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PubMed2000

[Diplopia as first symptom of a bronchogenic carcinoma].

BACKGROUND PATIENTS: In about 30% of patients with orbital metastases, these metastases are detected before the primary tumour is known. Less than 5% of orbital metastases are located in extraocular muscles. We report on a patient with diplopia caused by diminished abduction of the left eye as first symptom of a bronchogenic carcinoma. PATIENT: A 86-year-old patient presented with a newly developed diplopia. On examination, the left eye showed a diminished abduction, ptosis and miosis. Pharmacological testing revealed peripheral Horner's syndrome. On cranial magnet resonance tomography, the lateral rectus muscle belly was enlarged. A chest X-ray showed a large tumour (6 cm in diameter) of the left upper lobe with multiple metastases to the lungs. Further examinations revealed a large cell bronchogenic carcinoma with metastases to the lungs, adrenal glands, and the lateral rectus muscle. CONCLUSIONS: Diplopia caused by metastases to extraocular muscles is rare as first sign of a bronchogenic carcinoma. The combination of peripheral Horner's syndrome with diminished abduction of the homolateral eye primarily suggests a lesion of the cavernous sinus. The bronchogenic carcinoma could not be causative for Horner's syndrome in the patient presented here, however an undetected tumor-infiltration of the postganglionic region cannot be excluded. This case demonstrates that in all patients with newly developed diplopia and Horner's syndrome, even in absence of orbital signs, apart from a ophthalmological examination detailed radiographic or magnetic resonance tomographic imaging is necessary of both skull base and orbita.

Aged↗
PubMed2006

[Binocular diplopia after cataract operation].

BACKGROUND: The development of binocular diplopia after cataract surgery is a serious complication. The present retrospective study aims to improve our understanding of this phenomenon and its prevention. PATIENTS AND METHODS: A series of 11 patients with binocular diplopia after cataract surgery under local retrobulbar anaesthesia is presented. The patients were followed over a period ranging from 1 to 31 months. RESULTS: Three types of disorders were found: muscular or nervous injuries (7/11), decompensated latent heterophorias (2/11), and disclosed previous strabismus with abnormal retinal correspondence (2/11). The treatment was surgical for 3 patients, and a prismatic correction was prescribed for 6 patients. Spontaneous recovery was seen in 5 patients. CONCLUSION: Fortunately, binocular diplopia after cataract surgery is a rare complication, with multiple aetiopathologies. Muscular injuries, related to the anaesthesic technique, are the most frequent disorders responsible for diplopia and often require strabismus surgery.

Aged↗
PubMed1999

[Diplopia: from symptom to diagnosis].

BACKGROUND: This overview gives a rough frame how to proceed to a quick diagnosis and possible differential diagnosis in patients with diplopia. METHOD: A thorough interview concerning the onset of symptoms, invariability, and subjective perception is mandatory. The first step before examining ocular motility is to verify monocular or binocular double vision. When the reported diplopia is binocular, the examiner can carry out the red-glass test to determine the site of the double image. In a next step monocular range of movement in the 9 directions of gaze is evaluated to search for incomitance. RESULTS: The main causes of diplopia are palsies of the oculomotor nerves, mechanical restriction--posttraumatic or inflammatory--, supranuclear lesions and disturbed neuromuscular junction. CONCLUSION: With a simple and clear diagnostic diagram ist is easy to work out the underlying cause of diplopia.

Diagnosis, Differential↗
PubMed2001

Evaluation of motor vehicle driving performance in patients with chronic diplopia.

