Download Diplopia

Diplopia
Dr. Mohammed Alanazy
Versions - Terminology
Esotropia
Exotropia
Left Hypertropia
Diplopia
• For horizontal diplopia, there are only four
candidate muscles. Simply distinguishing an
esotropia from an exotropia and determining
the effect of lateral gaze identifies the weak
muscle.
• Horizontal eye movement
• The two most common causes of horizontal
diplopia are VI nerve palsy and INO
• MG and thyroid eye disease must be
considered in every case of diplopia if pupils
are spared
A 40-year-old man has vertical double vision that is worse in the evening. The patient
has no other symptoms and denies head trauma or other systemic illness. Examination
showed no apparent ocular motility disturbance.
1: Identifying the hypertropic eye.
2:Determining whether hypertropia increases in right-gaze or
left-gaze
IR (SO)
SR(IO)
SO
SR
3:Determining whether the hypertropia increases with right
head-tilt or left head-tilt.
SO
• Right 4th nerve palsy results in a right-left-right
pattern.
– Right hyperdeviation, worse in left gaze, worse on
right head tilt.
• Left 4th nerve palsy results in a left-right-left
pattern.
• Left hyperdeviation, worse in right gaze, worse on left
head tilt.
•
Schematic of the third nerve nucleus and its fascicles in the midbrain. P, parasympathetic; IR,
inferior rectus; IO, inferior oblique; LP, levator palpebra; CCN, caudal central nucleus; MR (a,
b, c), medial rectus (three subnuclei); SR, superior rectus.
• All patients with pupil-sparing partial palsies
who do not undergo catheter angiography
should be re-examined during the week
following onset to ensure the pupil remains
normal.
Describe eye movement and localize the
lesion.
Quiz?
• Questions?