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Clinical Medicine (London, England) Mar 2022Diplopia or double vision is the separation of images vertically, horizontally or obliquely and can be monocular or binocular in origin. Binocular diplopia is most...
Diplopia or double vision is the separation of images vertically, horizontally or obliquely and can be monocular or binocular in origin. Binocular diplopia is most commonly caused by ocular misalignment or strabismus that can be detected using simple clinical tests. All patients with diplopia of acute onset should be investigated urgently and those with a headache or pupillary involvement need to be referred for same-day urgent imaging. Diplopia secondary to microvascular causes on the other hand often spontaneously resolves within six months.
Topics: Diplopia; Humans
PubMed: 35304368
DOI: 10.7861/clinmed.2022-0045 -
Continuum (Minneapolis, Minn.) Oct 2019"Double vision" is a commonly encountered concern in neurologic practice; the experience of diplopia is always sudden and is frequently a cause of great apprehension and... (Review)
Review
PURPOSE OF REVIEW
"Double vision" is a commonly encountered concern in neurologic practice; the experience of diplopia is always sudden and is frequently a cause of great apprehension and potential disability for patients. Moreover, while some causes of diplopia are benign, others require immediate recognition, a focused diagnostic evaluation, and appropriate treatment to prevent vision- and life-threatening outcomes. A logical, easy-to-follow approach to the clinical evaluation of patients with diplopia is helpful in ensuring accurate localization, a comprehensive differential diagnosis, and optimal patient care. This article provides a foundation for formulating an approach to the patient with diplopia and includes practical examples of developing the differential diagnosis, effectively using confirmatory examination techniques, determining an appropriate diagnostic strategy, and (where applicable) providing effective treatment.
RECENT FINDINGS
Recent population-based analyses have determined that diplopia is a common presentation in both ambulatory and emergency department settings, with 850,000 such visits occurring annually. For patients presenting to an outpatient facility, diagnoses are rarely serious. However, potentially life-threatening causes (predominantly stroke or transient ischemic attack) can be encountered. In patients presenting with diplopia related to isolated cranial nerve palsy, immediate neuroimaging can often be avoided if an appropriate history and examination are used to exclude worrisome etiologies.
SUMMARY
Binocular diplopia is most often due to a neurologic cause. The onset of true "double vision" is debilitating for most patients and commonly prompts immediate access to health care services as a consequence of functional impairment and concern for worrisome underlying causes. Although patients may seek initial evaluation through the emergency department or from their primary care/ophthalmic provider, elimination of an ocular cause will not infrequently result in the patient being referred for neurologic consultation. A logical, localization-driven, and evidence-based approach is the most effective way to arrive at the correct diagnosis and provide the best outcome for the patient.
Topics: Adult; Diplopia; Humans; Male; Middle Aged
PubMed: 31584541
DOI: 10.1212/CON.0000000000000786 -
Seminars in Neurology Aug 2016Diagnosing the underlying etiology of diplopia requires a structured approach. Double vision can arise from ocular, mechanical, or neurologic causes. A careful history... (Review)
Review
Diagnosing the underlying etiology of diplopia requires a structured approach. Double vision can arise from ocular, mechanical, or neurologic causes. A careful history can greatly improve a targeted examination. The approach to initial diagnosis and examination in cases of diplopia has been previously described. Here the authors expand upon those recommendations, and add new techniques recently described in the literature, which may influence the approach to the diplopia patient. A description of the approach to the examination of torsion is discussed. The "three-step test" in the diagnosis of vertical strabismus is discussed, and recent advances in diagnosing skew deviation with the upright-supine test are described. Mechanical strabismus due to changes in orbital anatomy is also reviewed. This review should help the reader refine the differential diagnosis of the patient with diplopia.
Topics: Diagnosis, Differential; Diplopia; Humans; Ocular Motility Disorders; Strabismus
PubMed: 27643904
DOI: 10.1055/s-0036-1585428 -
The American Orthoptic Journal 2015Torsional diplopia can result in failure of fusion in an individual without a measureable strabismus. When presented with a patient with complaints of binocular... (Review)
Review
BACKGROUND AND PURPOSE
Torsional diplopia can result in failure of fusion in an individual without a measureable strabismus. When presented with a patient with complaints of binocular diplopia, physicians and orthoptists should consider cyclovertical muscle dysfunction when the source of the complaint is not readily apparent.
METHODS
A thorough review of the literature combined with the author's own personal experience in treating adult patients with strabismus was used to evaluate the different potential causes of torsional diplopia. Predisposing factors, diagnostic techniques, and strabismus diagnoses are considered.
RESULTS
The most common cause of torsional diplopia is a superior oblique palsy. Other more common causes include thyroid-related orbitopathy and skew deviations.
CONCLUSIONS
Torsional diplopia is a common cause of undiagnosed strabismus in the adult patient population. Proper consideration of the most common causes should be made.
