Materiały źródłowe

• #1 Diagnosing Double Vision | NYU Langone Health

  https://nyulangone.org/conditions/double-vision/diagnosis

  NYU Langone specialists are experts at diagnosing double vision, also called diplopia, in which a person sees two images instead of one. Our team of neurologists and neuro-ophthalmologists provides a thorough evaluation and develops a treatment plan for people experiencing double vision. […] To diagnose double vision, your doctor relies on your medical history, including your symptoms. Your doctor asks if you see a double image with both eyes open or with one closed and if closing one eye makes the double image disappear. […] NYU Langone specialists use several diagnostic tools to determine whether double vision has a neurological or mechanical cause. […] A series of painless tests helps your doctor evaluate your vision and determine if double vision is binocular or monocular and if your eyes are misaligned.

• #1 Basic Approach to Diplopia – EyeWiki

  https://eyewiki.org/Basic_Approach_to_Diplopia

  Diplopia is a common presentation to neurology, neuro-ophthalmology, ophthalmology, and general medicine. This article will outline an approach to understanding diplopia by highlighting key facts in the history and exam to guide further workup. […] The initial stage of diplopia workup is to identify whether it is monocular or binocular diplopia. […] Monocular diplopia persists when the unaffected eye is closed but will resolve when the affected eye is closed. Thus, the key and differentiating question between monocular and binocular diplopia is Does the double vision resolve with closing EITHER eye? […] Binocular diplopia resolves with either eye being closed and indicates ocular misalignment as an underlying problem. […] In binocular diplopia, key details to ascertain include those described below.

• #1 Double vision (Diplopia): Causes, treatments, and more

  https://www.medicalnewstoday.com/articles/170634

  Double vision occurs when a person sees a double image where there should only be one. […] This article looks at the causes, diagnosis, and treatment of double vision. […] Diagnosing double vision can be challenging for an eye specialist because there are many possible causes. […] The American Academy of Ophthalmology suggests the first step a specialist will take is asking whether the double vision is monocular or binocular. […] If the double vision is monocular, the problem is more likely to be within the eye rather than in the nerves. It is likely to be less serious. […] Treatment for double vision will usually depend on the underlying cause. […] Treatment varies depending on what is causing monocular double vision, including: […] Depending on the cause, the treatment for binocular vision varies. Treatments include:

• #1 Diplopia (Double Vision) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/double-vision

  Seeing double of the same image whether horizontal, vertical, or diagonal is called diplopia. […] Two types are monocular diplopia (affects one eye) and binocular diplopia (affects both eyes). […] An MRI may be the next step. […] Specialists at Yale Medicine are experts at evaluating double vision and, if necessary, performing surgery to correct it. […] Two main types of double vision exist: Monocular diplopia occurs when someone sees double vision with only one eye open, a second image usually appearing as a ghost. […] Binocular diplopia occurs when someone sees double vision only when both eyes are open. […] Dozens of medical conditions can lead to double vision. […] The doctor will perform a general examination, including a full eye exam. […] Doctors may order brain imaging usually magnetic resonance imaging (MRI) or blood testing to find the root cause of the double vision.

• #1 Double Vision (Diplopia) – Optometrists.org

  https://www.optometrists.org/vision-therapy/neuro-optometry/vision-and-brain-injuries/double-vision-diplopia/

  Each year, approximately 850,000 visits to the doctor and emergency room are associated with double vision. […] Double vision, medically termed diplopia, can be very worrisome. If you are seeing one object as two separate or overlapping images, you are experiencing double vision. […] Double vision can be temporary or long lasting. There are three different types of diplopia: Horizontal diplopia occurs when the two images are seen side by side. Vertical diplopia occurs when one image appears higher than the other. Monocular diplopia occurs in only one eye, and is noticed when the other eye is closed. […] Each eye creates an image that is sent to the brain for interpretation. The brain processes the visual information from each eye and combines them to produce a clear, single image. When a problem arises within this process, the brain cannot accurately interpret the two visual signals, and a double image can result.

• #1 Diagnostic Approach to Diplopia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10563939/

  This article offers a pragmatic roadmap to the practicing neurologist on how to approach the patient with double vision. […] Double vision, or diplopia, is a common visual concern that may be the first warning of vision-threatening or life-threatening neurologic disease. […] The evaluation of diplopia, using a detailed and targeted history, an examination of ocular alignment and motility, and, when appropriate, neuroimaging of the brain and orbits, is an essential skill for all practicing neurologists. […] With proper skills, the neurologist can elucidate the localization of diplopia, even in cases of complex ocular misalignment, and generate a management plan that can address the underlying disease, and, in many cases, ameliorate or cure the diplopia. […] Taking a careful history can often localize the site of anatomic dysfunction causing diplopia and, in some cases, even delineate the underlying disease process, before even examining the patient or obtaining any neuroimaging.

• #1 Double Vision (Diplopia) Causes, Symptoms, Tests & Treatment

  https://www.medicinenet.com/double_vision/article.htm

  Eye doctors (optometrists and ophthalmologists) can perform the assessment and treat underlying ocular diseases. The primary care doctor (family practitioner, internist, or pediatrician) is often involved when an underlying systemic is causing the double vision. In some cases, specialists such as neurologists, endocrinologists, and neurosurgeons may also be called upon to provide treatment. […] A thorough evaluation of double vision begins with a detailed history, including onset (gradual or sudden), duration, frequency (intermittent or constant), and variability with fatigue, head position, or direction of eye gaze, noting any associated symptoms (pain, headache, nausea, and weight loss among others) and other vision problems. […] Once the underlying cause has been determined, treatment is tailored to the underlying condition.

