2. • Diplopia, commonly known as double vision, is a visual condition
where a person sees two images of a single object simultaneously.
• These images can appear side-by-side, overlapping, or vertically
offset from each other.
• Diplopia can occur in one eye (monocular) or both eyes
(binocular), and it can be constant or intermittent.
3. • It often results from issues with eye muscles, nerve damage, or
problems with eye alignment.
4. Evaluation:
Determine the nature either monocular or binocular
Monocular is often An ocular problem
Binocular Occurs When the image produced By the two eye Donot absolutely
match
So that image produced are relatively misaligned
Mainly neurological problems
5. Common causes of monocular diplopia are
• Dry eyes
• Ectopia lentis
• Corneal opacity
• Lens opacity or irregularities
• Macular Or retinal disorders
6. Binocular Diplopia
• Due to the weakness of the EOM muscle
• Defective movement of affected eye result in image object falling on two different
point on retina of two eyes.
• UNCROSSED DIPLOPIA: occurs with abductor palsy–It is seen with LR. SO, & IR
paralysis
• CROSSED DIPLOPIA: occurs with adductor paralysis
• It seen with medial rectus, superior rectus and Inferior rectus paralysis.
7. Analysis
RULE: the displacement of the false image may be horizontal or vertical or both.
RULE2: separation of the 2 image is greatest in the direction in which the weak muscle
had its purest action
RULE 3: falls image is displaced furthest in the direction in which the weak muscle
should move the eye.
8. THE METHOD
Comfortable with his head erect and should preferably be still throughout the
examination carried out is dark room
- A red glass is put in front of one of the eyes (red in front right). It is desirable to use
Armstrong goggles since there are shaped to fit the orbital margin
9. Procedure
Examiner hold, the torch vertical source of light) at around ½ m or Im (it is imp to
mention the distance on chart). The source Of light could be horizontal & if the complain
is vertical seperation of image.
The light is held directly in front of the patient at First
If the patient note as double image, the relative position of the image is noted. The light
is now carried out to the right and then to other 8 positions of gaze If there is no double
vision in primary position the position in which double vision appears and is maximal is
to be noted
10. In each gaze position the patient must be asked whether the image are, parallel,
distance between the two image & tilt if present.
- coloured pencils can be given to patient to show the seperation.
11.
12.
13.
14. DISADVANTAGlES
i. It is mainly a subjective test.
ii. Needs a well cooperative patient.
iii. Test is not reproducible.
iv. In many cases the patients are uncooperative or their intelligence is
obscured by intracranial disease or contracture of the antagonistic
muscles may have set in.
v. The test may give false interpretations if the paresis unmasks a latent
squint or the patient starts fixing with the paralyzed eye,