BACKGROUND: Uncorrected diplopia is a condition that may make it unsafe for a person to operate a motor vehicle. In some jurisdictions, physicians are required by law to report the person with diplopia to the appropriate authority. METHODS: In this masked study, 10 patients of varying ages with stable diplopia of greater than 6 months' duration and 10 age-matched control subjects were placed in a driving simulator and evaluated on their performance. Various cues and threats, including near-accident situations, were presented; stimulus recognition and reaction times were recorded. RESULTS: No significant difference was found between the groups for either cue or threat recognition responses or reaction times. Increasing age was the factor most associated with poor response performance on all test measures (P < .001). Slowed response time in patients with poor binocular single vision was the only other significant association. CONCLUSION: Although response times were slower in subjects with poor binocular single vision scores, stimulus recognition responses were not significantly different; in our opinion, stimulus recognition is more relevant to driving performance and therefore chronic diplopia does not appear to be a contraindication for driving a motor vehicle.

Adult↗
PubMed2004

Diplopia secondary to endoscopic sinus surgery.

OBJECTIVE: Diplopia after endoscopic sinus surgery (ESS) is rare but very serious. In this study, we investigated the characteristics, prognosis and treatment of diplopia occurring after ESS. MATERIAL AND METHODS: A retrospective analysis was carried out to investigate three patients with diplopia after ESS referred to us from other hospitals. RESULTS: In one case, an improvement in ocular motility was seen after surgical treatment. In the other cases, no improvement was observed, despite surgical treatment. CONCLUSION: In order to prevent diplopia after ESS, the surgeon must possess a complete anatomical knowledge obtained by means of cadaveric dissection, the ability to carefully read preoperative CT scans and the necessary surgical experience.

Adult↗
PubMed2005

Heroin and diplopia.

AIMS: To describe the eye misalignments that occur during heroin use and heroin detoxification and to give an overview of the management of persisting diplopia (double vision) which results from eye misalignment. METHODS: A literature review using Medline and the search terms strabismus, heroin and substance withdrawal syndrome is presented. General management of cases presenting to the ophthalmologist and orthoptist with acute acquired concomitant esotropia is described. FINDINGS: A tendency towards a divergence of the visual axes appears to be present in heroin users, although when present it may not always lead to diplopia. Following detoxification intermittent esotropia or constant esotropia (convergence of the visual axes) can occur; if intermittent the angle tends to be small and diplopia present when viewing distance objects. Occlusion of one eye to eliminate the second image could encourage the development of a constant deviation. The deviation is not caused by a cranial nerve palsy. Constant deviations of this type are classified as 'acute acquired concomitant esotropia'. Relief from the diplopia may be gained by prismatic correction, and the deviation may then resolve spontaneously. Botulinum toxin or surgical intervention may be necessary in cases that do not resolve. CONCLUSIONS: Heroin use may lead to intermittent or constant exotropia and withdrawal may result in intermittent or constant esotropia. Awareness of the mechanism causing this may avoid referral to other specialties (e.g. neurology) and awareness of treatment modalities could encourage patients to seek appropriate help for relief of symptoms.

Acute Disease↗
PubMed1987

Diplopia after retinal detachment surgery.

Diplopia following retinal detachment usually responds to simple measures. Fifteen out of 311 cases developed diplopia lasting more than three months after conventional retinal detachment surgery. Binocular single vision was restored in 12 of the 15 cases (80%). The mean follow-up was four years. Diplopia was eliminated stepwise. If prisms were ineffective, our first surgical procedure was removal of the scleral buckle. If the retina was flat, we were prepared to remove the buckle early. When diplopia persisted after buckle removal, we proceeded to strabismus surgery. Our most consistent results followed strabismus surgery on the untreated eye. Prisms alone restored binocular single vision in six patients (40%), one of whom preferred to adopt a compensatory head posture. Removal of the scleral buckle restored binocular single vision in three patients (20%), with the help of a prism in one case and a compensatory head posture in another. Binocular single vision was restored after buckle removal and strabismus surgery in three further patients (20%), one requiring a prism in addition. Binocular single vision was not restored in three patients (20%).

Adult↗
PubMed1999

Recurrent proptotic diplopia due to congestive expansion of cavernous haemangioma with relapsing right-sided cardiac failure.

