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Diplopia - Eye Disorders - MSD Manual Professional Edition-Table

This document lists various causes of binocular diplopia (double vision), including disorders affecting cranial nerves, cerebrovascular diseases, compressive lesions, idiopathic causes, inflammatory/infectious lesions, Wernicke encephalopathy, mechanical interference, Graves' disease, orbital myositis, trauma, tumors, neuromuscular transmission disorders like botulism and Guillain-Barré syndrome, multiple sclerosis, and myasthenia gravis. For each cause, it provides suggestive clinical findings and the appropriate diagnostic approaches, which may include imaging tests, laboratory tests, or clinical exams.

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24 views

Diplopia - Eye Disorders - MSD Manual Professional Edition-Table

This document lists various causes of binocular diplopia (double vision), including disorders affecting cranial nerves, cerebrovascular diseases, compressive lesions, idiopathic causes, inflammatory/infectious lesions, Wernicke encephalopathy, mechanical interference, Graves' disease, orbital myositis, trauma, tumors, neuromuscular transmission disorders like botulism and Guillain-Barré syndrome, multiple sclerosis, and myasthenia gravis. For each cause, it provides suggestive clinical findings and the appropriate diagnostic approaches, which may include imaging tests, laboratory tests, or clinical exams.

Uploaded by

Apostolos T.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Some Causes of Binocular Diplopia

Cause Suggestive Findings Diagnostic Approach

Disorders affecting cranial nerves to extraocular muscles (presence of pain varies by


cause)

Older patients, risk factors (eg,


hypertension, atherosclerosis,
Cerebrovascular diabetes)
disease affecting pons Sometimes internuclear MRI
or midbrain ophthalmoplegia or other
neurologic deficits
No pain

Often pain (sudden if caused


Compressive lesion Immediate imaging
by ruptured aneurysm) and
(eg, aneurysm, tumor) (CT, MRI)
other neurologic deficits

Ophthalmologic
referral to check for
other deficits
For isolated diplopia,
Idiopathic (usually Occurs in isolation (no other observation for
microvascular) manifestations) spontaneous
resolution
Imaging (MRI, CT) if not
resolved in several
weeks

Inflammatory or
Constant pain
infectious lesions (eg,
Sometimes fever or systemic
sinusitis, abscess, CT or MRI
complaints, facial sensory
cavernous sinus
changes, proptosis
thrombosis)

Wernicke History of significant alcohol


Clinical diagnosis
encephalopathy abuse, ataxia, confusion

Mechanical interference with ocular motion (pain is often present)

Graves disease Local symptoms: Eye pain, Thyroid function


(infiltrative exophthalmos, lacrimation, dry testing
ophthalmopathy eyes, irritation, photophobia,
usually associated with ocular muscle weakness
hyperthyroidism) causing diplopia, vision loss
Cause Suggestive Findings Diagnostic Approach

caused by optic nerve


compression
Systemic symptoms:
Palpitations, anxiety, increased
appetite, weight loss, insomnia,
goiter, pretibial myxedema
Sometimes eye abnormalities
precede thyroid dysfunction

Constant eye pain that


Orbital myositis worsens with eye motion, MRI
proptosis, sometimes injection

Trauma (eg, fracture, Signs of external trauma;


CT or MRI
hematoma) apparent by history

Often pain (unrelated to eye


Tumors (near base of
motion), unilateral proptosis,
skull, in or near CT or MRI
sometimes other neurologic
sinuses or orbit)
manifestations

Neuromuscular transmission disorders (typically, pain is absent)

Sometimes preceded by
gastrointestinal symptoms
Descending weakness, other Serum and stool
Botulism
cranial nerve dysfunction, testing for toxin
dilated pupils, normal
sensation

Guillain-Barré
syndrome (Miller Ataxia, decreased reflexes Lumbar puncture
Fisher variant)

Intermittent, migratory
neurologic symptoms,
including extremity
paresthesias or weakness, MRI of brain and spinal
Multiple sclerosis
visual disturbance, urinary cord
dysfunction
Sometimes internuclear
ophthalmoplegia

Myasthenia gravis Diplopia intermittent, often Ice pack test, single


with ptosis, bulbar symptoms, fiber electromyogram
(EMG), anti–
Cause Suggestive Findings Diagnostic Approach

weakness that worsens with acetylcholine receptor


repeated use of muscle antibody testing

© 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. All rights reserved.

MSD MANUAL
Professional Version

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