Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “DIPLOPIA”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed2002

Intractable diplopia after strabismus surgery in adults.

OBJECTIVES: To investigate the incidence of persistent intractable diplopia in adults undergoing surgery for long-standing, constant strabismus and to define tests that may be useful for identifying patients at risk for developing this complication. METHODS: A retrospective medical record review of adults without diplopia undergoing surgery for constant strabismus. RESULTS: Medical records of 424 adult patients undergoing strabismus surgery were studied. Of these patients, 143 (34%) experienced diplopia when tested preoperatively with prisms to simulate the desired surgical outcome. Only 40 patients (9%) had temporary diplopia after surgery, which resolved in all cases by 6 weeks postoperatively. Three patients (0.8%) developed persistent intractable diplopia. Experiencing diplopia with preoperative prism testing was significantly more likely to result in postoperative diplopia than if diplopia was not present preoperatively (P<.001 and P =.04 for temporary and persistent postoperative diplopia, respectively). Preoperative testing had a sensitivity and negative predictive value for temporary postoperative diplopia of 100%, a specificity of 73%, and a positive predictive value of 28%. Similar values were found for persistent diplopia after surgery with the exception of the positive predictive value, which was only 2%. Patients who did not see double during preoperative testing with prisms never developed diplopia after surgery. However, the presence of preoperative diplopia with prism testing (including a prolonged trial with Fresnel prisms) was infrequently predictive of postoperative diplopia. CONCLUSIONS: Intractable diplopia after strabismus surgery in adults without previous diplopia is very rare. The diagnostic use of prisms prior to surgery may identify some patients who have little or no risk of postoperative diplopia, as well as a group of patients with a small but definite risk of intractable postoperative diplopia.

Adolescent↗
PubMedDate not supplied

Diplopia following subcutaneous injections of botulinum A toxin for facial spasms.

PURPOSE: To study the incidence, cause, recovery time, and prevention of diplopia following subcutaneous injection of botulinum A toxin for the treatment of facial spasms. METHODS: Patients who experienced diplopia after botulinum A toxin injections had their deviations examined in detail. When the muscle that caused diplopia was identifiable, the injection closest to that muscle was omitted in the next treatment in an attempt to prevent diplopia. RESULTS: Of 250 patients receiving about 1500 sets of injections, 25 (1.7%) incidents of diplopia occurred in 10 patients. Excluding two patients who declined further treatment after having diplopia on their first botulinum A toxin treatment, seven of the remaining eight patients had multiple incidents of diplopia. The most common pattern of diplopia was "uncertain diagnosis." The most common identifiable cause of diplopia was paresis of the inferior oblique muscle. Omission of the injection into the central portion of the lower eyelids in the next treatment prevented recurrence of diplopia in only one of the four patients. No significant correlation between botulinum A toxin doses injected and times to recovery was noted. CONCLUSIONS: Diplopia following botulinum A toxin treatment is uncommon. Seven patients (3% of patients studied) had 22 episodes of diplopia (88% of episodes). When diplopia occurs, it tends to recur on reinjection, sometimes with a prolonged recovery time. This response may not be dose dependent. The extraocular muscles of some patients may be more susceptible to chemodenervation than others, or botulinum A toxin may diffuse to extraocular muscles more easily in some patients than in others.

Aged↗
PubMed1996

[Diplopia as a complication after surgery for strabismus in adolescents and adults].

Diplopia may occur following surgery for the correction of constant manifest strabismus. Young children rarely complain of diplopia because of the plasticity of their visual system and the rapid development of suppression. However, in older children and adults post-operative diplopia may occur either as a transient well-tolerated phenomenon or occasionally as an intractable problem. It is a standard practice to carry out tests prior to surgery to try and predict the risk of post-operative diplopia, although the value of these tests and the incidence and severity of diplopia following squint surgery is not well documented. We reviewed the records of these 22 out of all our patients operated for squint who had diplopia (aged 13-45). 13 subjects presented diplopia only for 1 or 2 days after surgery 8 had intermittent one with good tolerance and 1 acquired constant diplopia (she was operated). Pre- and post-operative agents which could have had an impact on diplopia occurrence were evaluated. Diplopia was found in 48% patients who had positive test predicting the risk of post-operative diplopia. The test thus seems to be quite limited in its reliability and prior to surgery the patients should be thoroughly informed about a possibility of diplopia occurring as a surgery complication.

