The first step in the approach to diplopia in the ED is to determine if the diplopia is monocular or binocular - Andy Rogers MD
Diplopia, or double vision, can be a tricky and complicated disorder. There are various forms of double vision and many etiologies, ranging from non-serious to life-threatening. I always felt a little confused and unsure of how to approach someone with Diplopia. So here goes my step-wise approach to optimize the care of a patient with non-traumatic diplopia.
Step 1: Is this Monocular or Binocular? This is the most important initial question, as it distinguishes whether the problem stems from the brain or the eye.
Monocular diplopia is almost always eye related and not life-threatening. Binocular diplopia is brain-related and should therefore raise some alarms. Monocular…
Diplopia, or double vision, can be a tricky and complicated disorder. There are various forms of double vision and many etiologies, ranging from non-serious to life-threatening. I always felt a little confused and unsure of how to approach someone with Diplopia.
First, figure out is it monocular or binocular diplopia?
Monocular Diplopia- This does NOT resolve when one eye is closed or covered. The very fact that it does not resolve when one eye is closed indicates that it is NOT due to ocular misalignment ie ocular muscle issues. The cause is almost all cases due to a refractive error or dry eyes. Patients should be referred to ophthalmology.
Monocular diplopia is almost never a neurologic problem and results from distortions to the light path in the affected eye. The most common causes include keratoconjunctivitis sicca (dry eyes), cataracts, corneal irregularity and rarely retinal irregularities.
Diplopia refers to seeing two images and is due either to ocular misalignment, in which case it disappears when either eye is occluded or to an optical problem, in which case it is termed monocular diplopia and does not disappear with monocular viewing. Patients with ocular misalignment can harbor serious pathology and should be evaluated in a systematic and thorough manner in order to uncover all potentially serious cases.
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