• #1 Double Vision Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/eyes-and-vision/double-vision/diagnosis.html

  Double vision can result from minor eye problems such as dry eyes. But, it can also be a symptom of a life-threatening neurological condition. Our eye experts work quickly to pinpoint the underlying causes of double vision so that we can begin emergency treatment immediately, if necessary. […] If you are experiencing double vision, its important to visit your eye care professional as soon as possible. At Stanford, our ophthalmologists begin with a thorough eye exam to assess the health of your eyes and the pattern of eye movement. […] Whats unique about Stanford is that we have the latest generation eye trackerthe most sophisticated testing availableto record eye movement to find the exact type of problem. […] Once our physicians confirm a diagnosis, we develop a treatment plan to address the underlying cause of your double vision.

• #1 Diagnostic Approach to Diplopia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10563939/

  A careful assessment of ocular motility is essential to localization and diagnosis of diplopia. […] In some cases, diplopia occurs in patients with full or near-full motility of both eyes but whose eyes are nevertheless misaligned. […] When the misalignment is present with both eyes open, it is called a heterotropia or tropia, but if it manifests only when stereo fusion is disrupted (eg, with unilateral eye closure), it is termed a heterophoria or phoria. […] The presence of a left oculomotor palsy and an ipsilateral abducens palsy is suggestive of either cavernous sinus syndrome or orbital apex syndrome. […] Double vision may be the first or only sign of diseases affecting the orbit, including thyroid eye disease, inflammatory disease, trauma, infection, neoplasm, and congenital myopathies.

• #1 Diagnosing Double Vision | NYU Langone Health

  https://nyulangone.org/conditions/double-vision/diagnosis

  If you have binocular double vision, your NYU Langone doctor may ask questions about your symptoms to determine if an underlying condition may be causing it. […] NYU Langone doctors recommend an MRI if they want a better view of the brain, eye socket, and spinal cord. […] If your doctor suspects that double vision is due to an underlying medical condition, such as Graves disease or Lyme disease, he or she may perform a blood test.

• #1 Diplopia (Double Vision) Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/1214490-workup

  Perform laboratory studies as indicated by aspects disclosed after a comprehensive history and physical examination with emphasis on ocular findings and neurologic screening. Laboratory studies may include anti-acetylcholine (ACh) antibody, antistriated muscle antibody, antimuscle-specific receptor tyrosine kinase (MuSK) antibody, low-density lipoprotein receptor-related protein 4 (LRP4) antibody, thyroid-stimulating hormone (TSH), free T4, thyroperoxidase antibody, and thyroid-stimulating hormone receptor antibody. […] The absence of antibodies does not rule out disease, and further testing may be elicited to rule out disease. About 9% of patients with myasthenia gravis are seronegative. […] Order CT scan or MRI (with contrast) of the skull and orbits to rule out intracranial masses or other pathologic processes, such as the following: A blow-out fracture, which requires imaging of the orbital floor; Enlarged muscles due to thyroid ophthalmopathy; Tumor of orbit; Tumor along cranial nerve pathway; Increased intracranial pressure can account for bilateral abducens palsy; Aneurysm of intracranial carotid artery; Carotid cavernous fistula: Angiography may be required to confirm the presence of a low-flow fistula; Disease of sinuses (eg, infection, tumor) or bony disorders (eg, dysostoses, encephalocele) can account for displacement of the eye.

• #1 Diplopia (Double Vision) Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/1214490-workup

  Traditional guidelines for imaging patients with new-onset diplopia include imaging all patients younger than 50 years with other neurologic findings, with a progressive course of diplopia, or with a history of cancer. […] For patients older than 50 years with vasculopathic risk factors, imaging is not always necessary during the initial evaluation. Physicians should conduct a careful review of the patient’s history to determine if imaging is medically indicated. […] The cover-uncover test can be used to detect heterotropias. […] The edrophonium (Tensilon) test can be performed to exclude myasthenia gravis, although it largely has been supplanted in the clinic by safer and less-invasive clinical tests (eg, sleep or rest test, ice test). […] Intravenous injection of a short-acting anticholinesterase (ie, 10 mg/mL edrophonium chloride [Tensilon]) should be part of the initial workup of a patient with diplopia. […] Single-fiber electromyography (EMG) can be used to detect myasthenia gravis in seronegative cases with isolated ocular findings. […] Single-fiber EMG is a highly sensitive test for detecting defects in the neuromuscular junction.

• #1 Top Causes of Double Vision

  https://www.reviewofoptometry.com/article/top-causes-of-double-vision

  Other differentials to consider that present with a variable pattern of diplopia include thyroid eye disease, Guillain-Barr syndrome, Parinaud syndrome, Miller-Fisher syndrome, trauma, Parinaud (dorsal midbrain) syndrome and Wernickes encephalopathy. […] A patient with GCA can present with any CN palsy. […] GCA should be ruled out in all patients who present with diplopia, especially those older than age 60. […] Urgent blood work should include complete blood count, c-reactive protein (CRP) and sedimentation rate (ESR). […] If the platelet count, CRP and ESR are elevated or GCA is suspected based on accompanying scalp tenderness, headache, fever and generalized malaise, clinicians should refer the patient for urgent treatment. […] Studies indicate that GCA is the underlying cause of diplopia in anywhere from 3% to 15% of presenting cases of diplopia with biopsy proven GCA, but the risk of morbidity and mortality is too high to miss this disease.

• #1 Top Causes of Double Vision

  https://www.reviewofoptometry.com/article/top-causes-of-double-vision

  MG is the classic neuromuscular junction disease that can become life threatening when it affects the muscles of respiration, causing respiratory failure. […] Approximately 50% to 60% of MG patients present with a ptosis and diplopia, and approximately 20% to 30% have localized ocular involvement. […] The most common age of onset is in the third decade for women and the seventh decade for men. […] Weakness of the medial rectus is fairly common, but diplopia can vary between horizontal, vertical and oblique. […] Patients report variable fatigue and ptosis of one or both eyelids that worsens with prolonged activity or toward the end of the day. […] However, MG can cause a fluctuating diplopia at any time of the day, even on waking. […] Several in-office tests are available to help support the diagnosis of MG.

