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Conditions like fluid imbalance or local swelling that lead to puffy or swollen eyelids can cause shadows that make the area under the eyes appear darker. Trauma (a black eye) can cause darkening of the entire eye area. Some people notice that dark circles under the eyes tend to run in families, as well.

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Double vision can result from impairment in any part of the vision system, including the cornea, eye muscles, lens, nerves, or the brain. The most common cause of diplopia is misalignment of the two eyes that can arise from several different conditions. Some diseases such as myasthenia gravis and Graves disease can cause weakness of the eye muscles, leading to misalignment of the eyes and double vision.

Often when people are in pain they do not move normally. Since pain can limit motion, people tend to brace themselves in an attempt to protect the painful or injured area. As a result, they may hold the affected muscles in an abnormal position.

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