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Monocular Diplopia Binocular Diplopia

This document provides guidance on evaluating patients presenting with diplopia (double vision). It discusses evaluating whether the diplopia is monocular (involving one eye) or binocular (both eyes), and whether it is constant or intermittent. The review of systems should explore symptoms related to other cranial nerves and potential underlying causes. The past medical history may reveal risks for conditions like hypertension. Investigation may include referral to an ophthalmologist, neuroimaging such as MRI if multiple cranial nerves are involved, and thyroid testing if Graves' disease is suspected. The approach depends on whether the diplopia is monocular or binocular, and findings can help localize the cause to specific cranial nerves.

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109 views11 pages

Monocular Diplopia Binocular Diplopia

This document provides guidance on evaluating patients presenting with diplopia (double vision). It discusses evaluating whether the diplopia is monocular (involving one eye) or binocular (both eyes), and whether it is constant or intermittent. The review of systems should explore symptoms related to other cranial nerves and potential underlying causes. The past medical history may reveal risks for conditions like hypertension. Investigation may include referral to an ophthalmologist, neuroimaging such as MRI if multiple cranial nerves are involved, and thyroid testing if Graves' disease is suspected. The approach depends on whether the diplopia is monocular or binocular, and findings can help localize the cause to specific cranial nerves.

Uploaded by

Pomtung
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Definition

Approach
Monocular diplopia
Binocular diplopia

Monocular diplopia

Binocular diplopia

History of present illness


should determine whether diplopia
involves one or both eyes, whether diplopia is
intermittent or constant, and whether the
images are separated vertically, horizontally, or
both. Any associated pain is noted, as well as
whether it occurs with or without eye
movement

Review of systems

should seek symptoms of other cranial nerve dysfunction, such as


vision abnormalities (2nd cranial nerve);
numbness of forehead and cheek (5th cranial nerve);
facial weakness (7th cranial nerve);
dizziness, hearing loss, or gait difficulties (8th cranial nerve);
and swallowing or speech difficulties (9th and 12th cranial nerves).
Other neurologic symptoms, such as weakness and sensory
abnormalities, should be sought, noting whether these are
intermittent or constant.
Nonneurologic symptoms of potential causes are ascertained. They
include nausea, vomiting, and diarrhea (botulism); palpitations, heat
sensitivity, and weight loss (Graves disease); and difficulty with
bladder control (multiple sclerosis).

Past medical history


should seek presence of known
hypertension, diabetes, or both; atherosclerosis,
particularly including cerebrovascular disease;
and alcohol abuse.

Investigation
Patients with monocular diplopia are referred to an ophthalmologist for
evaluation of ocular pathology; no other tests are required beforehand.
For binocular diplopia, patients with a unilateral, single cranial nerve palsy, a
normal pupillary light response, and no other symptoms or signs can usually
be observed without testing for a few weeks. Many cases resolve
spontaneously. Ophthalmologic evaluation may be done to monitor the
patient and help further delineate the deficit.
Most other patients require neuroimaging with MRI to detect orbital, cranial,
or CNS abnormalities. CT may be substituted if there is concern about a
metallic intraocular foreign body or if MRI is otherwise contraindicated or
unavailable. Imaging should be done immediately if findings suggest
infection, aneurysm, or acute (< 3 h) stroke.
Patients with manifestations of Graves disease should have thyroid tests
(serum thyroxine [T4] and thyroid-stimulating hormone [TSH] levels). Testing
for myasthenia gravis and multiple sclerosis should be strongly considered
for patients with intermittent diplopia.


Approach monocular,binocular
Diplopia = perception of 2 images of a single object
monocular = light distortion
Binocular = disconjugate alignment of the eyes
Interpretation of findings:
3rd: Eyelid droop, eye deviated laterally and down,
sometimes pupillary dilation
4th: Vertical diplopia worse on downward gaze (patient
tilts head to improve vision)
6th: Eye deviated medially, diplopia worse on lateral gaze
(patient turns head to improve vision)

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