• #1 Top Causes of Double Vision

  https://www.reviewofoptometry.com/article/top-causes-of-double-vision

  A patient presenting with diplopiawhether horizontal, vertical or diagonalis often a clinical challenge. […] Constant diplopia with acute onset will have different differentials than intermittent diplopia, for example. […] While the cause can be benign, some cases, such as those accompanied by new headache, ocular pain, unilateral pupil dilation, muscle weakness, ptosis, trauma or papilledema, raise red flags for immediate referral. […] Most etiologies will fall into one of five categories: (1) refractive, (2) binocular vision disorder, (3) orbital disease, (4) neuromuscular junction dysfunction, or (5) injury to the central nervous system/cranial nerves (CNs). […] A systematic approach to the differentials is key to identifying and treating benign causesand promptly referring patients when it is vision or life threatening.

• #1 Top Causes of Double Vision

  https://www.reviewofoptometry.com/article/top-causes-of-double-vision

  The first step on the path to proper identification is a thorough patient history. […] The clinician must determine if the diplopia is monocular or binocular, as binocular diplopia may have a life-threatening cause. […] Diplopia that persists when one eye is covered falls into the category of monocular diplopia, or polyopia (greater than two images). […] Clinicians should have the patient cover each eye separately when testing for monocular diplopia. […] This finding is rarely due to cortex lesion and is generally attributable to causes within the eye itself. […] Decreased vision due to uncorrected astigmatism, dry eye and tear film deficiencies, corneal pathology or scarring, iris abnormalities, lenticular changes, vitreal opacities and macular disease are all possible causes of monocular diplopia.

• #1 Basic Approach to Diplopia – EyeWiki

  https://eyewiki.org/Basic_Approach_to_Diplopia

  Binocular horizontal diplopia (images displaced horizontally) is usually due to disease of the medial or lateral rectus muscle, the neuromuscular junction, or the nerves supplying these muscles (e.g., cranial nerves [CN] III or VI). […] Vertical diplopia (images displaced vertically) can be due to involvement of extraocular muscles, the neuromuscular junction (e.g., myasthenia gravis), or cranial nerves (e.g., CN III, IV). […] The hallmark of monocular diplopia from refractive abnormalities is improvement with pinhole. Cerebral monocular diplopia is bilateral and rare. […] Binocular diplopia indicates ocular misalignment as an underlying problem. […] The efferent ocular motor pathway is divided into supranuclear, nuclear, and internuclear segments. […] In a vertical or horizontal gaze palsy, the first question to determine is whether the lesion is supranuclear or inter/infranuclear.

• #1 Approach to Double Vision in the ED — NUEM Blog

  https://www.nuemblog.com/blog/double-vision

  Giant cell arteritis (also known as temporal arteritis) is an important diagnosis to always consider in an elderly patient presenting with diplopia. […] Diplopia is a relatively rare presenting complaint in the Emergency Department, and it can portend a wide range of disease, from the benign to the emergent. […] A good history and physical exam are key to diagnosis. […] Use your physical exam and the presence of other neurologic signs and symptoms to try to localize the lesion and guide imaging choice. […] Screen for temporal arteritis in the 60 population. […] In patients presenting with diplopia, the first concern must be the possibility of stroke and the need to consider time-sensitive treatment with thrombolytics. […] If no associated signs or symptoms exists, evaluate the patient for an isolated CN palsy.

• #1 Sudden Double Vision? Visit ReFocus Eye Health

  https://www.refocuseyedoctors.com/services/eye-emergencies/understanding-sudden-double-vision/

  As a demyelinating disease, multiple sclerosis can disrupt nerve conduction, potentially affecting cranial nerves responsible for eye movement. […] Abnormal formations of blood vessels or brain masses can pressure nerves or brain areas linked to vision, manifesting as sudden diplopia. […] Injuries to the head can damage eye muscles, nerves, or brain structures that coordinate eye movements. […] Conditions such as meningitis or orbital cellulitis may cause inflammation around the eyes or brain, interfering with normal visual functions. […] In longstanding diabetes, cranial nerves particularly the third, fourth, or sixth may sustain damage, leading to double vision. […] High blood pressure can inflict vascular damage affecting nerves involved in eye movement, thus contributing to vision disturbances.

• #1 Sudden Double Vision? Visit ReFocus Eye Health

  https://www.refocuseyedoctors.com/services/eye-emergencies/understanding-sudden-double-vision/

  This autoimmune inflammation associated with thyroid dysfunction can impact eye muscles, sometimes resulting in sudden symptoms. […] Some individuals encounter neurological manifestations like double vision during migraine attacks. […] Certain medications or toxins, such as alcohol or benzodiazepines, may impair muscle coordination, contributing to diplopia. […] Trauma causing fractures around the eye socket can lead to muscle entrapment, affecting ocular alignment. […] Lesions or demyelination in the brainstem can disrupt pathways crucial for eye movements. […] Increased pressure within the skull can impact nerves and structures related to vision. […] Addressing sudden double vision requires a nuanced approach, with attention to both immediate safety and long-term health outcomes.

