Diplopia
- This is mostly an approach to isolated diplopia
- Monocular diplopia = refraction problem
| Binocular diplopia | |
|---|---|
| History | - Speed of onset |
| Examination | - Eye position at rest - Head position (head tilt may suggest congenital CN4 palsy?) - CN3: vertical/horizontal diplopia, anisocoria, ptosis, mydriatic/dilated pupil on affected side - CN4: vertical diplopia, worse on downgaze, head tilted away from affected side - CN6: horizontal, binocular diplopia, worse in the distance and worse looking to the ipsilateral side |
| Diagnostic investigations | Generally aiming to rule out cavernous sinus lesions e.g. cavernous sinus thrombosis. Other ddx: trauma; microvascular; Bilateral CN6 palsy: check for Raised ICP |
| Differentials | Myasthenia gravis Thyroid eye disease e.g. Graves disease Convergence insufficiency Trauma e.g. Facial bone fractures - orbital floor fracture nasopharyngeal cancers; multiple sclerosis, drug induced, botulism infection |
| Immediate management | |
| Ongoing management |
- internuclear ophthalmoplegia looks like diplopia/impaired extraocular movement o/e but they don't usually complain of diplopia??
- = lesion of medial longit fasciculus
- yes you learned this for finals