Chapter 21 – Diplopia. Episode overview: 1) List the differential diagnosis (critical emergent, urgent) for Diplopia. ▫ Including at least 7 causes of binocular. Transcript of DIPLOPIA BINOCULAR Puede tener diversas causas, especialmente una serie de enfermedades y trastornos de los músculos. Las causas más frecuentes de diplopía binocular fueron las parálisis de los nervios craneales, especialmente del vi, seguidas de estrabismos descompensados.

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Intermittent monocular diplopia often results from tear film insufficiency measured by early tear-film breakup time or Schirmer test. Dacryoadenitis Epiphora Dacryocystitis Xerophthalmia. Nevertheless, because the majority of the retinas correspond, these patients maintain peripheral fusion. The deviation either resolves within the next several days to weeks or evolves into a permanent restrictive strabismus.

Diplopia – Viquipèdia, l’enciclopèdia lliure

A complete third nerve palsy indicates total dysfunction of the EOMs and levator. If the patient can see singly fuse centrallythen this is a positive test indicating dragged-fovea diplopia syndrome. In addition, it is important to check for incorporated prism in glasses prior to any refractive surgery procedure, as patients may be unaware of its presence. With decompensated fourth diolopia palsy, due to the long- standing nature, the hypertropia may become more comitant with time. Preoperatively, the surgeon should pay attention to ocular history, cover testing, and Worth four-dot testing to assess for potential fixation switch diplopia in the refractive and cataract patient.

The pupil is described separately as spared or involved. Binocula, often worse in the morning, may start with complaints of irritation and blurry vision followed by slowly progressive binocular diplopia. Hemianopsia binasal bitemporal homonymous Quadrantanopia. Divergence insufficiency arises as a benign phenomenon with spontaneous resolution in many cases.

Corneal topography and hard-contact- lens refraction can detect an irregular corneal surface or contour. Patients typically complain of vertical diplopia in the early postoperative period and demonstrate a paresis of the involved EOM. Asthenopia Hemeralopia Photophobia Scintillating scotoma.


Partial third nerve palsy reveals variable degrees of dysfunction of the EOMs and levator. Complications of augmented superior rectus transposition in Other technical problems include scarring, under- or overcorrected refractive error, or an ablation zone smaller than the scotopic pupil.

One should consider a posterior communicating artery aneurysm in an adult with a new-onset third nerve palsy and pupillary involvement including relative pupil involvement. The medial longitudinal fasciculus MLF connects the sixth nerve nucleus on one side of the pons to fe contralateral medial rectus subnucleus in the midbrain. Neil MandavaEric D. KellyD H Haight Causzs of cataract and refractive surgery It can develop after head trauma, but often the cause is unknown.

Some patients may have relative pupil sparing where the affected pupil is larger 0. By using this site, you agree to the Terms of Use and Privacy Policy. The most frequent causes of binocular diplopia were cranial nerve palsies, especially the sixth cranial nerve, followed by decompensated strabismus.

First, patients with well- compensated intermittent strabismus eg, exophoria, congenital fourth nerve palsy are able to fuse images to eliminate diplopia. CiteScore measures average citations received per document published.

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Also, all lenses have some degree of prismatic power with eccentric viewing from the optical center proportional to the power of the lens. Monovision correction may render some patients diplopic by two mechanisms. Careful observation of the pupil will show constriction with attempted abduction.

The main treatment objective in patients with binocular diplopia is to create the largest and most central area of single binocular vision. Convergence Insufficiency and Paralysis Convergence insufficiency is a relatively common cause of diplopia at near in children and adults. Only one third of patients had a spontaneous resolution, and half of them did not have a good outcome despite of treatment. The ice test, sleep test, or neostigmine test can also be considered. Aetiology, diagnosis and treatment.


A complete, pupil-sparing third nerve palsy in a patient older than 50 with vasculopathic risk dkplopia does not necessitate neuroimaging.

Patients with significant ophthalmoplegia and incomitance generally do not fare cauzas with surgery. Retrieved 27 March Thyroid eye disease TED is a common cause of dr in adults. SRJ is a prestige metric based on the idea that not all citations are the same. Thus, those with childhood strabismus almost never complain of diplopia while adults who develop acusas almost always do. With normal neuroimaging, the clinician may consider lumbar puncture with opening pressure, especially if optic nerve edema is also present.

Lastly, scleral buckling can induce a myopic shift in the affected eye leading to anisometropia and aniseikonia. In addition bimocular a thorough ophthalmologic examination, specific attention should be directed to eyelid position, orbicularis oculi strength, facial sensation, and exophthalmometry.

The “lights on-off test” is a very reliable test for this syndrome. Thus, when the eyes are misaligned, two different objects will be perceived as superimposed in the same space.

Raised intracranial pressure can cause sixth nerve palsy presumably from mechanical stretching of the nerve; thus, many cases may actually have bilateral, but asymmetric, sixth nerve palsy. Skew Deviation Patients with skew deviation complain of vertical and occasionally torsional binocular diplopia.

Therefore, patients may note diploppia of diplopia initially central fusion with prism trials. There was a spontaneous resolution in Demyelination often causes INO in younger adults and microvascular infarction typically causes INO in elderly patients. From Wikipedia, the free encyclopedia.