• #1 Top Causes of Double Vision

  https://www.reviewofoptometry.com/article/top-causes-of-double-vision

  Although less frequently, certain medications can cause binocular diplopia, such as anticonvulsants, selective serotonin reuptake inhibitor antidepressants, erectile dysfunction medications, migraine therapies and other medications with anticholinergic properties. […] Many antidepressants may aggravate the symptoms of a convergence insufficiency by affecting accommodation. […] Ocular motility and alignment testing may include the cover/uncover test, alternate cover test, Maddox rod and corneal light reflex. […] Horizontal diplopia, when the images are truly side-by-side, is suggestive of a medial or lateral rectus under action or restriction. […] Horizontal diplopia present only at near, and especially noted with prolonged near work, is more likely attributable to a convergence insufficiency, which can occur in children and adults idiopathically.

• #1 Diplopia: Diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8966821/

  Diplopia or double vision is the separation of images vertically, horizontally or obliquely and can be monocular or binocular in origin. […] Binocular diplopia is most commonly caused by ocular misalignment or strabismus that can be detected using simple clinical tests. […] All patients with diplopia of acute onset should be investigated urgently and those with a headache or pupillary involvement need to be referred for same-day urgent imaging. […] Diplopia secondary to microvascular causes on the other hand often spontaneously resolves within six months. […] Diplopia may be binocular or monocular and can be differentiated by asking the patient to close one eye. […] Acute onset of binocular diplopia is a red flag and needs to be investigated. […] A dilated pupil or severe headache associated with diplopia is an emergency and needs urgent imaging.

• #1 Diplopia: Diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8966821/

  Diplopia, especially of acute onset, is a red flag and the possibility of an underlying neurological cause should be strongly considered. […] A fixed dilated pupil associated with headache and diplopia is a neurosurgical emergency and necessitates urgent imaging. […] Urgent, same-day imaging should be sought for patients with a fixed dilated pupil, headache and diplopia.

• #1 Understanding Sudden Double Vision – Insight Vision Center Optometry

  https://www.insightvisionoc.com/primary-eye-care/eye-emergencies/understanding-sudden-double-vision/

  Understanding Sudden Double Vision Sudden double vision, or diplopia, occurs when an individual sees two images of a single object. This condition can affect one or both eyes and may arise suddenly, signaling underlying health issues. Immediate understanding and recognition of this phenomenon are vital for timely and effective intervention. […] Immediate medical attention should be sought if double vision develops suddenly, especially if accompanied by other symptoms like pain, headaches, or neurological signs such as slurred speech or muscle weakness. These could be indicative of serious conditions requiring urgent care. […] Timely diagnosis and appropriate treatment of double vision are crucial in preventing potential complications and permanent damage. Early intervention can often resolve underlying issues, restore normal vision, and improve overall quality of life.

• #2 Double Vision (Diplopia): What It Is, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/22203-diplopia-double-vision

  Double vision is usually a temporary issue, but it can also be a sign of more serious health conditions. […] Visit a healthcare provider or eye care specialist right away if you start seeing double. […] An eye care specialist will diagnose double vision and whats causing it. […] Which treatments youll need depends on whats causing diplopia. […] Double vision is usually a short-term issue. […] You shouldnt drive or do anything else that could hurt yourself or others while your vision is impaired. […] Double vision is always concerning, but you shouldnt assume the worst. […] If you have double vision more than once, or if it comes and goes, you could have transient (intermittent) diplopia. […] Diplopia can be the first sign of serious brain issues like strokes, and you shouldnt ignore it.

• #2 An Action Plan For Assessing Double Vision

  https://www.reviewofoptometry.com/article/an-action-plan-for-assessing-double-vision

  Determining the etiology of a patients complaint of double vision can be akin to a detective solving a mystery in a novel; it is best to approach the case in a stepwise fashion and ask the appropriate questions. Here, we present a four-step process with 20 questions to ask or consider during an eye exam when a patient presents with diplopia. […] This guide will help anatomically localize the cause of the diplopia and create a differential diagnosis. As the eye care provider goes through the exam, these questions will help determine if the cause is in the brain, nerve, junction between nerve and muscle or orbit. […] The first step to uncovering the etiology is to determine if the patient has true binocular diplopia. […] If the answer is yes, continue to question 2. […] If no, then the patient likely has true binocular diplopia, and you need to continue to Step 2.

• #2 Double Vision (Diplopia): Monocular, Binocular and Other Types

  https://www.allaboutvision.com/conditions/symptoms/diplopia/double-vision-types/

  There are several different types of diplopia (double vision), each classifying a slightly different form of the condition. Depending on the diagnosis, a patients double vision may be classified using more than one type. […] When a patient experiences double vision, the first thing a doctor will determine is whether its monocular or binocular diplopia. This can help indicate if the cause of double vision is related to a problem with the brain or within the eye itself and whether the underlying condition may be life-threatening. […] Monocular diplopia is when a person experiences double vision often as a ghost image even if one eye is closed. […] Unlike monocular diplopia, binocular or bilateral double vision affects both eyes and only occurs when both eyes are open. Misalignment of the eyes, the root cause of binocular diplopia, occurs when:

• #2 Diplopia: Diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8966821/

  Diplopia or double vision is the separation of images vertically, horizontally or obliquely and can be monocular or binocular in origin. […] Binocular diplopia is most commonly caused by ocular misalignment or strabismus that can be detected using simple clinical tests. […] All patients with diplopia of acute onset should be investigated urgently and those with a headache or pupillary involvement need to be referred for same-day urgent imaging. […] Diplopia secondary to microvascular causes on the other hand often spontaneously resolves within six months. […] Diplopia may be binocular or monocular and can be differentiated by asking the patient to close one eye. […] Acute onset of binocular diplopia is a red flag and needs to be investigated. […] A dilated pupil or severe headache associated with diplopia is an emergency and needs urgent imaging.

