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Diplopia is a topic covered in the 5-Minute Emergency Consult.

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  • Double vision
    • Simultaneous perception of 2 images
    • Can be oriented horizontally, vertically, or diagonally from one another.
  • 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


  • 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)

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Rosen, Peter, et al., editors. "Diplopia." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307664/all/Diplopia.
Diplopia. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307664/all/Diplopia. Accessed April 26, 2019.
Diplopia. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307664/all/Diplopia
Diplopia [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. 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
TY - ELEC T1 - Diplopia ID - 307664 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307664/all/Diplopia PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -