2020–2021 BCSC Basic and Clinical Science Course™
Chapter 7: The Patient With Abnormal Ocular Motility or Diplopia
This chapter includes related videos, which can be accessed by scanning the QR codes provided in the text or going to www.aao.org/bcscvideo_section05.
Most patients with acquired ocular motility disorders will have diplopia unless the motility limitation is symmetric. Depending on their motility limitation, some patients without diplopia in primary gaze may develop diplopia in horizontal or vertical gaze. Diplopia can also occur in patients with full ocular motility. Answers to the following questions, which are discussed in this chapter, offer important insight into the nature of a patient’s diplopia:
Does the diplopia resolve when either eye is covered (monocular vs binocular diplopia)?
Is the diplopia horizontal, vertical, oblique, or torsional?
Is the diplopia the same in all fields of gaze (comitant) or does it vary with gaze direction (incomitant)?
Is the diplopia constant, intermittent, or variable?
Patients with an ocular misalignment may report double vision or simply “blurred vision.” If closing either eye eliminates the visual disturbance, the blurred vision can be attributed to ocular misalignment (“binocular blur”). If binocular diplopia resolves when the patient closes either eye, it is because the diplopia results from misalignment of the visual axes. It is helpful to determine if the double vision is more bothersome with far or near fixation, or in a particular position of gaze. Ascertaining whether the patient has a history of head or eye pain, eye or eyelid swelling or redness, numbness, or other neurologic symptoms provides clues about possible orbital, cavernous sinus, or central nervous system causes of diplopia. It is also important to establish whether there is any history of malignancy, trauma, thyroid disease, or generalized weakness when formulating a differential diagnosis for binocular diplopia.
Excerpted from BCSC 2020-2021 series: Section 5 - Neuro-Ophthalmology. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.