• #2 An Action Plan For Assessing Double Vision

  https://www.reviewofoptometry.com/article/an-action-plan-for-assessing-double-vision

  A patient with intermittent or fluctuating diplopia can make the diagnosis more challenging because you may not be able to elicit the diplopia while in the exam room. […] We now need to determine the pattern of diplopia in order to localize the problem and narrow down our differential diagnoses. […] Many presentations of diplopia will have the same misalignment at all distances. […] If the cause of the diplopia is paretic, the diplopia will be worse in the direction of the paresis. […] Many patients presenting with diplopia may have risk factors for a vasculopathic etiology, such as diabetes, hypertension and smoking. […] This question will give the provider insight to any precipitating factor (i.e., trauma or stroke). […] If the patient has a history of being treated for strabismus or strabismic amblyopia as a child, such as with patching, this may indicate that they are now experiencing a decompensating phoria resulting in diplopia.

• #2 Top Causes of Double Vision

  https://www.reviewofoptometry.com/article/top-causes-of-double-vision

  Medications (e.g., antidepressants, antihistamines, diuretics) may contribute to ocular surface dryness and induce a monocular diplopia. […] Unlike monocular diplopia, binocular diplopia, due to ocular misalignment, will disappear when either eye is covered. […] The type of diplopia the patient complains ofhorizontal, vertical or diagonal; worse at distance or near; increased or decreased in a particular gaze positionhelps to identify which extraocular muscle is involved. […] A thorough systemic health history and step-by-step examination is key to localizing most underlying etiologies. […] A systemic health history should include questions regarding trauma, diabetes, hypertension, thyroid disease, cancer, infection and immunosuppressionall of which could cause CN palsies and diplopia through vascular or restrictive mechanisms.

• #2 Double Vision and Eye Movement Abnormalities – Clinical Services – Robert Cizik Eye Doctors Clinic

  https://www.cizikeyedoctors.org/clinical-services/double-vision-and-eye-movement-abnormalities

  Eye movement disorders, including double vision, can be caused by a range of conditions, including problems in the eye, muscles, nerves, or brain. […] Your ophthalmologist will discuss your symptoms, conduct a full eye exam, and determine the appropriate diagnostic tests. […] A blood test might be ordered, and imaging tests, such as a CT or MRI scan might be performed. […] Eye movement tests provide significant information about vision.

• #2 Top Causes of Double Vision

  https://www.reviewofoptometry.com/article/top-causes-of-double-vision

  Although less frequently, certain medications can cause binocular diplopia, such as anticonvulsants, selective serotonin reuptake inhibitor antidepressants, erectile dysfunction medications, migraine therapies and other medications with anticholinergic properties. […] Many antidepressants may aggravate the symptoms of a convergence insufficiency by affecting accommodation. […] Ocular motility and alignment testing may include the cover/uncover test, alternate cover test, Maddox rod and corneal light reflex. […] Horizontal diplopia, when the images are truly side-by-side, is suggestive of a medial or lateral rectus under action or restriction. […] Horizontal diplopia present only at near, and especially noted with prolonged near work, is more likely attributable to a convergence insufficiency, which can occur in children and adults idiopathically.

• #2 Diplopia (Double Vision): Monocular and Binocular Causes and Treatment

  https://www.healthline.com/health/diplopia

  Diplopia causes you to see two images of one object. This condition is commonly called double vision. Typically, this vision problem is the result of an underlying condition. Identifying and treating the cause can help you recover your eyesight and stop other symptoms from occurring. […] Once your doctor identifies which type of double vision you have, they can start looking for the cause. […] Double vision always requires a doctors evaluation to determine the cause. Double vision is a symptom of something abnormal going on within your eye, brain, or nervous system. The problem needs a complete evaluation in order to uncover the cause. […] Diagnosing double vision as monocular or binocular is usually straightforward. Determining the cause may be more difficult. If you have double vision, your symptoms and vision experiences will aid in the diagnosis.

• #2 Double Vision Symptoms, Diagnosis & Treatment | Pacific Eye & Ear Center

  https://www.pacificneuroscienceinstitute.org/eye-ent/vision/conditions-treatments/double-vision/

  Many conditions may cause double vision (diplopia) such as: […] Double vision, medically known as diplopia, is a visual condition where a person sees two overlapping images of a single object instead of the normal single, fused image. […] If double vision occurs when only one eye is open, it generally is due to eye problems such as astigmatism, corneal irregularity or cataract, but if double vision persists when both eyes open, but resolves when looking with only one eye, the cause may be orbital, muscular or neurological. […] Diagnostic evaluation will include eye examination, sensorimotor examination and may include orbital ultrasound evaluation. Additional diagnostic studies may be indicated, including blood tests, CT or MRI.

• #2 Diplopia (Double Vision) Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/1214490-workup

  Perform laboratory studies as indicated by aspects disclosed after a comprehensive history and physical examination with emphasis on ocular findings and neurologic screening. Laboratory studies may include anti-acetylcholine (ACh) antibody, antistriated muscle antibody, antimuscle-specific receptor tyrosine kinase (MuSK) antibody, low-density lipoprotein receptor-related protein 4 (LRP4) antibody, thyroid-stimulating hormone (TSH), free T4, thyroperoxidase antibody, and thyroid-stimulating hormone receptor antibody. […] The absence of antibodies does not rule out disease, and further testing may be elicited to rule out disease. About 9% of patients with myasthenia gravis are seronegative. […] Order CT scan or MRI (with contrast) of the skull and orbits to rule out intracranial masses or other pathologic processes, such as the following: A blow-out fracture, which requires imaging of the orbital floor; Enlarged muscles due to thyroid ophthalmopathy; Tumor of orbit; Tumor along cranial nerve pathway; Increased intracranial pressure can account for bilateral abducens palsy; Aneurysm of intracranial carotid artery; Carotid cavernous fistula: Angiography may be required to confirm the presence of a low-flow fistula; Disease of sinuses (eg, infection, tumor) or bony disorders (eg, dysostoses, encephalocele) can account for displacement of the eye.

