Diplopia
Basics
Description
Description
- Double vision
- Simultaneous perception of 2 images
- Can be oriented horizontally, vertically, or diagonally from one another
- Two types: monocular (ophthalmologic causes) and binocular (neurologic causes)
- Binocular and sixth nerve palsies most common
- Diplopia is usually due to abnormal movement of the extraocular muscles (EOMs), which are innervated by 3 cranial nerves (CNs):
- CN 3 – superior, inferior, and medial rectus and inferior oblique muscles
- CN 4 – superior oblique muscle
- CN 6 – lateral rectus muscle
- Brainstem lesions can damage CN nuclei or their connections (medial longitudinal fasciculus, MLF), causing an internuclear ophthalmoplegia (INO)
- CN dysfunction:
- Compression as they traverse the subarachnoid space and venous sinuses
- Inflammation
- Elevation (or reduction) of CSF pressure can cause CN 6 palsy
- Disease affecting the orbits and the bony skull can cause restriction of motion of one or both eyes or EOMs
Etiology
Etiology
- Traumatic diplopia:
- Orbital fracture
- Contusions
- Hematoma
- Rarely brainstem contusion or hematoma
- Monocular diplopia:
- Nearly always due to an intrinsic eye problem
- Corneal surface keratoconus
- Subluxation of the lens
- Structural defect within the eye
- Functional disorders such as conversion disorder, factitious disorder, or somatization
- Nontraumatic binocular diplopia:
- Brain and brainstem dysfunction:
- Stroke
- Multiple sclerosis
- Cerebral cortical problems (e.g., migraine) are rare
- CN dysfunction:
- Aneurysm of posterior communicating artery (CN 3 palsy)
- Chronic lymphocytic meningitis (multiple CN deficits)
- Pseudotumor cerebri (CN 6 palsy)
- Low pressure (spontaneous intracranial hypotension) (CN 6 palsy)
- Bony skull and orbits:
- Tumor
- Thyroid disease
- Inflammation (Tolosa-Hunt)
- Neuromuscular junction (NMJ) of EOMs:
- Myasthenia gravis (MG)
- Brain and brainstem dysfunction:
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Citation
Schaider, Jeffrey J., et al., editors. "Diplopia." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307664/all/Diplopia.
Diplopia. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307664/all/Diplopia. Accessed December 10, 2024.
Diplopia. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307664/all/Diplopia
Diplopia [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 10]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307664/all/Diplopia.
* Article titles in AMA citation format should be in sentence-case
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