Diplopia: A Practical Approach

  • Igor Šivec University Eye Hospital Ljubljana
  • Dragica Kosec University Eye Hospital Ljubljana
Keywords: diplopia, eye movements, monocular, binocular, cranial nerves, giant cell arteritis, myastenia gravis, ophthalmology, neurology

Abstract

Diplopia means seeing two images of the same, one object. It is a symptom with numerous causes that can involve many different structures. The cause can lay in the eyeball itself: the cornea, the lens and the retina or behind the eyeball: in the orbit or intracranial. Diplopia is only a symptom that can indicate a life threatening ilness like an aneurysm, a dissection or a brain tumor. That is why when presented with it we have to do a thorough examination and look for a red flag that could indicate danger. This way we can make a timely intervention, saving the patients sight or life. This article describes the most crucial signs of a dangerous underlying condition that we cannot afford to miss, a practical guide to the historical assesment, as well as to the physical examination of a patient with double vision to help localize the cause.

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Author Biography

Dragica Kosec, University Eye Hospital Ljubljana
Ophthamologist, Head of ortoptic and strabology at University eye clinic ljubljana

References

Karmel M. Deciphering Diplopia. EyeNet Magazine [internet]. 2009 [citirano 2012 Mar 10]: 31-4. Dosegljivo na: http://www.aao.org/publications/eyenet/200911/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=117256

Pelak VK. Evaluation of diplopia: an anatomic and systemic approach. Hosp Physician. 2004; 40 (3): 16-25.

Finlay A. The differential diagnosis of diplopia [internet]. Optometry Today. 2006 Oct 6 [citirano 2012 Feb 15]; 31-40. Dosegljivo na: http://www.optometry.co.uk/uploads/articles/2c8b0cc4c7b2636385085b3991c9f03e_finlay20001006.pdf

Lang KG. Ophtalmology: A Pocket Textbook Atlas. Stuttgart: Thieme; 2007.

Fakin A, Kerni V, Hawlina M. Prizadetost vida pri temporalnem arterititu. Zdrav vestn. 2012; Suppl 81: 140-50.

Root T. OpthoBook [internet]. Port Orange (FL): Tomoka Eye Association; 2009. Chapter 6, Neuroophtalmology; [citirano 2012 Feb 15]; [12 p]. Dosegljivo na: http://www.ophthobook.com/chapters/neuroophthalmology

Hunder GG. Clinical manifestations of giant cell (temporal arteritis [internet]. Alphen aan den Rijn (Nizozemska): Uptodate; c2013 [citirano 2012 Mar 10]; [13 p]. Dosegljivo na: www.uptodate.com

Kedar S, Biousse V, Newman NJ. Approach to the patient with anisocoria [internet]. Alphen aan den Rijn (Nizozemska): Uptodate; c2013 [citirano 2012 Apr 2]; [7 p]. Dosegljivo na: www.uptodate.com

Tan AK, Faridah HA. The two-minute approach to monocular diplopia. Malaysian Family Physician. 2010; 5: 115-8.

Bienfang BC. Overview of diplopia [internet]. Alphen aan den Rijn (Nizozemska): Uptodate; c2013 [citirano 2012 Mar 10]; [11 p]. Dosegljivo na: www.uptodate.com

Pelak SV. Ocular myastenia gravis [internet]. Alphen aan den Rijn (Nizozemska): Uptodate; c2013 [citirano 2012 Mar 10]; [12]. Dosegljivo na: www.uptodate.com

Brazis PW. Isolated Palsies of Cranial Nerves III, IV and VI. Semin Neurol. 2009; 29: 14-28.

Skuta GL, Cantor LB, Weiss JS. The patient with diplopia. San Francisco: American Academy of Ophtalmology; 2009. p 224-6.

Mercks Manual. Diplopa [internet]. Whitehouse station (NJ): Merck Sharp & Dohme Corp; c2010-2013 [citirano 2012 Feb 15]; Dosegljivo na: http://www.merckmanuals.com/professional/eye_disorders/symptoms_of_ophthalmologic_disorders/diplopia.html

Lee AG. Third cranial nerve (oculomotor nerve) palsy in adults [internet]. Alphen aan den Rijn (Nizozemska): Uptodate; c2013 [citirano 2012 Feb 15]; [11 p]. Dosegljivo na: www.uptodate.com

Comer RM, Dawson E, Plant G, et al. Causes and outcomes for patients presenting with diplopia to an eye casualty department. Eye (Lond). 2007; 21 (3): 413-8.

Morris RJ. Double vision as a presenting symptom in an opthalmic casualty department. Eye (Lond). 1991; 5 (Pt 1): 124-9.

Schiefer U, Wilhelm H, Hart W. Clinical Neuro-Ophthalmology: A Practical Guide. Berlin Heidelberg: Springer; 2007

Published
2015-06-29
How to Cite
1.
Šivec I, Kosec D. Diplopia: A Practical Approach. TEST ZdravVestn [Internet]. 29Jun.2015 [cited 5Aug.2024];84(5). Available from: http://vestnik-dev.szd.si/index.php/ZdravVest/article/view/1116
Section
Review