• #2 Top Causes of Double Vision

  https://www.reviewofoptometry.com/article/top-causes-of-double-vision

  As with CN VI palsies, microangiopathy is the major cause of a CN IV palsy in patients older than 50. […] A complete oculomotor palsy results in complete ptosis, a mid-dilated pupil and an eye that appears down and out. […] Patients report an oblique diplopia when the eyelid is lifted. […] Any CN III palsy needs immediate imaging, including CTA or MRA, as compression from an aneurysm of the posterior communicating artery is the most common etiology of a complete palsy with pupil involvement and is life threatening. […] Ischemic or microvascular causes are more common, and the diplopia often improves during the recovery from the event. […] The presence of pain may occur in both scenarios but does not help to differentiate between them. […] However, most CN III palsies are not complete, and clinicians must use cover testing to catch a subtle signs.

• #2 Approach to Double Vision in the ED — NUEM Blog

  https://www.nuemblog.com/blog/double-vision

  Giant cell arteritis (also known as temporal arteritis) is an important diagnosis to always consider in an elderly patient presenting with diplopia. […] Diplopia is a relatively rare presenting complaint in the Emergency Department, and it can portend a wide range of disease, from the benign to the emergent. […] A good history and physical exam are key to diagnosis. […] Use your physical exam and the presence of other neurologic signs and symptoms to try to localize the lesion and guide imaging choice. […] Screen for temporal arteritis in the 60 population. […] In patients presenting with diplopia, the first concern must be the possibility of stroke and the need to consider time-sensitive treatment with thrombolytics. […] If no associated signs or symptoms exists, evaluate the patient for an isolated CN palsy.

• #2 Diplopia (Double Vision) Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/1214490-workup

  Traditional guidelines for imaging patients with new-onset diplopia include imaging all patients younger than 50 years with other neurologic findings, with a progressive course of diplopia, or with a history of cancer. […] For patients older than 50 years with vasculopathic risk factors, imaging is not always necessary during the initial evaluation. Physicians should conduct a careful review of the patient’s history to determine if imaging is medically indicated. […] The cover-uncover test can be used to detect heterotropias. […] The edrophonium (Tensilon) test can be performed to exclude myasthenia gravis, although it largely has been supplanted in the clinic by safer and less-invasive clinical tests (eg, sleep or rest test, ice test). […] Intravenous injection of a short-acting anticholinesterase (ie, 10 mg/mL edrophonium chloride [Tensilon]) should be part of the initial workup of a patient with diplopia. […] Single-fiber electromyography (EMG) can be used to detect myasthenia gravis in seronegative cases with isolated ocular findings. […] Single-fiber EMG is a highly sensitive test for detecting defects in the neuromuscular junction.

• #2 Differential Diagnosis of Diplopia

  https://ddxof.com/diplopia/

  38F with no medical history, presenting with double vision. […] The patient represented due to persistent diplopia that is worse with right gaze. […] Examination notable for right hypertropia increased on right or downward gaze suggestive of isolated inferior rectus weakness. […] Further evaluation included CXR and CT chest with intravenous contrast which did not identify a mediastinal mass. […] On hospital day one, an edrophonium test was performed which was positive. […] The patient was started on pyridostigmine, completed a course of IVIG and was discharged with outpatient neurology follow-up. […] Algorithm for the Evaluation of Diplopia. […] Causes of Diplopia. […] Myasthenia gravis Fatigability, ice test.

• #2 How To Diagnose Double Vision – with Downloadable Flowchart!

  https://eyesoneyecare.com/resources/how-to-diagnose-double-vision-with-downloadable-flowchart/

  Get ready to tackle any double vision cases that walk into your exam room. Use this guide, with a comprehensive downloadable flowchart, to learn the latest on diagnosing diplopia. […] Diagnosing the cause of new onset diplopia can be daunting. It can be doubly challenging if you are not familiar with or have forgotten common causes of it. This flowchart serves to re-acquaint you with common causes of diplopia and help streamline your clinical thought process and decision making when presented with unexpected double vision in the exam room. […] Correctly diagnosing diplopia always starts with taking a good clinical history. Be sure to determine that the patient has true diplopia and not a masquerader such as ghosting or blurry vision. Once you have determined they are in fact presenting with diplopia, the best initial question to ask is Does the double vision go away when you cover one eye? If the answer is no, then they have a monocular cause of diplopia.

• #2 Basic Approach to Diplopia – EyeWiki

  https://eyewiki.org/Basic_Approach_to_Diplopia

  Binocular horizontal diplopia (images displaced horizontally) is usually due to disease of the medial or lateral rectus muscle, the neuromuscular junction, or the nerves supplying these muscles (e.g., cranial nerves [CN] III or VI). […] Vertical diplopia (images displaced vertically) can be due to involvement of extraocular muscles, the neuromuscular junction (e.g., myasthenia gravis), or cranial nerves (e.g., CN III, IV). […] The hallmark of monocular diplopia from refractive abnormalities is improvement with pinhole. Cerebral monocular diplopia is bilateral and rare. […] Binocular diplopia indicates ocular misalignment as an underlying problem. […] The efferent ocular motor pathway is divided into supranuclear, nuclear, and internuclear segments. […] In a vertical or horizontal gaze palsy, the first question to determine is whether the lesion is supranuclear or inter/infranuclear.

