Diplopia

Overview

• Diplopia refers to double vision, which may be binocular (due to disordered conjugate gaze) or monocular.

• • Ask About

  • Double vision as the patient moves their eyes. Identify whether this is on looking centrally, laterally, inferiorly or superiorly.
• If diplopia is present, ask the patient to cover one eye. Determine whether the diplopia originates from a single eye (monocular), and whether the eyes are aligned.

• • Interpretation

  • Monocular diplopiaCerebral polyopia, refractive error, retinal disease
  • Non-misaligned - no strabusmus presentPhysiologic, macular disease, refractive asymmetry, multiple sclerosis, myaesthenia gravis
  • Horizontal diplopia - double vision on lateral gaze associated with strabismus Intraocular / orbital mass, CN VI palsy, CNS lesion, Graves disease, myaesthenia gravis
  • Vertical diplopia - double vision on superior / inferior gaze associated with strabismus Intraocular / orbital mass, CN III / IV palsy, CNS lesion, myaesthenia gravis