Investigating diplopia (summary)

This is a basic article for medical students and other non-radiologists

Diplopia, also known as double vision, is a visual symptom of seeing two images of a single object.

Reference article

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Summary

• epidemiology

  • more common among adults and the elderly because of age-related eye conditions (e.g. cataracts, macular degeneration, presbyopia) and neurological conditions (e.g. multiple sclerosis, stroke)

  • less common in pediatric with strabismus is a significant contributor to double vision

• pathophysiology

  • diplopia is the result of disruption to the normal functioning of the visual system, with abnormalities ranging from problems with eye muscle coordination and cranial nerve function to ocular disorders and neurological conditions affecting the visual pathway

• questions

  • is double vision intermittent or constant?

  • monocular or binocular?

  • what is the direction in which double vision occurs?

  • associated symptoms

  • onset and duration

  • age and patient history

  • associated medical conditions

  • eye examination findings

  • response to cover-uncover test

• investigation

  • depending on the clinical presentation and suspected causes, imaging studies like MRI or CT of the brain and orbit may be ordered

• common pathology

  • strabismus

  • refractive errors

  • cranial nerve palsies (third, fourth, sixth nerve palsy)

  • ocular diseases (e.g. cataracts, macular degeneration, glaucoma)

  • neurological disorders (e.g. multiple sclerosis, myasthenia gravis, brain tumors)

  • head trauma, facial fractures

  • thyroid eye disease

  • medications and drugs

  • other causes (infection, sinus pathologies, idiopathic intracranial hypertension)

• treatment

  • ocular treatments, e.g. corrective lenses, eye patching, prism lenses.v, vision therapy

  • surgery

  • treatment of underlying conditions