Topics: Diplopia; Eye Movements; Humans; Oculomotor Muscles; Trochlear Nerve Diseases
PubMed: 26564921
DOI: 10.3368/aoj.65.1.21 -
Seminars in Ophthalmology 2018Diplopia is a disappointing and, at times, unanticipated consequence of what might otherwise be considered anatomically successful strabismus surgery. In this study, we... (Review)
Review
Diplopia is a disappointing and, at times, unanticipated consequence of what might otherwise be considered anatomically successful strabismus surgery. In this study, we review the existing literature regarding diplopia after strabismus surgery in the context of the senior author's experience. We divide postoperative diplopia types into cases that occur in the setting of normal binocular vision (or "normal" suppression) vs. cases that are the consequence of rare or anomalous sensorial adaptations. We then discuss how to identify patients at greatest risk based on history and preoperative testing, and we offer strategies for managing these sometimes-challenging cases.
Topics: Diplopia; Humans; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Postoperative Complications; Prognosis; Strabismus; Vision, Binocular
PubMed: 29193991
DOI: 10.1080/08820538.2017.1353827 -
The American Orthoptic Journal 2015Maculopathies affect point-to-point foveal correspondence causing diplopia. The effect that the maculopathies have on the interaction of central sensory fusion and... (Review)
Review
Maculopathies affect point-to-point foveal correspondence causing diplopia. The effect that the maculopathies have on the interaction of central sensory fusion and peripheral fusion are different than the usual understanding of treatment for diplopia. This paper reviews the pathophysiology of macular diplopia, describes the binocular pathology causing the diplopia, discusses the clinical evaluation, and reviews the present treatments including some newer treatment techniques.
Topics: Diplopia; Eye Movements; Humans; Macula Lutea; Oculomotor Muscles; Retinal Diseases; Tomography, Optical Coherence; Vision, Binocular; Visual Acuity
PubMed: 26564922
DOI: 10.3368/aoj.65.1.26 -
Seminars in Ophthalmology 2018Diplopia after cataract extraction is an unexpected outcome for the patient and often a source of confusion for the physician, owing to its relative infrequency. This... (Review)
Review
Diplopia after cataract extraction is an unexpected outcome for the patient and often a source of confusion for the physician, owing to its relative infrequency. This article reviews the pertinent literature on the subject. Mechanisms include anesthetic myotoxicity, surgical trauma, optical aberrations, cortical disorders in patients with congenital strabismus, and the unmasking of previously unnoticed ocular misalignment. As the population continues to age and cataract extraction is performed in increasing volume, familiarity with this uncommon but important outcome may help to clarify and effectively treat post-cataract-extraction diplopia.
Topics: Cataract Extraction; Diplopia; Humans; Oculomotor Muscles; Postoperative Complications
PubMed: 28990829
DOI: 10.1080/08820538.2017.1353806 -
Journal of Binocular Vision and Ocular... 2022Heavy eye syndrome is a condition that results in an acquired, progressive strabismus that is due to extreme myopia and long axial length. The underlying pathogenesis of... (Review)
Review
Heavy eye syndrome is a condition that results in an acquired, progressive strabismus that is due to extreme myopia and long axial length. The underlying pathogenesis of the condition is due to prolapse of the supero-temporal aspect of the myopic globe causing displacement of the lateral and superior rectus muscles inferiorly and nasally, respectively. Treatments for heavy eye syndrome often target this anatomical defect and seek to re-place the globe within the extraocular muscle cone. This review will discuss current theories of pathogenesis and treatment of heavy eye syndrome.
Topics: Adult; Humans; Esotropia; Diplopia; Magnetic Resonance Imaging; Oculomotor Muscles; Strabismus; Ocular Motility Disorders; Syndrome
PubMed: 36279483
DOI: No ID Found -
Seminars in Neurology Feb 2010Double vision may arise from ocular, neurologic, or extraocular muscle disorders. The approach to patients with diplopia requires a systematic approach to the history... (Review)
Review
Double vision may arise from ocular, neurologic, or extraocular muscle disorders. The approach to patients with diplopia requires a systematic approach to the history and the physical examination. There are many challenges in the evaluation of diplopia, ranging from the patient's mental status to the fine points of the examination. This article provides a process for interviewing and examining these patients, explaining the rationale and differential diagnosis of various clinical presentations. Common causes of monocular and binocular diplopia are addressed by the pattern of diplopia described by the patient. The examination and the interpretation of examination findings are presented by incorporating the "upside-down-and-backwards" concept. This review offers some Pearls-perhaps even diamonds-on evaluating patients who complain of diplopia, as well as those who have eye movement abnormalities but can't articulate their symptoms.
Topics: Adult; Child; Diagnosis, Differential; Diplopia; Humans; Neurologic Examination; Ocular Motility Disorders; Terminology as Topic
PubMed: 20127583
DOI: 10.1055/s-0029-1244995 -
Journal of Pediatric Ophthalmology and... Sep 2020
Topics: Diplopia; Disease Management; Eyeglasses; Humans; Vision, Binocular
PubMed: 32956474
DOI: 10.3928/01913913-20200501-01