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PubMedDate not supplied

Transient vertical diplopia and nystagmus associated with acute thalamic infarction.

We describe a patient who presented with a 1-h history of vertical diplopia and nystagmus and was found to have acute left ventrolateral thalamic infarction on the diffusion-weighted magnetic resonance imaging (DWI MRI). This is the first case report demonstrating that vertical diplopia and nystagmus, which typically suggest a lesion in the brainstem or cerebellum, may also occur in acute thalamic infarction. DWI MRI can detect thalamic infarction as early as 1 h after its clinical manifestations.

Aged, 80 and over↗
PubMed1998

Binocular vertical diplopia.

The assessment of a patient with binocular vertical diplopia begins with a thorough history and neuro-ophthalmologic examination. The neuro-ophthalmologic examination includes observation for a compensatory head, face, or chin position; ocular ductions and versions in the nine cardinal positions of gaze; the three-step test; the double Maddox rod test; indirect ophthalmoscopy to observe the location of the fovea in relationship to the optic nerve head to determine cyclodeviation; and the forced ductions test. Binocular vertical diplopia may be due to supranuclear processes, ocular motor nerve dysfunction, neuromuscular junction disease, diseases of eye muscle, mechanical processes causing vertical eye misalignment, and even retinal disease. In this article, the differential diagnosis of these processes is outlined.

Diplopia↗
PubMed1987

Functional scoring of the field of binocular single vision in patients with diplopia.

A simple method for scoring the field of binocular single vision (BSV) is presented. The field is plotted on the Goldmann Perimeter using the III-4e target. The method gives greater weight to functionally important areas, especially the primary and reading positions. Several cases illustrate the application of the proposed scoring system by correlating patients' subjective disabilities with their diplopia scores. The method is more precise than any previous scheme and provides a quantitative measure that makes the examination of patients with diplopia more accessible to legal evaluation and numerical analysis.

Adult↗
PubMed1987

Proptosis and diplopia following traumatic asphyxia.

We describe a previously unreported complication of traumatic asphyxia. An 11-year-old boy developed proptosis and diplopia following a crush injury in an automatic garage door. Computed tomography scan confirmed displacement of the eye. There was no retrobulbar hemorrhage or skull fracture, and the proptosis appeared secondary to traumatic displacement of orbital fat. Proptosis and diplopia resolved completely over six weeks. Visual disorders may be overlooked as a complication of trauma.

Accidents, Home↗
PubMed2002

Diplopia in a patient with carcinomatous meningitis: a case report and review of the literature.

In a patient with a history of malignancy, an isolated neurologic sign or symptom may indicate metastasis to the central nervous system. To exclude this possibility, a lumbar puncture should still be performed after a nondiagnostic cranial computed tomography (CT) scan even in the absence of signs of infection. A case is presented of a 59 year-old man recently diagnosed with non-Hodgkin's lymphoma that presented to the Emergency Department (ED) with the sole complaint of diplopia. Examination was unremarkable except for a left abducens nerve palsy. Cranial CT scan was normal but initial cerebrospinal fluid results were suggestive of carcinomatous meningitis, and cytology results later confirmed this diagnosis. A review of diplopia and carcinomatous meningitis is presented, along with a suggested conservative diagnostic algorithm for cancer patients presenting with neurologic signs or symptoms.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2000

Incidence of ocular misalignment and diplopia after uneventful cataract surgery.

PURPOSE: To evaluate the incidence of ocular misalignment and diplopia after uneventful cataract surgery. SETTING: An outpatient private practice eye institute. METHODS: One hundred thirty-eight patients referred to 1 cataract surgeon were prospectively evaluated. Orthoptic evaluations were performed within 1 month before and then 1 day, 1 week, and 1 month after cataract surgery. Anesthesia was by retrobulbar injection, and cataract extraction was done by phacoemulsification. RESULTS: Cataract surgery was performed in 118 patients. Preoperatively, 16 patients had ocular misalignment; 10 were phoric, 4 were intermittently tropic, and 2 were tropic. Follow-up evaluation was obtained for 101 patients (86%) at 1 day, 91 (77%) at 1 week, and 88 (75%) at 1 month. A change in ocular alignment occurred in 22 of 101 patients (22%) at 1 day, 9 of 91 (10%) at 1 week, and 6 of 88 (7%) at 1 month. Only 1 patient who had a change in alignment at 1 month was symptomatic. CONCLUSIONS: A persistent change in ocular alignment after uneventful cataract surgery occurred in 7% of patients. However, symptomatic diplopia was uncommon (1 in 118; 0.85%) in this relatively small series.

Aged↗
PubMed2002

Diplopia following sub-Tenon's infiltration of local anesthesia.

A series of 3 patients with persistent diplopia following sub-Tenon's local anesthesia is presented. All 3 patients showed a pattern of vertical diplopia consistent with restriction of the inferior rectus muscle. The pathogenesis and significance of this complication are discussed.

Aged↗
PubMedDate not supplied

Opaque iris claw lens in a phakic eye to correct acquired diplopia.

A 25-year-old man had diplopia caused by abducens nerve paresis on both sides after cranial injury. Because of the patient's reports of persistent diplopia after surgical correction, a specially manufactured, tinted iris claw lens was implanted in the left eye, with the crystalline lens in situ. Fourteen years after surgery, specular microscopy was performed to evaluate the corneal endothelium. The difference in mean endothelial cell density in both eyes was 18.6%. The difference between eyes in polygonality and polymegathism was not significant.

Adult↗
PubMed1996

Taking a history of the patient with diplopia.

The diagnosis and treatment of adult diplopia is challenging. Having a thorough and complete history of the patient can make this difficult process easier. This article describes the most important questions to ask when taking the history of a patient with diplopia and explains why a particular question is essential. Tips of what to search for in the patient's answers are also provided.

Adult↗
PubMed1998

Diplopia: double the fun! Part 1: History taking.

The history is the most important part of a diploic evaluation. Determining the type of diplopia and its onset, duration, and frequency are critical questions that must be answered. The examiner must ask the right question to get the right answers. This article will review the history of the diploic patient step by step and give suggestions on how to avoid some common problems. Common causes for diplopia will also be reviewed. Knowing what questions to ask can make a big difference to you, the patient, and the ophthalmologist and turn a challenge into a rewarding experience.

Diplopia↗
PubMed1990

Management of diplopia on down-gaze following orbital trauma.

Diplopia in the inferior field due to orbital trauma is a notoriously difficult and disabling problem. Even if a blow-out fracture is repaired by current methods, patients may still have diplopia. There also exists another group in whom no demonstrable radiological fracture can be found, and yet there is a severe down gaze deficit. The possible mechanisms of this phenomenon are discussed and the results of horizontal muscle transposition surgery in a series of nine patients is reported. The authors conclude that this procedure is a valuable method of increasing the useful field of binocular single version in these patients.

Adolescent↗
PubMed1999

Does diplopia persist after blow-out fractures of the orbital floor in children?

Blow-out fractures of the orbital floor are comparatively rare in children, particularly those less than 8 years old. Published reports have suggested that the long-term outcome in children is worse than that in adults with similar injuries. In this study, we examine this question in the light of data from 45 children from Birmingham and Glasgow who were divided into three age ranges: 0-9 years (n = 9), 10-12 years (n = 11) and 13-15 years (n = 25). Fourteen were treated conservatively and 31 were treated surgically. The 0-9-year-old group were more likely to have small- or medium-sized defects in the anterior part of the orbital floor, which were of a linear 'trapdoor' type. The 13-15-year-olds tended to have larger 'open-door' defects. More than half the 0-9-year-olds had persistent diplopia compared with just under a third of the two other age groups. This diplopia took twice as long to resolve in the younger group compared with the other two groups. Our results confirm the view that younger patients have more persistent problems than adults after blow-out fractures of the orbital floor.

