Diplopia Exercises in OT
Double vision, or diplopia, can significantly impact a patient’s ability to perform daily activities safely and independently. As occupational therapists, especially in acute care or neuro settings, we often encounter patients struggling with diplopia due to stroke, TBI, cranial nerve palsies, or other neurological conditions.
This post covers how OTs can support recovery through functional, evidence-informed exercises that improve visual skills and safety.
What Causes Diplopia?
Diplopia occurs when the eyes don’t align properly, leading to two images instead of one. It can be:
Binocular (resolves when one eye is covered – common in nerve palsies)
Monocular (often related to corneal or lens issues – usually ophthalmology managed)
Common causes in OT settings include:
CN III, IV, or VI palsy
Brainstem stroke or TBI
Decompensated strabismus
Post-surgical changes
OT’s Role in Managing Diplopia
While vision therapy and prism prescription are often handled by optometry or neuro-ophthalmology, occupational therapists address functional implications and provide compensatory strategies and graded visual-motor exercises within scope.
Functional OT Exercises for Diplopia
OT interventions to use based on patient tolerance and acuity:
1. Eye Patching or Spot Patching
For binocular diplopia, temporary occlusion can reduce symptoms during functional tasks.
Use a translucent spot patch over the non-dominant eye’s glasses lens to allow light in but block double images.
Apply only during high-risk tasks (e.g., eating, transfers) to avoid over-reliance.
Tip: Avoid full patching long-term—it can promote suppression and worsen alignment.
2. Pencil Push-Ups
Great for convergence insufficiency and mild cranial nerve palsies.
Hold a pencil at arm’s length.
Focus on the tip and slowly bring it toward the nose until double vision occurs.
Pause, then return to starting position.
Repeat 5–10 reps, 2–3x/day.
3. Eye Tracking and Scanning
Targets oculomotor coordination and compensatory awareness.
Tasks:
Follow a moving target (pen light or colored dot) in H and X patterns.
Use letter or number find activities (e.g., word searches, scanning worksheets).
Track an object while maintaining head still.
4. Functional Activities with Controlled Visual Demands
Integrate eye work into daily tasks:
Sorting laundry (find matching socks)
Wiping surfaces (visual scanning)
Folding towels (depth perception)
Reaching for labeled items (eye-hand coordination)
Start seated with large items and progress to standing with smaller, complex visuals.
5. Balance and Gaze Stabilization
For patients with diplopia and dizziness (common post-TBI):
Have the patient fix their gaze on a target while moving their head side-to-side.
Add walking while focusing on a fixed point.
Gradually increase visual and vestibular demand.
Cognitive + Vision Integration
Many patients with diplopia also have attention or memory deficits. Combine tasks:
Find the number “5” in a grid of numbers while scanning (attention)
Recall items found in a visual search (memory)
Cook a simple recipe while tracking ingredients visually
Documentation Sample
“Pt presents with binocular diplopia post-CVA. Completed 10 min of visual scanning and convergence activities with increased compensatory head movements noted. Spot patch applied to L lens for meal setup task, improving performance and safety. Recommend continuation of oculomotor exercises and further vision rehab referral.”