9Īs many as 60% of MG patients, such as this one, present with ptosis and diplopia. 4,7,8 Medications (e.g., antidepressants, antihistamines, diuretics) may contribute to ocular surface dryness and induce a monocular diplopia. Decreased vision due to uncorrected astigmatism, dry eye and tear film deficiencies, corneal pathology or scarring, iris abnormalities, lenticular changes, vitreal opacities and macular disease are all possible causes of monocular diplopia. This finding is rarely due to cortex lesion and is generally attributable to causes within the eye itself. Clinicians should have the patient cover each eye separately when testing for monocular diplopia. 3,4 Monocular Diplopiaĭiplopia that persists when one eye is covered falls into the category of monocular diplopia, or polyopia (greater than two images). The clinician must determine if the diplopia is monocular or binocular, as binocular diplopia may have a life-threatening cause. The first step on the path to proper identification is a thorough patient history. 6 A systematic approach to the differentials is key to identifying and treating benign causes-and promptly referring patients when it is vision or life threatening.ĬN VI palsy, seen here in the right eye, accounts for 50% of all isolated CN palsies. 4,5 Most etiologies will fall into one of five categories: (1) refractive, (2) binocular vision disorder, (3) orbital disease, (4) neuromuscular junction dysfunction, or (5) injury to the central nervous system/cranial nerves (CNs). 2,3 While the cause can be benign, some cases, such as those accompanied by new headache, ocular pain, unilateral pupil dilation, muscle weakness, ptosis, trauma or papilledema, raise red flags for immediate referral. 1 Constant diplopia with acute onset will have different differentials than intermittent diplopia, for example. Correctly diagnosing the disease, like diabetes, high blood pressure, or myasthenia gravis is essential to determining the appropriate course of treatment.A patient presenting with diplopia-whether horizontal, vertical or diagonal-is often a clinical challenge. For binocular diplopia, however, a serious condition is typically associated with the eye misalignment. In the case of monocular diplopia, refractive errors can be corrected with glasses or contact lenses if cataracts are the cause, surgery can correct this problem. Treatment for double vision depends on the cause. In some cases specialized imaging, like an MRI, may be necessary. If a neurological cause is suspected, close attention will be paid to the pupils and eyelid position when looking for ocular or orbital abnormalities. This is necessary to determine whether the double vision is monocular or binocular.Īn eye care professional will also examine how shifting the head’s position affects the double vision. The eye care professional will conduct a physical examination to measure visual acuity in each eye. An eye care professional will start by taking a detailed medical history, including when the problem first began, whether it was a sudden onset or developed gradually, and whether the double vision is a frequent problem or an intermittent concern. Diagnosis and TreatmentĬorrectly diagnosing the cause for diplopia is essential to developing an appropriate treatment plan. Each eye is seeing the correct single image when working alone, but when the eyes are working together, the brain perceives two adjacent images. For binocular diplopia, the eyes are simply misaligned and when one eye is covered, the condition is resolved. With monocular diplopia, double vision is affecting both eyes and does not resolve itself when a single eye is covered. There are two types of double vision: monocular and binocular. This visual overlap can vary as the affected individual turns or tilts his head or gazes from side to side. Symptoms of DiplopiaĬommon symptoms of double vision include the visual appearance of objects overlapping each other or appearing adjacent to one another. Consequently, when diagnosing double vision and creating a treatment plan, it is critical for a medical professional to determine the specific cause in order to develop an appropriate treatment plan. There are many different causes for double vision, ranging from life-threatening to benign. Over time, the brain eventually begins to compensate for this misinformation by suppressing one signal so that only a single image is perceived. This occurs when two nonmatching images are sent to the part of the brain that processes visual input. Double vision, also known as “seeing double” or the medical term diplopia, is the perception of two images of a single object.
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