Adolescent↗
PubMed1999

[Investigation of the diplopia after intraocular lens implantation].

OBJECTIVE: To investigate the pathogenesis, mechanism and prognosis of diplopia after cataract extraction with intraocular lens implantation (IOL). METHODS: Besides routine ocular examinations, refraction, ocular position, ocular movement, fusional function and image of diplopia were examined on all the patients. Forced duction was examined on partial patients. RESULTS: Among 24 cases with diplopia after IOL implantation, there were 19 cases of binocular diplopia and 5 cases of monocular diplopia. Of the binocular diplopia, there were 17 cases of strabismic diplopia and 2 cases of diplopia due to central fusional impairment. Of the cases with monocular diplopia, there were 4 cases resulted from operative complication and one case with congenital iridocoloboma. CONCLUSIONS: The pathogenesis of strabismic diplopia resulted from dysfunction of ocular movement is unknown. Most of the patients can obtain binocular vision by early active treatment. Monocular diplopia is partly resulted from operative complication.

Adult↗
PubMed1995

Fixation switch diplopia.

OBJECTIVE: To present guidelines for the diagnosis and management of fixation switch diplopia. BACKGROUND: Adults with a history of strabismus since childhood may experience acquired diplopia if a change in their refractive error or use of spectacles encourages fixation with their nondominant eye. This is referred to as "fixation switch diplopia." If correctly diagnosed, this seldom-recognized cause of acquired diplopia in adults can almost always be successfully treated with the proper optical management. PATIENTS: A retrospective review was carried out for all patients with the diagnosis of fixation switch diplopia who were seen in my private practice. RESULTS: A review of patient records identified 16 patients with fixation switch diplopia. In four patients, the switch in fixation was spontaneous owing to the development of myopia in the previously preferred eye in patients with mild contralateral amblyopia. Six patients developed diplopia owing to their "monovision" (one eye optically corrected for distance and the other eye presbyopic). In six patients, fixation switch diplopia occurred because a noncycloplegic subjective refraction was performed in the presence of amblyopia, resulting in an unbalanced refractive correction. In all 16 patients, symptoms were eliminated when proper optical correction was instituted to encourage fixation with the dominant eye. CONCLUSIONS: Fixation switch diplopia is a cause of acquired diplopia in adults with a history of strabismus since childhood. It can usually be successfully treated with proper optical management.

Adult↗
PubMed2002

Diplopia and enophthalmos after surgical repair of blowout fracture.

PURPOSE: To evaluate the incidence of residual diplopia and enophthalmos and the possible risk factors leading to their occurrence in patients who had orbital blowout fracture repair. METHODS: Forty-two patients with pure orbital blowout fracture who had at least 6 months postoperative follow-up were included in the study group. Nineteen (45.2%) patients had orbital floor, two (4.8%) patients had medial orbital wall and 21 (50%) patients had a combination of orbital floor and medial orbital wall fractures. The fracture was reconstructed with porous polyethylene (Medpore) in 22, supramide in 12 and gelatin (Gelfilm) in 8 orbits. Mean postoperative follow-up was 11 months. RESULTS: Preoperatively, 35 patients (83%) had diplopia and 13 patients (30.9%) had enophthalmos greater than 2 mm. Of 35 patients who had preoperative diplopia, only 7 (17%) patients experienced diplopia postoperatively. Diplopia improved 1 to 4 weeks (mean, 3 weeks) following surgery in 28 patients. Timing of surgery and age of the patient were significant for the development of postoperative diplopia (p < 0.05). Sex, location of the blowout fracture and the alloplast material were not found to be significant for the development of postoperative diplopia (p > 0.05). Enophthalmos persisted in three (7%) patients postoperatively. CONCLUSION: Old patients were more likely to have residual postoperative diplopia. Surgical repair of blowout fractures within two weeks of trauma decreases the incidence of residual diplopia.

Adolescent↗
PubMed1996

[A clinical analysis on 131 senile cases with diplopia].

