Advertisement

Diplopia

  • Linus D. SunEmail author
Chapter

Abstract

Double vision is a common neuro-ophthalmic symptom for which the underlying etiology can vary from simple to emergency. Determining the diagnosis can be straightforward to challenging. This chapter provides an overview of the approach to the patient with double vision from the perspective of an internist, and we will cover common and some less common diagnoses which will be in the differential diagnosis for the neuro-ophthalmologist. Anatomic locations for the pathologies of diplopia can span the anterior surface of the eye to the occipital cortex. In the past binocular diplopia (i.e. strabismus) was described as underaction or overaction of the extraocular muscles, however our understanding of the mechanisms of action are emerging that go beyond this description. For details on the neuroanatomical pathways that may cause double vision, primary source and review articles are referenced at the end of this chapter.

Keywords

Diplopia Double vision Binocular diplopia Oculomotor pathway lesions Strabismus and eye movement abnormalities Oculomotor nerve palsies Horizontal binocular diplopia Monocular diplopia Anisometropia 

Suggested Reading

  1. Evaluation and management of diplopia – clinical education focal point excerpt. Am Acad Ophthalmol. https://www.aao.org/focalpointssnippetdetail.aspx?id=8eb21322-ab3c-49f9-a772-b9ba8bd9783f.
  2. Horn AKE, Adamczyk C. Chapter 9 – Reticular formation: eye movements, gaze and blinks. In: The human nervous system, vol. 3. 3rd ed. Amsterdam: Elsevier Academic Press; 2012.Google Scholar
  3. Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009;40(11):3504–10.Google Scholar
  4. Kattah JC. Update on HINTS Plus, with discussion of pitfalls and pearls. J Neurol Phys Ther. 2019;43(2):S42–5.CrossRefGoogle Scholar
  5. Krauzlis RJ. Chapter 32: Eye movements. In: Fundamental neuroscience. 4th ed. Amsterdam: Elsevier/Academic Press; 2013.Google Scholar
  6. Leigh RJ, Zee DS. The neurology of eye movements, Contemporary neurology series. 5th ed. New York: Oxford University Press; 2015. (HIGHLY RECOMMENDED REFERENCE GUIDE).Google Scholar
  7. Purvin VA, Kawasaki A. Common neuro-ophthalmic pitfalls: case-based teaching. Cambridge: Cambridge University Press; 2009. (HIGHLY RECOMMENDED).CrossRefGoogle Scholar
  8. Rutar T, Demer JL. “Heavy Eye” syndrome in the absence of high myopia: a connective tissue degeneration in elderly strabismic patients. J AAPOS. 2009;13(1):36–44.CrossRefGoogle Scholar
  9. Schoser BG. Ocular myositis: diagnostic assessment, differential diagnoses, and therapy of a rare muscle disease – five new cases and review. Clin Ophthalmol. 2007;1(1):37–42.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Ophthalmology, Edward S. Harkness Eye InstituteColumbia University Vagelos College of Physicians and SurgeonsNew YorkUSA

Personalised recommendations