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[Diplopia: from symptom to diagnosis]
1Abteilung Orthoptik, Neuroophthalmologie und Kinderophthalmologie, Universitäts-Augenklinik, Basel.
Background:
This overview gives a rough frame how to proceed to a quick diagnosis and possible differential diagnosis in patients with diplopia.
Method:
A thorough interview concerning the onset of symptoms, invariability, and subjective perception is mandatory. The first step before examining ocular motility is to verify monocular or binocular double vision. When the reported diplopia is binocular, the examiner can carry out the red-glass test to determine the site of the double image. In a next step monocular range of movement in the 9 directions of gaze is evaluated to search for incomitance.
Results:
The main causes of diplopia are palsies of the oculomotor nerves, mechanical restriction--posttraumatic or inflammatory--, supranuclear lesions and disturbed neuromuscular junction.
Conclusion:
With a simple and clear diagnostic diagram ist is easy to work out the underlying cause of diplopia.