OBJECTIVE: To approach the pathogenic features of senile diplopia to elevate the rate of accurate clinical diagnosis and the therapeutic effect of treatment. METHODS: Prism, synoptophore, Hess' screen and red glass test were used to examine the ocular position, muscle movement and diplopia image in 131 cases (aged 60 or older). Biochemical examination of blood and imaging diagnosis were also involved. RESULTS: Among 131 cases, 120 (91.6%) suffered from binocular diplopia and 11 cases (8.4%) monocular diplopia. The majority of cases (110/120) with binocular diplopia were of ocular dyscinesia type resulting from intracranial vascular diseases, while the majority of cases with monocular diplopia resulted from complications of intraocular operation. CONCLUSIONS: Most of the diplopia in the aged are binocular one whose main cause is ocular dyscinesia resulting from vascular diseases. The cause of monocular diplopia in most of the cases is frequently due to the complications of intraocular operation. The authors emphasize a thorough examination of patients with diplopia.

Aged↗
PubMed1983

[Diplopia as an initial symptom of intracranial tumors].

Among 716 patients with intracranial blastomatous changes 74 showed diplopia as a consequence of involvement of the oculomotorius, trochlearis or (and) the abducens nerve. Diplopia as primary symptom of disease was observed in 20 cases. Patients with isolated initial diplopia were on average 10 years younger than patients where diplopia occurred only in the further course of the tumour. There were no preceding other diseases demonstrable in patients with initial diplopia. Papilloedema did not occur significantly more frequently in them than in patients with diplopia as secondary symptom. In rare cases latency between occurrence of diplopia and further symptoms may be months to two years. For this reason exact neurologic and ophthalmologic follow-up controls, particularly in young patients with isolated persistent diplopia, are required.

Abducens Nerve↗
PubMed1997

The risk of diplopia following orbital floor and medial wall decompression in subtypes of ophthalmic Graves' disease.

We preoperatively divided 58 ophthalmic Graves' disease patients into types I and II categories before two-wall orbital decompression. Type I classification was given to patients who had no diplopia and essentially normal versions. Type II classification was assigned to patients with restrictive motility loss and diplopia within 20 degrees of the primary position. Ocular motility was assessed before and after two-wall orbital decompression. Only one of 25 type I patients (4%) experienced diplopia after orbital decompression, while seven of 14 (50%) (p = 0.001) type II patients without preoperative primary-position diplopia had primary diplopia postoperatively. Of 12 type II patients who had preoperative primary-position diplopia, esotropia increased by an average of 12.4 diopters postoperatively. Vertical deviation increased an average of 13.4 diopters for 10 patients who underwent unilateral two-wall decompression. The likelihood of new or worsening diplopia in all type II patients following decompression was 22 of 36 (61%). We conclude that adverse motility change following two-wall orbital decompression is rare in type I disease patients, but it occurs 61% of the time in type II disease patients. Predicting preoperatively which patients are likely to develop adverse motility change and diplopia may help clarify indications and risks of orbital decompression surgery in patients with ophthalmic Graves' disease.

Adolescent↗
PubMed2000

Graves' ophthalmopathy: eye muscle involvement in patients with diplopia.