• #2 Top Causes of Double Vision

  https://www.reviewofoptometry.com/article/top-causes-of-double-vision

  Convergence insufficiency can occur after trauma, in neurodegenerative diseases such as Parkinsons disease and with medications that have an anti-cholinergic effect on accommodation. […] Differential diagnosis for horizontal diplopia at distance includes unilateral or bilateral CN VI palsy, internuclear ophthalmoplegia (INO), age-related decompensating esophoria or muscle restriction, most commonly from thyroid disease, a space occupying lesion or myasthenia gravis (MG). […] Vertical diplopia assessment involves the four remaining muscles: the superior and inferior recti and the superior and inferior oblique. […] Some diseases may cause variable patterns of horizontal, vertical and oblique diplopia throughout the day. […] Diplopia that varies throughout the day, improves with rest and may have an associated ptosis is highly suggestive of MG as the underlying cause.

• #2 Sudden Double Vision? Visit ReFocus Eye Health

  https://www.refocuseyedoctors.com/services/eye-emergencies/understanding-sudden-double-vision/

  Sudden double vision, or diplopia, occurs when an individual sees two images of a single object. […] Immediate medical attention should be sought if double vision develops suddenly, especially if accompanied by other symptoms like pain, headaches, or neurological signs such as slurred speech or muscle weakness. […] Timely diagnosis and appropriate treatment of double vision are crucial in preventing potential complications and permanent damage. […] Sudden double vision, medically termed diplopia, can be alarming for both patients and their families. […] An interruption in blood flow to the brain can impact regions controlling eye movement, leading to sudden diplopia. […] This autoimmune disorder induces muscle weakness, including that of muscles involved in eye movements, leading to fluctuating double vision.

• #2 Sudden Double Vision? Visit ReFocus Eye Health

  https://www.refocuseyedoctors.com/services/eye-emergencies/understanding-sudden-double-vision/

  As a demyelinating disease, multiple sclerosis can disrupt nerve conduction, potentially affecting cranial nerves responsible for eye movement. […] Abnormal formations of blood vessels or brain masses can pressure nerves or brain areas linked to vision, manifesting as sudden diplopia. […] Injuries to the head can damage eye muscles, nerves, or brain structures that coordinate eye movements. […] Conditions such as meningitis or orbital cellulitis may cause inflammation around the eyes or brain, interfering with normal visual functions. […] In longstanding diabetes, cranial nerves particularly the third, fourth, or sixth may sustain damage, leading to double vision. […] High blood pressure can inflict vascular damage affecting nerves involved in eye movement, thus contributing to vision disturbances.

• #2 Diplopia (Double Vision) Differential Diagnoses

  https://emedicine.medscape.com/article/1214490-differential

  Several commonly prescribed medications can cause diplopia through various mechanisms including CNS disturbance of ocular alignment or motility, impairment of ciliary muscle accommodation and convergence, or mechanical impairment of extraocular muscle movements such as tendonitis caused by fluoroquinolone antibiotics. […] Table. Drugs Associated with Diplopia […] A-Pattern Esotropia and Exotropia […] Abducens Nerve Palsy (Sixth Cranial Nerve Palsy) […] Accommodative Esotropia […] Acquired Esotropia […] Acquired Exotropia […] Amblyopia […] Aniridia […] Astigmatic Keratotomy for the Correction of Astigmatism […] Botulism […] Brown Syndrome […] Orbital Cavernous Hemangioma […] Chronic Progressive External Ophthalmoplegia (CPEO) […] Refractive Lens Exchange (Clear Lens Extraction) for Myopia Correction

• #2 Diplopia: Diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8966821/

  Diplopia, especially of acute onset, is a red flag and the possibility of an underlying neurological cause should be strongly considered. […] A fixed dilated pupil associated with headache and diplopia is a neurosurgical emergency and necessitates urgent imaging. […] Urgent, same-day imaging should be sought for patients with a fixed dilated pupil, headache and diplopia.

• #2 Top Causes of Double Vision

  https://www.reviewofoptometry.com/article/top-causes-of-double-vision

  In addition, all patients with a new onset diplopia and a history of cancer require urgent imaging studies to rule out a metastatic lesion. […] Researchers have debated the use of imaging in all CN palsies for some time, and most agree those with an acute isolated CN III palsy need urgent imaging to rule out a compressive aneurysm or suspected cavernous sinus thrombosis. […] Imaging of the brain and orbits is appropriate in suspected retro-bulbar mass, TED or orbital trauma. […] In patients older than 60, referral for urgent bloodwork is indicated to rule out GCA.

• #2 Managing TMJ-Induced Double Vision: Treatment Options in Bend – Kelley Mingus

  https://kelleymingus.com/managing-tmj-induced-double-vision-treatment-options-in-bend/

  Temporomandibular joint, or TMJ, dysfunction can lead to a range of symptoms, including pain in the jaw and face, headaches, and even double vision. Anyone experiencing double vision, as a result of TMJ, should seek prompt diagnosis and effective treatment. […] Double vision, or diplopia, occurs when both eyes are misaligned, causing overlapping images and can be a major issue. […] If it is found that the patient has TMJ-induced double vision, the endodontist may recommend various treatment options including physical therapy, appliance therapy, and medication. […] An ophthalmologist is ideally trained to assist with the diagnosis and management of TMJ-induced double vision. […] Once seeing an ophthalmologist the patient will undergo various tests such as a comprehensive eye examination and a computerized evaluation of the visual system, known aptly as a synoptophore.

• #2 An Action Plan For Assessing Double Vision

  https://www.reviewofoptometry.com/article/an-action-plan-for-assessing-double-vision

  Careful assessment of ocular motilities frequently helps with localization. […] This is one of the most helpful in-office tests in localizing a lesion causing diplopia. […] The presence of multiple CN involvement is more suggestive of a neurological etiology and can help with the localization of the lesion. […] A yes to this question may indicate a systemic etiology and should prompt an urgent work-up. […] The etiology of the diplopia may be secondary to an underlying systemic condition, so it is important to obtain a thorough history of known conditions, even if the patient has already been treated or is in remission. […] The practitioner should now be able to determine if the etiology is localized in the brain, nerve, junction or orbit. […] Generally, any acute-onset diplopia that shows any other abnormalities on exam (i.e., multiple CN involvement, proptosis, pain, significant systemic history) warrants urgent additional testing. […] The most important thing an eye care provider can do for a patient with diplopia is to rule out any underlying systemic conditions or potential lesions causing their symptoms.

