II. History

  1. Monocular or binocular
    1. Does it resolve with either eye covered
      1. Test by covering each eye separately
    2. Monocular Diplopia is due to tears, Cornea or lens
      1. Emergent evaluation is not needed
  2. Timing red flags
    1. Is it new?
    2. Is it constant?
  3. Does it get worse as the day progresses?
    1. Intermittent esotropia
    2. Myasthenia Gravis
    3. Decompensated congenital strabsismus
  4. Is the Diplopia vertical, horizontal or both?
    1. Vertical
      1. Third nerve palsy
      2. Fourth nerve palsy
      3. Graves Ophthalmopathy
      4. Myasthenia Gravis
    2. Horizontal
      1. Sixth nerve palsy
      2. Congenital Strabismus
      3. Papilledema
  5. Is the Diplopia the same in all directions?
    1. Distinguishes incomitant vs comitant strabsimus
  6. Is there a childhood history of Strabismus?
    1. Untreated childhood Strabismus persists
  7. Is there a comorbid condition (e.g. Diabetes)
    1. Consider microvascular Cranial Nerve palsy
  8. Are there changes in speech or swallowing?
    1. Myasthenia Gravis
    2. Temporal Arteritis
    3. Brainstem ischemia
  9. Is there Vision Loss, Headache, or jaw pain?
    1. Temporal Arteritis
  10. Dizziness, Ataxia, whooshing sound, metal taste?
    1. Increased Intracranial Pressure

III. Causes: Urgent

  1. Aneurysm (Posterior Communicating Artery)
    1. Worst Headache
    2. Third nerve palsy (Ptosis, eye is down and out)
    3. Mydriasis may be present
  2. Temporal Arteritis
    1. Fever, Night Sweats, Jaw Claudication
    2. Sixth Cranial Nerve palsy may occur
    3. Associated with Polymyalgia Rheumatica
  3. Increased Intracranial Pressure
    1. Headache, Ataxia, Nausea, whooshing sound in ear
    2. Metallic Taste in mouth
    3. Esotropia or sixth Cranial Nerve palsy
    4. Causes: Mass lesions, Pseudotumor Cerebri
  4. Multiple cranial Neuropathy
    1. Brainstem cause or
    2. Cavernous Sinus process
  5. Trauma
    1. Blowout Fracture of orbit
    2. Orbital Congestion
    3. Neurological injury/lesion

IV. Causes: Non-urgent

  1. Cranial Nerve palsy
    1. Third nerve palsy (Image and refer to eye and neuro)
    2. Sixth nerve palsy
      1. May be associated with Head Tilt
  2. Incomitant Strabismus (not same in all gaze directions)
    1. Graves Ophthalmopathy (restricted EOM)
  3. Comitant Strabismus (same in all gaze directions)
    1. Childhood Strabismus
    2. Increased Intracranial Pressure
    3. Intermittent exotropia
    4. Accomodative esotropia

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Ontology: Diplopia (C0012569)

Definition (NCI) The condition in which a single object appears as two objects. Also called "double vision." (from medterms.com)
Definition (MSH) A visual symptom in which a single object is perceived by the visual cortex as two objects rather than one. Disorders associated with this condition include REFRACTIVE ERRORS; STRABISMUS; OCULOMOTOR NERVE DISEASES; TROCHLEAR NERVE DISEASES; ABDUCENS NERVE DISEASES; and diseases of the BRAIN STEM and OCCIPITAL LOBE.
Concepts Finding (T033)
MSH D004172
ICD9 368.2
ICD10 H53.2
SnomedCT 139545001, 162276002, 155141003, 24982008
LNC LA15082-3
English Double Vision, Vision, Double, DIPLOPIA, VISION DOUBLE, diplopia, double vision, diplopia (symptom), seeing double, seeing double images (diplopia), Vision double, Diplopias, Diplopia [Disease/Finding], Diplopia (finding), Double vision, Seeing double, Diplopia (disorder), double vision; vision, vision; double vision, Diplopia
French DIPLOPIE, DEDOUBLEMENT DE LA VISION, Diplopie, Vision double
Portuguese DIPLOPIA, VISAO DUPLA, Visão dupla, Poliopia, Diplopia, Visão Dupla
Spanish DIPLOPIA, VISION DOBLE, Visión doble, Poliopia, diplopía (trastorno), diplopía, visión doble, Visión Doble, Diplopía
Dutch dubbelzicht, dubbelzien; visus, visus; dubbelzien, diplopie, Diplopie, Dubbelzien
Swedish Dubbelseende
Japanese フクシ, 複視, 二重視
Czech diplopie, Dvojité vidění, Diplopie, dvojité vidění
Finnish Diplopia
Russian POLIOPSIIA, DIPLOPIIA, ДИПЛОПИЯ, ПОЛИОПСИЯ
German DOPPELBILDERSEHEN, DOPPELTSEHEN, Diplopie, Doppeltsehen, Doppelbilder
Italian Visione doppia, Diplopia
Korean 복시
Polish Widzenie podwójne
Hungarian Kettőslátás
Norwegian Diplopi, Dobbeltsyn