Mohammad Pakravan MD Associate professor Labbafinejad Medical Center
Diplopia when occur that visual axis of eyes do not drop over an object. In this situation image of an object drop over one fovea of one eye and extrafoveal of other eye.
In some situations like cataract, cornea opacity, or vitreous hemorrhage light rays from one object distract and drop over more than one point of retina. Sometimes it occurs after head trauma or CVA and sometimes occurs after amblyopiatherapy.
physiologic Occurs after neuro-mascular diseases and usually eye deviation exists. Refractive errors, cranial N. palsies (3, 4, 6) thyroid eye diseases, tumors of orbit, blowout fracture may be present.
History taking of any eye disease, cataract, strabismus, trauma to head and neck, CVA, amblyopiatherapy, hyperthyroidism, and any tumor. Examinations: test of visual acuity and refraction, slit lamp, ophthalmoscope (red reflex), extraocular muscles exam, cover test Other tests: imaging of orbit and brain. Binocular VF test
Cover one eye to differentiate monocular from binocular diplopia. If pinhole improves monocular diplopia > media opacity If pinhole doesn’t improve monocular diplopia > head trauma, CVA, patching for treatment of amblyopia
If binocular diplopia > Cover test > no movement > physiologic diplopia Cover test > movement > ET,XT,HT, or cyclodeviation All gaze diplopia > concomitant otherwise incomitant Transiant diplopia in MS, Myasthenia gravis If diploplia in far or near > accomodation or convergence problem If diplopia in one gaze > paralytic strabismus