BACKGROUND: Diplopia identifies patients with eye muscle involvement in Graves' ophthalmopathy (GO). OBJECTIVE: To identify clinical parameters that could eliminate the need for magnetic resonance imaging (MRI) to assess the activity of inflammation in the eye muscles of GO patients with diplopia. METHODS: In 43 patients with GO with recently developed diplopia, orbital ultrasound and MRI were performed. Muscle diameters and MRI T2 relaxation times were measured, and the amount of orbital connective tissue was calculated from MRI scans and compared with ultrasound readings, diplopia grades, degree of protrusion, ocular pressure, tear production, antibody levels and hormonal parameters of thyroid function. RESULTS: No correlation was found between diameters of 233 extraocular muscles measured by MRI and by ultrasound. For each of the four muscles, there was a diameter above which ultrasound was always unreliable. MRI data were used in further analysis. Of the muscles examined, the inferior rectuses were the most frequently enlarged - at least one, in 93% of cases. Medial, lateral and superior rectuses were enlarged in 59%, 37% and 34% of the orbits respectively. The pattern of muscle involvement of the two orbits tended to be symmetric (r=0.49, P=0.003), particularly for the medial rectuses (r=0.90, P=0.000). Proptosis correlated with the sum of the muscle diameters for a given eye (right eye: r=0.54, P=0.003; left eye: r=0.57, P=0.001), but it failed to correlate with the amount of orbital connective tissue. In 53% of the patients, normal T2 relaxation times were found in all eight muscles. There was only a weak correlation between muscle thickness and T2 relaxation time (r=0.49, P=0.003), indicating that muscle enlargement alone is not a sign of disease activity. The severity of diplopia was independent of T2 relaxation time. The amount of orbital connective tissue showed a negative correlation with the greatest T2 relaxation time for a given eye (r= -0.52, P=0.004); this suggests that disease types exist that have predominant muscle involvement and predominant connective tissue expansion. No correlation between connective tissue expansion and proptosis, diplopia grade, muscle thickness or disease duration was found - that is, connective tissue expansion is not a major factor in diplopia. Both muscle and connective tissue findings were independent of thyroid function. CONCLUSION: Ultrasound and MRI eye muscle diameter readings do not correlate, because of the inherent inaccuracy of orbital ultrasound. Muscle enlargement alone does not mean oedematous swelling and active disease. Neither ultrasound, nor any combination of 11 clinical and laboratory parameters provided the degree of information on muscles and connective tissue that was obtainable by MRI. In unclear cases of recently developed diplopia, before orbital decompression surgery, in the case of treatment failure or if, for any other reason, imaging is needed in GO, MRI is the method of choice.

Adult↗
PubMed1997

[Diplopia after intraocular lens implantation].

PURPOSE: Seven patients with diplopia after intraocular lens implantation were reported. Possible causes and prevention of diplopia were investigated preliminarily. METHODS: Sixty successive cases, who had accepted uniocular cataract extraction and intraocular lens implantation, were followed-up. The kinds of diplopia, position of eyes, the movements of eyes, refrective state, pupil, fundus of eyes and the states of IOL were examined in all diplopia cases. RESULTS: The incidence of diplopia in our cases was 11.67%. There was a close relationship between postoperative diplopia and preexistent strabismus, fusion disruption, myotoxic effects of local anesthetics, decentration of intraocular lens, macular disease and in identical opacity of posterior capsule. CONCLUSION: Diplopia is a important complication after cataract extraction and intraocular lens implantation. Usually, it is difficult to deal with. It is helpful for decreasing diplopia to take corresponding methods according to possible causes.

Adult↗
PubMed1975

Surgical management of persistent diplopia in blowout fractures of the orbit.

Persistent diplopia continues as a problem in a significant number of patients following the surgical management of a blowout fracture of the orbital floor even when repaired within 15 days of the traumatic incident. Inferior rectus and inferior oblique muscles which have been incarcerated in a blowout fracture for longer periods have a worse prognosis for adequate functioning postoperatively. There is some presumptive evidence to suggest a myogenic or neurogenic cause for such dysfunction. Experiments with posterior fractures clearly demonstrate that the nerve entering the inferior rectus can be damaged. Vertical diplopia which persists beyond 3 months following release of entrapped muscle tissue requires surgical correction depending upon the degree of vertical dissociation. Motility surgery was required in 18 of 20 patients with persistent diplopia. Multiple muscle combinations were frequently required to achieve success. The criterion for a successful result was elimination of vertical diplopia in the primary and reading position. The elimination of persistent diplopia in association with blowout fractures of the orbit is usually possible even in late treated cases when one uses specific criteria for success. Three cases were considered cured since there was no diplopia in any direction of gaze, while 17 cases developed single binocular vision in the primary and reading positions. In these latter patients, on extreme upward or downward gaze, diplopia could still be demonstrated in all patients, especially when the individuals were specifically requested to look for diplopia.

Diplopia↗
PubMed2001

Persistent vertical binocular diplopia after cataract surgery.