A 75-year-old man with a recent history of pulmonary embolism, presented with collapse followed by a gran mal seizure and right-sided non-pulsatile proptosis. On recovery, he had diplopia on lateral and upward gaze and signs of congestive cardiac failure. Further pulmonary embolism was proven by lung scintigraphy. Computed tomography of his orbits confirmed a contrast-enhancing space-occupying lesion of the medial wall of the right orbit, with no intracranial abnormality. The patient was investigated for metastatic tumour as a possible cause of the space-occupying lesion and the unprovoked thromboembolic event, but no evidence of malignancy was found. The orbital lesion was not biopsied because of the risk of bleeding from anticoagulation. Three weeks later, the patient represented with recurrent cardiac failure, proptosis, and diplopia. A transorbital ultrasound confirmed an encapsulated, well-defined vascular lesion, with typical appearances and Doppler flow characteristics of a cavernous haemangioma. Diuretic therapy abolished the proptosis and diplopia in tandem with relief of the cardiac failure. This is the first description of recurrent proptosis with diplopia due to recurrent congestive expansion of an orbital cavernous haemangioma.

Aged↗
PubMedDate not supplied

Large subconjunctival emphysema causing diplopia and lagophthalmos.

PURPOSE: To describe a patient who developed diplopia, lagophthalmos and exposure keratopathy due to a large subconjunctival emphysema. METHODS: A 24-year-old man sustained an injury in his left eye from a compressed air hose. The patient complained of pain and diplopia. He underwent slit-lamp examination, funduscopy and computed tomography. RESULTS: Ophthalmic examination revealed a decrease in vision in the left eye to 0.5, a conjunctival laceration adjacent to the medial limbus, subconjunctival hemorrhage, a large subconjunctival emphysema, lagophthalmos, hypertropia and superficial punctate keratopathy. The posterior pole was intact as were the orbital bones. Two weeks after the injury the conjunctival emphysema, diplopia, lagophthalmos and superficial keratopathy resolved, and visual acuity improved to 1. CONCLUSIONS: Large subconjunctival emphysema can result in diplopia, lagophthalmos and exposure keratopathy.

Adult↗
PubMedDate not supplied

Orbital emphysema and diplopia following thoracotomy.

PURPOSE: To describe the clinical and radiological findings in a patient with diplopia and orbital emphysema following thoracotomy. METHODS: Reported is a 71-year-old woman who presented with diplopia several days following thoracotomy. RESULTS: Physical examination revealed diffuse subcutaneous emphysema and a right hypertropia. Head computed tomography revealed facial and palpebral subcutaneous emphysema extending into the infratemporal fossa and orbits bilaterally. A chest tube was replaced and her diplopia resolved. CONCLUSIONS: Subcutaneous emphysema can lead to diplopia and orbital emphysema in the absence of orbital trauma. Contrary to previously suggested mechanisms of orbital emphysema associated with subcutaneous emphysema, computed tomography imaging suggested that air entry into the orbit in this case was through the inferior orbital fissure.

Aged↗
PubMed2003

Prospective analysis of diplopia after anterior temporal lobectomy for mesial temporal lobe sclerosis.

OBJECT: In this prospective study the authors investigated the incidence and natural history of postoperative diplopia in patients undergoing anterior temporal lobectomy (ATL) and amygdalohippocampectomy for medically intractable mesial temporal lobe epilepsy. METHODS: Forty-seven patients scheduled for ATL for medically refractory seizures were examined preoperatively, 2 to 7 days postoperatively, and 3 to 6 months postoperatively. Ophthalmological examination including pupillary measurements, stereoacuity measurements, palpebral fissure measurements, vertical fusional amplitudes, Lancaster red green testing, visual field testing, and alternate cover testing was performed. Antiepileptic drug levels were monitored. Nine (19%) of 47 patients developed diplopia postoperatively. The diplopia was caused by trochlear nerve palsy in every case. No oculomotor nerve dysfunction was documented. Trochlear nerve function recovered completely in all patients within 3 to 6 months postoperatively. CONCLUSIONS: Postoperative diplopia following ATL occurs more often than previously thought and is primarily due to trochlear nerve dysfunction. Awareness of this transient complication is important in preoperative patient counseling.