• #2 Diplopia (Double Vision): Monocular and Binocular Causes and Treatment

  https://www.healthline.com/health/diplopia

  Once you have a diplopia diagnosis, the work of finding a cause begins. To do this, your doctor will likely perform three types of testing: […] Before deciding on a treatment, its important you and your doctor find the cause of the vision problem. In many cases, vision issues can go away once you correct or treat the underlying issue. […] People with double vision often make a full recovery. Some people will recover with minimal treatment depending on the cause. Others may need more care, but still experience a full recovery once your doctor identifies the problem.

• #3 Double Vision Symptoms, Diagnosis & Treatment | Pacific Eye & Ear Center

  https://www.pacificneuroscienceinstitute.org/eye-ent/vision/conditions-treatments/double-vision/

  Many conditions may cause double vision (diplopia) such as: […] Double vision, medically known as diplopia, is a visual condition where a person sees two overlapping images of a single object instead of the normal single, fused image. […] If double vision occurs when only one eye is open, it generally is due to eye problems such as astigmatism, corneal irregularity or cataract, but if double vision persists when both eyes open, but resolves when looking with only one eye, the cause may be orbital, muscular or neurological. […] Diagnostic evaluation will include eye examination, sensorimotor examination and may include orbital ultrasound evaluation. Additional diagnostic studies may be indicated, including blood tests, CT or MRI.

• #3 Diplopia (Double Vision) Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/1214490-workup

  Traditional guidelines for imaging patients with new-onset diplopia include imaging all patients younger than 50 years with other neurologic findings, with a progressive course of diplopia, or with a history of cancer. […] For patients older than 50 years with vasculopathic risk factors, imaging is not always necessary during the initial evaluation. Physicians should conduct a careful review of the patient’s history to determine if imaging is medically indicated. […] The cover-uncover test can be used to detect heterotropias. […] The edrophonium (Tensilon) test can be performed to exclude myasthenia gravis, although it largely has been supplanted in the clinic by safer and less-invasive clinical tests (eg, sleep or rest test, ice test). […] Intravenous injection of a short-acting anticholinesterase (ie, 10 mg/mL edrophonium chloride [Tensilon]) should be part of the initial workup of a patient with diplopia. […] Single-fiber electromyography (EMG) can be used to detect myasthenia gravis in seronegative cases with isolated ocular findings. […] Single-fiber EMG is a highly sensitive test for detecting defects in the neuromuscular junction.

• #3 Top Causes of Double Vision

  https://www.reviewofoptometry.com/article/top-causes-of-double-vision

  Other differentials to consider that present with a variable pattern of diplopia include thyroid eye disease, Guillain-Barr syndrome, Parinaud syndrome, Miller-Fisher syndrome, trauma, Parinaud (dorsal midbrain) syndrome and Wernickes encephalopathy. […] A patient with GCA can present with any CN palsy. […] GCA should be ruled out in all patients who present with diplopia, especially those older than age 60. […] Urgent blood work should include complete blood count, c-reactive protein (CRP) and sedimentation rate (ESR). […] If the platelet count, CRP and ESR are elevated or GCA is suspected based on accompanying scalp tenderness, headache, fever and generalized malaise, clinicians should refer the patient for urgent treatment. […] Studies indicate that GCA is the underlying cause of diplopia in anywhere from 3% to 15% of presenting cases of diplopia with biopsy proven GCA, but the risk of morbidity and mortality is too high to miss this disease.

• #3 Understanding Sudden Double Vision – Insight Vision Center Optometry

  https://www.insightvisionoc.com/primary-eye-care/eye-emergencies/understanding-sudden-double-vision/

  Understanding Sudden Double Vision Sudden double vision, or diplopia, occurs when an individual sees two images of a single object. This condition can affect one or both eyes and may arise suddenly, signaling underlying health issues. Immediate understanding and recognition of this phenomenon are vital for timely and effective intervention. […] Immediate medical attention should be sought if double vision develops suddenly, especially if accompanied by other symptoms like pain, headaches, or neurological signs such as slurred speech or muscle weakness. These could be indicative of serious conditions requiring urgent care. […] Timely diagnosis and appropriate treatment of double vision are crucial in preventing potential complications and permanent damage. Early intervention can often resolve underlying issues, restore normal vision, and improve overall quality of life.

• #3 How To Diagnose Double Vision – with Downloadable Flowchart!

  https://eyesoneyecare.com/resources/how-to-diagnose-double-vision-with-downloadable-flowchart/

  Get ready to tackle any double vision cases that walk into your exam room. Use this guide, with a comprehensive downloadable flowchart, to learn the latest on diagnosing diplopia. […] Diagnosing the cause of new onset diplopia can be daunting. It can be doubly challenging if you are not familiar with or have forgotten common causes of it. This flowchart serves to re-acquaint you with common causes of diplopia and help streamline your clinical thought process and decision making when presented with unexpected double vision in the exam room. […] Correctly diagnosing diplopia always starts with taking a good clinical history. Be sure to determine that the patient has true diplopia and not a masquerader such as ghosting or blurry vision. Once you have determined they are in fact presenting with diplopia, the best initial question to ask is Does the double vision go away when you cover one eye? If the answer is no, then they have a monocular cause of diplopia.

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