diplopia (double vision)
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Etiology
- horizontal diplopia:
- images side by side
- cranial nerve 3 or cranial nerve 6 dysfunction
- vertical diplopia
- images on top of another
- cranial nerve 3 or cranial nerve 4 dysfunction
- diplopia in one eye with the other eye closed
- binocular
- extraocular muscle paralysis or weakness (cranial nerve 3, cranial nerve 4, cranial nerve 6)
- difficulty moving the eyes within the orbit
- tumor
- Graves' disease
- fracture
- pharmaceuticals[4]
- binocular diplopia suggests more serious etiology than monocular diplopia
Management
- isolated cranial nerve 6 palsy can be observed for a few weeks looking for improvement
- with cranial nerve 3 palsies, absence of pupillary involvement suggests a benign process that may be observed over a couple of weeks
- most cranial nerve 4 palsies are traumatic or idiopathic postpone neuroradiology testing until 2 months have passed
- if more than one cranial nerve is involved, referral to a neurologist or ophthalmologist is indicated
- eye patch over affected eye can be useful if cause is benign[3]
More general terms
References
- ↑ Guide to Physical Examination & History Taking, 6th edition, Bates, B, JB Lippincott, Philadelphia, 1995, pg 35
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ 3.0 3.1 UpToDate, Online version 15.3 http://www.utdol.com
- ↑ 4.0 4.1 4.2 Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019