Diplopia charting involves recording the separation of double images seen by a patient in nine positions of gaze. The examiner uses a red glass over one eye while holding a light source in different positions. The patient reports if they see one image, two separate images, or a tilted image. The separation is greatest in the direction of an underacting or paralyzed eye muscle. When recording the results, the patient's right and left sides are noted along with the distance of any separation between images and any tilting. The diplopia chart should be interpreted along with a clinical exam and Hess chart.

1. Diplopia Charting
Mantu Akon
M.Optom,(FCOVD) UK
Faculty and Consultant Optometrist
Sankara College Of Optometry and Eye Hospital

2. Introduction
• Diplopia chart is the record of separation of
the diplopic or double images in the nine
positions of gaze.
• It can be plotted charted in patients who
cooperate and can appreciate double vision
and with incomitant or comitant deviation.

3. Proceudure
• The patient should be comfortable with his head
erect and should preferably be still throughout
the examination.
• The test is preferably carried out in a dark room.
• A red glass is put in front of one of the eyes (red
in front of right, R for R, is a convention).
• It is desirable to use Armstrong goggles since
these are shaped to fit the orbital margin and
therefore patient would be looking only through
the colored medium.

4. Procedure
• The examiner holds the torch or Retinoscopy light
(vertical source of light) at around ½ m or 1 m (It
is important to mention the distance on the
chart).
• This source of light could be horizontal if the
complain is of vertical separation of images.
• If the patient sees a single image, the examiner
must establish whether it is a fused image or
supression.

5. • In the direction of the action of the paralyzed
muscle the double vision or the separation
would be greatest because of the underaction
of the muscle and overaction of the antagonist
muscle .

6. Interpretation

7. Diplopia chart (precautions)
• Head must be kept straight during the examination
• The goggles must be well fitting.
• The light should be kept upright (or horizontal in case
of vertical or torsional diplopia) and held at a
consistent distance
• The patient should be asked about tilting of images
• The light should be visible to both the eyes
• Never interpret the diplopia chart in isolation, clinical
examination and Hess chart should be used in
conjunction to come to a conclusion.

8. Diplopia chart (recording on paper)
• While recording the diplopia on paper the right
and left is the patient’s right and left and not the
examiner’s .
• Always note the distance at which the diplopia
charting was done.
• Note the distance of separation of the images in
each position as told by the patient subjectively.
• Tilting of image is drawn as the patient describes
• Although the charting could be drawn from
examiner’s viewpoint too, it is imperative to note
it in the chart.