1. Mohammad Pakravan MD Associate professor Labbafinejad Medical Center

2.  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.

3.  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.

4.  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.

5.  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

6.  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

7.  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