Adolescent↗
PubMedDate not supplied

Monocular diplopia related to asymmetric corneal topography after laser in situ keratomileusis.

PURPOSE: To show a specific relationship between monocular diplopia and corneal refractive asymmetry after laser in situ keratomileusis (LASIK). METHODS: One hundred thirty-eight eyes of 98 patients who underwent LASIK for myopia between -2.12 and -17.75 D were examined under room-lighted conditions. We examined 51 eyes at 2 weeks, 46 eyes at 3 months, 32 eyes at 6 months, and 9 eyes at 1 year after LASIK. We attempted to correlate the presence of monocular diplopia with their corneal topographical features. RESULTS: Eight eyes of five patients (five eyes at 2 weeks, three eyes at 3 months after LASIK) produced symptoms of monocular diplopia. These symptomatic patients had a common corneal topographical feature caused by decentralized or inhomogeneous ablation. Every pupillary area in the patients' topographies contained steeper and flatter areas. The range of refractive power variation in these asymmetric areas was at least 1.50 D. The location of the secondary image correlated with the direction of the steeper area in all eight eyes. Pinhole viewing eliminated or reduced the prominence of secondary images in every case. CONCLUSION: Monocular diplopia following LASIK appears to correlate with postoperative corneal refractive power variation inside the pupillary area, caused by decentralized or inhomogeneous ablation.

Adult↗
PubMed2006

[Diplopia after sub-Tenon's anesthesia for cataract surgery].

PURPOSE: To study the clinical signs, treatment and prognosis of strabismus after sub-Tenon's anesthesia for cataract surgery. METHODS: Eight patients without previous strabismus developed incomitant diplopia immediately after cataract surgery; the left eye was affected in five patients and the right eye in three. Restrictive strabismus was diagnosed with the cover test, prisms, and active and passive ductions in all cases. In seven cases the deviation was vertical and in one patient it was horizontal. The average deviation was 17.5 S.D. 9.84 (range 5-35) prismatic dioptres in primary position. The deviation increased looking upward in seven cases, and looking sideways to the left in the other. It was considered to be a good result if the diplopia disappeared after treatment. RESULTS: Botulinum toxin was the first treatment applied in four patients, but only one showed a good response and required no further therapy. Strabismus surgery was required in four cases, and prisms were adapted in three. Three patients required two strabismus operations. A good result was achieved in all cases, with the average time interval being 10.12 (SD 5.5) months. CONCLUSIONS: Sub-Tenon's anesthesia may result in restrictive strabismus and incomitant diplopia which does not resolve spontaneously. The inferior rectus is the most commonly affected muscle. Strabismus surgery is required to resolve the diplopia in half of the cases. Good results have been achieved in all patients.

Aged↗
PubMed2002

[Surgical treatment of diplopia in patients with Graves' ophthalmopathy].

OBJECTIVES: To investigate the timing and effect of surgical treatment of diplopia caused by hypertrophic inferior rectus in patients with Graves' ophthalmopathy and pathologic changes of inferior recti. METHODS: Eleven diplopic patients with restrictive superior motion and enlarged inferior recti confirmed by CT scan were collected, and the inferior recti were recessed. Specimens of inferior recti obtained during operation were stained by HE, PAS and observed by light microscope. RESULTS: There was no diplopia after operation when patients looked down and horizontally in eleven cases. Eye position was normal. HE and PAS stain showed stiffness of muscular fiber, small muscular cell with degeneration, obvious proliferation of fibrous tissue in endomysium, perimysium and epimysium, which enlarged extraocular muscle. CONCLUSION: Poor function of inferior recti due to enormous proliferation of fibrous tissue and degeneration of muscular fiber results in the occurrence of diplopia. Recession of inferior recti can eliminate patients' diplopia.

