Binocular diplopia is the perception of two images of a single object that disappears when closing either eye. It is most commonly caused by an abducens nerve palsy. The most common etiology is microvascular ischemia. Ninety-eight percent of cases resolve spontaneously.

1. Ade Wijaya, MD – October 2021

2.  Binocular diplopia is the simultaneous
perception of two images of a single object
and is characterized by the disappearance of
the double image on closing either eye
 In addition to diplopia, patients may also
complain of visual confusion and be found to
have a disturbed vestibulo–ocular reflex, and
collectively, these symptoms may be referred
to as acute onset binocular diplopia (AOBD)
Danchaivijitr C, Kennard C. Diplopia and eye movement disorders. J Neurol Neurosurg Psychiatry. 2004;75:24–31.
Comer R, Dawson E, Plant G, Acheson J, Lee J. Causes and outcomes for patients presenting with diplopia to an eye casualty department. Eye. 2007;21:413–8.

3.  An ocular misalignment of more than 200 µm
can cause binocular diplopia
 0.1% of the patients that present at an
emergency department
 16 % of the 50,000 emergency department
visits due to diplopia were due to a life-
threatening underlying disease
Nazerian P, Vanni S, Tarocchi C, Portaccio E, Vannucci N, Para O, Giannazzo G, Gigli C, Grifoni S (2014) Causes of diplopia in the emergency department:
diagnostic accuracy of clinical assessment and of head computed tomography. Eur J Emerg Med 21(2):118–124.
Cornblath WT (2014) Diplopia due to ocular motor cranial neuropathies. Continuum (Minneap Minn) 20(4):966–980.
Rucker JC, Tomsak RL (2005) Binocular diplopia. A practical approach. Neurologist 11(2):98–110.

4. Kremmyda O, Frenzel C, Hüfner K, Goldschagg N, Brem C, Linn J, Strupp M. Acute binocular diplopia: peripheral or central?. Journal of neurology. 2020
Dec;267(1):136-42.

5.  Male:Female = 2:1
 Median: 56 years
 Microvascular ischaemia and ocular
myasthenia gravis were two most common
pathogenic mechanisms.
 Resolved spontaneously in 98 % patients
Kumar S. Acute onset binocular diplopia: a retrospective observational study of 100 consecutive cases managed at a tertiary eye centre in Saudi Arabia. Eye.
2020 Sep;34(9):1608-13.

6. VI III IV
Most
common
Kremmyda O, Frenzel C, Hüfner K, Goldschagg N, Brem C, Linn J, Strupp M. Acute binocular diplopia: peripheral or central?. Journal of neurology. 2020
Dec;267(1):136-42.

7. Number of positive cases of Dizziness/vertigo, SVV deviation and central Ocular
motor disorder (Omd) in the non-paretic eye. The initials (DSO) can be
remembered using the mnemonic device “Don’t Snub the Other eye”
Kremmyda O, Frenzel C, Hüfner K, Goldschagg N, Brem C, Linn J, Strupp M. Acute binocular diplopia: peripheral or central?. Journal of neurology. 2020
Dec;267(1):136-42.

8.  Simultaneous perception of two images of a
single object and is characterized by the
disappearance of the double image on
closing either eye
 Most common: abducens palsy
 Most common etiology: microvascular
ischaemia
 98 % resolve spontaneously