PURPOSE: To report the incidence of, and factors associated with, persistent vertical diplopia after cataract surgery. DESIGN: Consecutive interventional case series. METHODS: Retrospectively, all adult patients examined during a five year, five month period because of new onset persistent (>3 months) vertical binocular diplopia after cataract surgery were analyzed. All patients had their cataract surgery at the same outpatient ophthalmic surgery center, and were referred to the author, enabling calculation of incidence. Trends in anesthesia type and strabismus complications therefrom were also assessed. Comparison was made between ophthalmologist-administered retrobulbar anesthesia versus anesthesia staff-administered retrobulbar anesthesia. Incidence during a period in which hyaluronidase was not incorporated in the retrobulbar anesthetic was calculated. RESULTS: Persistent vertical diplopia occurred after cataract surgery in 32 (0.18%) of 17,531 eyes that had cataract surgery. No patient whose cataract surgery was conducted with topical anesthesia (3817 eyes) had persistent vertical diplopia, whereas 32 (0.23%) of the 13714 eyes whose cataract surgery was done after retrobulbar anesthesia were affected. No cases of persistent postoperative diplopia were found among 7410 cataract surgery eyes after retrobulbar injection given by one cataract surgeon. There was a threefold greater number of left eyes involved than right eyes (P <.005). No significant (P >.20) increase in cases of persistent vertical diplopia was noted during a period of hyaluronidase shortage. CONCLUSIONS: In this study, persistent binocular vertical diplopia after cataract surgery occurred in 0.23% of cases in which retrobulbar anesthesia was performed. No cases were found after topical anesthesia. Occurrence may be technique-related.

Aged↗
PubMed1998

[Silent sinus syndrome: an unusual cause of vertical diplopia].

BACKGROUND: Causes of transient vertical diplopia include myasthenia, dysthyroid orbitopathy, multiple sclerosis, decompensation of a pre-existing state. PURPOSE: To describe an unusual cause of transient diplopia, silent sinus syndrome. METHODS: Clinical, radiological and pathology findings from a 55-year-old man with acquired transient vertical diplopia are reported. RESULTS: Eight months after onset of symptoms, vertical diplopia was constant. Hypoglobus and enophthalmos were present. On CT scan, orbital floor was thinned and lowered by 8 mm. Maxillary sinus was filled with material compatible with the histological diagnosis of mucocele. Sinus surgery and orbital floor reconstruction resulted in resolution of diplopia. CONCLUSION: Sinus disorders can produce diplopia and/or visual loss, when invading the orbit. Usually, an acute orbitopathy is obvious. Our case shows that chronic sinus disorders can produce "silent" oculomotor disturbances and, at least in the beginning, transient diplopia.

Diplopia↗
PubMed2001

Diplopia after limited macular translocation surgery.

PURPOSE: Full macular translocation surgery relocates the fovea away from choroidal neovascularization, inducing significant postoperative torsional diplopia. In "limited macular translocation," a saline-induced retinal detachment is followed by scleral imbrication with mattress sutures and spontaneous retinal reattachment. In this study, diplopia was characterized in patients treated with limited macular translocation. METHODS: Two surgeons performed retinal translocation surgery on 250 patients over an 18-month time span. The extent and direction of the retinal translocation, and the amount and location of scleral imbrication, were recorded. All patients complaining of diplopia were referred for ocular motility evaluation and treatment. RESULTS: Thirteen (5.2%) patients complained of occasional or constant diplopia. Imbricating sutures were placed supero-temporally in all cases. Inferior foveal translocation ranged from 200 to 2115 microm (median, 1750 microm). Visual acuity ranged from 20/40 to 20/400 in the operated eye. Prism-and-cover testing underestimated the strabismus when compared with subjective testing. In 3 patients, there was no shift on alternate-cover testing despite binocular diplopia. Excyclotorsion ranged from 0 degrees to 16 degrees. Diplopia resolved in 10 cases with prism; 3 required an occlusive filter for distortion or aniseikonia. One patient underwent successful strabismus surgery to eliminate dependence on prism glasses. CONCLUSIONS: Limited macular translocation only rarely produces symptomatic diplopia. Suprisingly, traditional prism-and-cover testing does not reliably quantify the misalignment. This may result from the combination of a persistent macular scotoma and a repositioned fovea relative to the peripheral retina. Prism therapy is generally satisfactory in the absence of retinal distortion or aniseikonia.

Aged↗
PubMed2003

Anaesthesia-related diplopia after cataract surgery.

