![]() In binocular diplopia, key details to ascertain include:ġ. Cortical lesions can produce bilateral monocular polyopia but is rare Monocular diplopia is typically due to an ocular cause and will not be discussed further here. Monocular diplopia can be bilateral or unilateral and sometimes patients with monocular symptoms complain of triplopia or more images. Binocular diplopia resolves with either eye being closed and indicates ocular misalignment as an underlying problem. It is important not to ask the more vague and potentially misleading question: “Does the double vision go away with covering ONE eye?” because if the patient happens to close the affected (monocular diplopia) eye then the response might lead the examiner to conclude that the diplopi is binocular when in fact it is monocular. Thus, the key and differentiating question between monocular and binocular diplopia is: “Does the double vision resolve with closing EITHER eye?”. Monocular diplopia persists when the unaffected eye is closed, but will resolve when the affected eye is closed. The initial stage of diplopia workup is to identify whether it is monocular diplopia or binocular diplopia. This article will outline an approach to understanding diplopia through highlighting key facts in the history and exam to guide further workup. 9.2 Cavernous Sinus and Superior Orbital Fissure Involvementĭiplopia is a common presentation to neurology, neuro-ophthalmology, ophthalmology, and general medicine.6.3 Parinaud Syndrome (Dorsal Midbrain Syndrome).5 Binocular diplopia Diagnostic approach.
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