Adolescent↗
PubMed1994

[Diplopia after retrobulbar anesthesia in cataract surgery--a case report].

A case report. A homolateral hypertrophia accompanied by diplopia occurred after retrobulbar anesthesia for cataract operation. In the course of the next few months a hypotrophia developed in the same eye. Two and a half years later a 5 mm recession of the inferior rectus muscle of the hypotrophic eye was performed under local anesthesia. The passive motility upwards improved already during the operation when the muscle was sectioned. After the operation there was a remarkable improvement of motility and field of vision. Conclusion. The cause of this diplopia is probably an injury of the inferior rectus muscle with a secondary contraction caused by the retrobulbar anesthesia. An injection along the inferior rectus muscle to achieve the retrobulbar anesthesia should be avoided.

Aged↗
PubMed1986

Vertical diplopia.

At this point, it is customary for all hands to gather round the old decision tree and whittle on a few algorithms. Because I have been chastened by occasional painful falls from slippery decision branches, however, I must make do with a short reprise. Some nodal points in analyzing vertical diplopia include: (1) evidence of central nervous system involvement; (2) pupillary sparing; and (3) the presence of proptosis of orbital congestion. As endlessly stated, premature closure of the differential diagnosis should be avoided and the tendency to diagnose partial third nerve palsy staunchly resisted. However, all of this will probably be of little comfort to you when you face your next lethargic patient who has small angle diplopia and speaks one of the obscure rural dialects of Freedonia.

Brain Diseases↗
PubMed1996

Late migration of an orbital implant causing orbital hemorrhage with sudden proptosis and diplopia.

A 31-year-old woman complained of sudden diplopia and proptosis associated with a headache. Approximately 10 years earlier, she had sustained a right orbital blowout fracture during a snow machine accident that was repaired using a Supramid implant. She presented with 4 mm of right-sided proptosis by Hertel exophthalmometry, with limitation of up and down gaze. She manifested a right gaze preference with a left head turn to achieve fusion. Visual acuity was 20/20 on both sides; however, there was 20% red desaturation and a subtle afferent pupillary defect on the right side. Goldmann visual fields were full and the retinal examination was normal. A computed tomography (CT) scan of the orbits with and without contrast demonstrated a large right posterior inferior orbital mass. Once the periorbita was breached during orbitotomy, a burgundy serosanguinous material emerged. Gram staining revealed red cells without organisms. The implant had not been fixed by wires or screws. Upon removal, the implant appeared oversized, encompassing the orbital floor, medial and lateral walls. Postoperatively, the proptosis, gaze preference with face turn, afferent pupillary defect, desaturation abnormality, and diplopia resolved.

Adult↗
PubMed2003

Diplopia following porous polyethylene orbital rim onlay implant.

An 81-year-old man with ocular irritation associated with lower eyelid retraction, horizontal laxity of the lower eyelids, and hypoplastic inferior orbital rims underwent bilateral placement of porous polyethylene orbital rim onlay implants. Two weeks after surgery, he developed vertical binocular diplopia on downgaze. Examination of extraocular motility demonstrated limited infraduction OD. Surgical exploration revealed scarring in the anterior orbit between the inferior rectus pulley and the orbital implant. The orbital implant was found to lie higher than the inferior orbital rim. After surgical lysis of the scar and reduction of the vertical height of the implant, the patient's diplopia resolved. Orbital connective tissues critical to ocular motility may be abnormally superficial in orbital rim hypoplasia. Onlay grafts must be carefully placed so that they do not interfere with these tissues.

Aged↗
PubMed1978

Corneal topography and monocular diplopia following near work.

Monocular diplopia, reported by a subject following near work, was shown to be caused by changes in the corneal topography. Prior slit lamp biomicroscopy had revealed no corneal abnormality. The degree of corneal distortion and ray tracing calculations confirmed the presence and position of the resultant diplopia.

Adult↗