. Non-surgical management, including orthoptic and physical eye exercises, may be useful in selected patients, particularly those with mild ocular motility disorders or convergence-related problems. Objective: This study aimed to evaluate the role of physical eye exercises as a non-surgical treatment modality in selected patients with diplopia. Methods: A Prospective interventional clinical study was conducted on 20 patients diagnosed with diplopia at the Consulting Clinic for Health and Medical Technologies, Baghdad, during the period from October 1, 2024, to April 1, 2025. All patients underwent a complete ophthalmic and optometric examination, including visual acuity assessment, refractive error evaluation, cover test, ocular motility test, Worth four-dot test, prism bar measurement, and fundus examination when required. Patients with diplopia due to causes requiring medical or surgical intervention, such as cataract, severe neurological disease, or uncontrolled systemic disease, were excluded from the physical exercise treatment group. Selected patients received a structured program of eye exercises and were followed to assess improvement. Results: Among the 20 patients, 13 patients were males (65%) and 7 were females (35%). The highest percentage of patients was found in the age group of 20–25 years, representing 45% of the sample. The most common associated causes of diplopia were squint and extraocular muscle weakness. After treatment, 12 patients

(60%) showed improvement with physical eye exercises, 4 patients (20%) required other treatment methods such as prism correction, and 4 patients (20%) showed limited or no improvement mainly due to poor compliance or the need for further management. Conclusions: Physical eye exercises may be beneficial as a non-surgical treatment option in selected patients with binocular diplopia related to mild ocular misalignment or extraocular muscle weakness. However, accurate diagnosis, proper patient selection, and regular follow-up are essential. Physical exercises should not replace medical, optical, or surgical treatment when these are clinically indicated.