Seeing double when I tilt my head down

Last night while watching TV, I started having pain in one of my eyes when I turned my head a certain way, especially if I turned my head too quickly.  I thought I was just tired, but then in the bathroom, I noticed that when I tried to look up without moving my head, I was seeing double.  When I look straight ahead, it seems fine.  As I tilt my head down with my eyes focused on the same point, it became double, getting progressively more pronounced.  It's as if my right eye, which feels strained, isn't keeping in alignment with my left eye.  It is still occurring today.  The pain isn't sharp, kind of like a pulled or strained muscle.  This afternoon, before I was going to call a doctor, I tried tilting my head and looking up again, and my eye slowly adjusted, and then everything was fine.  But that only lasted for an hour.  I noticed it again later.  Now, when I tilt my head while focusing on a object, it goes double and then corrects itself.  Also, my wife says that I'm holding my head back a little during normal activities.  Any suggestions?

[Michael J Kutryb, MD]

You have a diplopia problelm which can be caused by several things, including: cranial nerve palsy due to a stroke or diabetic or athersclerotic small vessel disease; neurologic disease such as myasthenia gravis; orbital diseases such as thryoid eye disease, orbital inflammatory disease and even certain tumors; neurologic side effects due to drug side effects or other systemic diseases.  Diplopia in an adult needs to be taken seriously and needs to be evaluated by an ophthalmologist right away.  Hopefully it will not be anything serious.

MJK MD