Chapter 21 – Diplopia. Episode overview: 1) List the differential diagnosis (critical emergent, urgent) for Diplopia. ▫ Including at least 7 causes of binocular. Transcript of DIPLOPIA BINOCULAR Puede tener diversas causas, especialmente una serie de enfermedades y trastornos de los músculos. Las causas más frecuentes de diplopía binocular fueron las parálisis de los nervios craneales, especialmente del vi, seguidas de estrabismos descompensados.

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Single-fiber EMG of the orbicularis oculi is highly sensitive and specific for both the ocular and generalized forms of MG. The brain calculates the visual direction of an object based upon the position of its image relative to the fovea. Binocular diplopia may occur after glaucoma implant surgery.

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Most patients have a visible maculopathy, but others may simply note metamorphopsia on Amsler grid testing. Surgical ocular refractive procedure Search for additional papers on this topic.

In other projects Wikimedia Commons. Patients report diplopia, blurred vision, and asthenopia with prolonged near tasks.

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The pupillary examination should be normal and there should be no sensory symptoms ie, pain or numbness. Patients with a fairly comitant deviation may prefer prismatic correction. Other patients suffer from surgical trauma to the EOMs after peribulbar injections or superior rectus bridle sutures.


It makes viewing stereograms possible. The right eye demonstrates abducting nystagmus. Binokulare probleme durch aniseikonie und anisophorie nach katarakt operation. Orthoptic training using base-out prisms for near viewing, convergence exercises using stereograms, home computer orthoptics, and changing fixation from distance to near targets may improve symptoms. Monocular occlusion appears to be the sole therapy in most instances.

Also, the need for overcorrected myopia to control intermittent exotropia may go unrecognized by the refractive surgeon. Corneal topography and hard-contact- lens refraction can detect an irregular corneal surface or contour. Ductions are full without evidence of abduction deficit. Glaucoma Surgery Binocular diplopia causss occur after glaucoma implant surgery.

The appropriate treatment for binocular diplopia will depend upon the cause of the condition producing the symptoms.

Evaluation and Management

Examination of the eyelids may demonstrate ptosis or orbicularis weakness, although cases without eyelid involvement occur. In some patients with binocular diplopia, the extraocular motility may appear full but saccadic velocity is slow. Internuclear Ophthalmoplegia The medial longitudinal fasciculus MLF connects the sixth nerve nucleus on one side of the pons to the contralateral eiplopia rectus subnucleus in the midbrain. Idplopia using this site, you agree to the Terms of Use and Privacy Policy.

Neil MandavaEric D. If diplopia appears with other symptoms such as fatigue and acute or chronic pain, the patient should see an ophthalmologist immediately. Patients with long-standing, stable strabismus for more than 6 to 12 months could consider strabismus surgery.

With decompensated fourth nerve palsy, due to the long- standing nature, the hypertropia may become more comitant with time. The most common cause of a neurologically isolated, acute, ocular motor cranial neuropathy third, fourth, or sixth nerve palsy is microvascular ischemia.


Although she has right upper lid ptosis requiring the examiner to hold the lid open, the ptosis does not occur until midway through the examination. In addition to a thorough ophthalmologic examination, specific attention should be directed to eyelid position, orbicularis oculi strength, facial sensation, and exophthalmometry. Base-out prisms eliminate diplopia effectively but may cause diplopia at near unless they are applied on the distance portion of the glasses only.

For the most part, patients with monocular diplopia do not warrant a neurologic evaluation since a careful ophthalmic evaluation will reveal the cause see Table 1. Continuing navigation will be considered as acceptance of this use.

The most frequent causes of binocular diplopia were cranial nerve palsies, especially the sixth cranial nerve, followed by decompensated strabismus. Abscess Anisometropia Botulism Brain tumor Cannabis Cancer Damaged thirdfourthor sixth cranial nerves, which control eye movements.

Diplopia: Diagnosis and Management: Evaluation and Management

Monocular diplopia may be induced in many individuals, even those with normal eyesight, with simple defocusing experiments involving fine high contrast lines. Patients with skew deviation complain of vertical and occasionally torsional binocular diplopia. Skip to search form Skip to main content.