BACKGROUND: We studied the incidence and clinical characteristics of persistent diplopia related to anaesthesia for cataract surgery in a general hospital. METHODS: This was a retrospective review of anaesthesia for 3587 cataract surgeries. Of all the cases of diplopia referred to the ocular motility clinic after cataract surgery, those involving anaesthesia-related diplopia lasting longer than 1 month were studied. RESULTS: During the study period, 3450 cataract surgeries were performed by phacoemulsification and 137 by extracapsular extraction. Retrobulbar block was used in 2024 cases, peribulbar block in 98, topical anaesthesia in 1420 and general anaesthesia in 43. Twenty-six cases of persistent diplopia were found (0.72% incidence), nine of which (0.25%) were considered to be related to anaesthetic factors; five of the latter involved the left eye. Five were caused by paresis of the inferior rectus muscle and three by fibrosis. In one patient, the inferior oblique muscle was affected. Anaesthesia was by retrobulbar block in eight cases (0.39%) and by peribulbar block in one. No diplopia was found in patients who had topical or general anaesthesia. Treatment was with surgery in two patients and with prisms in six. One patient continues to be studied. CONCLUSIONS: Persistent diplopia can occur after cataract surgery using retrobulbar block predominantly through direct damage to the inferior rectus muscle. The overall incidence of anaesthesia-related diplopia in this series was 0.25%.

Aged↗
PubMedDate not supplied

[Clinical picture and treatment of diplopia].

A total of 203 patients with stable binocular diplopia were observed. Examinations included coordimetry, analysis of double images, and investigation of the doubling field in the gaze field. All examinations were performed using an original method with a serial computer. The treatment included therapy of the underlying disease, choice of correcting prisms, exercises aimed at extension of separate vision field, and operation on the oculomotor muscles. Three main forms of diplopia were distinguished: 1) muscular; 2) sensory; and 3) mixed. The first form includes diplopias in paresis of n.III and n.IV, n.VI, late development of convergent squint, orbital injuries, endocrine ophthalmopathy, and myasthenia. The second form includes diplopias developing after delayed operations for convergent squint, and the third form are diplopias after operations for detachment of the retina and implantation of intraocular lenses. The treatment led to complete neutralization of doubling in 18.7% cases, neutralization in the main part of the gaze field in 53.7%, the same with prism correction in 12.8% cases; in 14.8% patients adaptation to diplopia was attained after suppression of the second image. Diplopia in late squint is prognostically the most favorable, and the following conditions are listed in the order of more or less good prognosis: paresis of n.VI, n.IV, orbital injuries, endocrine ophthalmopathy, and artiphakia. The least favorable prognoses are for patients after delayed operation for squint and detachment of the retina. A new operation, plastic repair of the external m. rectus, was used in 96 patients with pareses of n.VI; no compensation was attained in only 2 patients.

Adolescent↗
PubMed1996

[Clinical significance of diplopia in HIV infection. Assessment of a personal caseload and review of the literature].

Diplopia is one of the neuro-ophthalmic manifestations that can be observed during HIV-infection. The etiologic agents of diplopia in HIV-positive patients can be identified with HIV itself or opportunistic pathogens or other related conditions. We reviewed the clinical records of 13 HIV-positive patients with mono or bilateral diplopia, focusing on etiologic agents, clinical evaluation and prognosis. This review encompassed all cases observed from January 1992 to June 1995 at the Infectious Diseases Department, Policlinico S. Matteo, University of Pavia. All patients underwent a complete ophthalmologic examination, including visual acuity, anterior segment evaluation with biomicroscopy, dilated indirect ophthalmoscopy and ocular motility evaluation (with Cover test and Hess-Lancaster test). If requested by clinical findings, radiologic (TC and/or MRI) and cerebrospinal fluid examination were performed in some patients. The most common causes of diplopia-CNS lesions or ocular diseases-, resulted in agreement with those reported in the literature (T. gondii, C. neoformans, non-Hodgkin lymphomas, HIV, JC virus, CMV). We were able to confirm, according to our experience, that diplopia occurrence is often a negative prognostic factor, since it is commonly associated with CNS conditions. In most cases diplopia can herald a near demise (8 patients on 13 died with 60 days from diplopia onset). In those cases where a treatment was available (2 cases of cryptococcosis, 1 case of neurotoxoplasmosis and 1 case of CMV retinitis) a complete resolution of neuro-ophthalmic symptoms was achieved.

Adult↗