Diplopia

Question 1

DDx of diploplia

Answer 1

• Emergency
• Refractive
• Functionality
• Neuropathological
• Mechanical

Question 2

Pt presents w diplopia - rule out emergency:

Answer 2

• More than 1 CN involved, refer
• Distressed
• Neurological signs
• Stroke (CN7): sudden onset

Question 3

If diplopia mono then…

Answer 3

Refract and check media (astig, dislocated lens)

Question 4

If diplopia bino then there is a…

Answer 4

Deviation/misalignment of the eyes

Question 5

Bino comitant -

Answer 5

Size of deviation within 5 or fewer PD in all gaze positions

Question 6

Bino non-comitant

Answer 6

Size of deviation greater than 5 PD in some gaze positions

Question 7

Comitancy testing:

Answer 7

• Good observer
• Muscle field testing (red lens, CT) - bino
• Projection test (ARFT, foster torches)

Question 8

If deviation is comitant then perform…

Answer 8

Fxn analysis, manage, spread of comitancy

Question 9

Spread of comitancy -

Answer 9

Problem has been there for awhile (abnormal head turn, large fusional reserves)

Assoiciated w diploplia related to fatigue, cyclophoria, AV syndrome

Question 10

If deviation is non-comitant then identify…

Answer 10

Paretic/weak EOMs

Question 11

Purely horizontal comitant will affect how many muscles?

Answer 11

4

Question 12

Purely vertical comitant will affect how many muscles?

Answer 12

8

Question 13

Exo deviation greater on left gaze =

Answer 13

RMR

Question 14

Exo dev greater on right gaze =

Answer 14

LMR

Question 15

Eso dev greater on left gaze =

Answer 15

LLR

Question 16

Eso dev greater on right gaze =

Answer 16

RLR

Question 17

What are the 3 questions of Park’s 3 step?

Answer 17

1. Which eye is hyper?
2. Is the dev greater on the left or right gaze?
3. Is the dev greater on the head tilt to the left or right gaze?