Adult↗
PubMed2002

[Diplopia as a reason to operative strabismus surgery on patients with macula damages: a case report].

PURPOSE: This report presents two clinical interested cases. The main indication to intervene was diplopia, despite of macula damages and amblyopia. MATERIAL AND METHODS: We describe two clinical interested cases of divergent squint caused by sensory deprivation in course of permanent macula damage. Every patient was observed at least 5 years. We estimated decrease of diplopia and final eye alignment. RESULTS: Both patients did not complain of diplopia, we confirmed very good cosmetic effect and fixed angle of squint. CONCLUSIONS: Diplopia can exist even in cases with squint and macula damages. In spite of this, we can obtain postoperative improvement.

Adult↗
PubMed2004

[Diplopia and blepharoptosis associated with orbital emphysema following thoracotomy with lung cancer; report of a case].

BACKGROUND: Orbital emphysema is a common complication of trauma and fracture of orbital bones. However, subcutaneous emphysema also can rarely lead to orbital emphysema. We reported the clinical and radiological findings in a patient with diplopia and blepharoptosis following thoracotomy for lung cancer. CASE: A 76-year-old man had undergone left inferior lobectomy and ND 2 a in October 2002, based on the clinical diagnosis of stage IB lung squamous cell carcinoma. He presented with diplopia and blepharoptosis several days following thoracotomy. Chest X-ray demonstrated extensive subcutaneous emphysema, and physical examination also revealed diffuse subcutaneous emphysema including face and palpebrae. Head computed tomography (CT) revealed subcutaneous emphysema in the infratemporal fossa bilaterally. His diplopia and blepharoptosis gradually resolved, and he was discharged with no visual complaints on the fourteenth postoperative day. CONCLUSIONS: Subcutaneous emphysema can lead to diplopia and orbital emphysema in the absence of orbital trauma. Early surgical intervention for air leakage is highly recommended to avoid both the orbital emphysema and the visual complications in the event that subcutaneous emphysema should get to including face or palpebrae.

Aged↗
PubMed2006

Difficult vertical diplopia studied by video-oculography in aphakia after contact lens use. A case report.

PURPOSE: To establish the utility of a video-oculography system (3D-VOG) in the diagnosis of a patient with difficult idiopathic vertical diplopia. CASE REPORT: We present a clinical case of an 87 year old female who was operated for glaucoma and cataract with the intracapsular technique in both eyes. She reported vertical diplopia with the use of contact lenses but not while using her aphakia spectacles. A complete ophthalmological study was carried out with special interest in the ocular motility study with 3D-VOG. RESULTS: Besides the hypertropia in lateroversion of the non-fixing eye, the video-oculography showed an incyclotorsion of the hypertropic eye, a fundamental factor for the differential diagnosis between bilateral superior oblique overaction and DVD or dissociated vertical divergence. Such a torsional strabismic deviation is very difficult to detail by other methods and is the important clue for diagnosis. The 3D-VOG made this diagnosis possible. CONCLUSIONS: The occurrence of a vertical diplopia with use of contact lenses, and not with spectacles, is explained by the limitation of ocular gaze movements with the aphakia spectacles which limitation is not found with the use of contact lenses, with diplopia appearing in the more extreme lateroversion possible with the contact lenses. The 3D-VOG system enabled us to analyze torsional movements in lateroversion that allowed the diagnosis of bilateral superior oblique overaction to be made.

Aged, 80 and over↗
PubMedDate not supplied

[Monocular diplopia].

Monocular diplopia is a condition when a single object is seen double with one of the eyes. Fifty-seven cases of this condition are described. Traditional ophthalmologic methods, as well as examinations of the optic system aberrations and determination of diplopia type with a cross pattern were employed in examinations of the patients. A classification of monocular diplopia has been developed, including (1) refraction, (2) aberration, (3) pupillary, (4) retinal, and (5) neurogenic diplopia. Methods of examining this patient population are described and recommendations on the treatment of this condition presented.

Adolescent↗