Diplopia differential diagnosis

Diplopia Microchapters
Home
Patient Information
Overview
Historical Perspective
Pathophysiology
Causes
Differentiating Diplopia from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Diplopia differential diagnosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Diplopia differential diagnosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Diplopia differential diagnosis
CDC on Diplopia differential diagnosis
Diplopia differential diagnosis in the news
Blogs on Diplopia differential diagnosis
Directions to Hospitals Treating Diplopia
Risk calculators and risk factors for Diplopia differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Overview

Diplopia may be caused by disorders of the orbit, extraocular muscles, neuromuscular junction dysfuntion, paralysis of the oculomotor, trochlear and abducens nerves, and injuries affecting the central nervous system (CNS). Given the various causes of diplopia, it is important to differentiate between the different causes that lead to diplopia.

Differentiating Diplopia From Other Diseases

Diplopia may be caused by disorders of the orbit, extraocular muscles, neuromuscular junction dysfuntion, paralysis of the oculomotor, trochlear and abducens nerves, and injuries affecting the central nervous system (CNS). Given the various causes of diplopia, it is important to differentiate between the different causes that lead to diplopia. The following table differentiates between various causes of diplopia:

Dilopia causing disorder	Subcategory	Mechanism	Distinguising Features	Exam Findings
Orbital disorder	Trauma
	Orbital apex mass	Inflitration or mass effect in the orbital apex or cavernous sinus Compression of the oculomotor nerve	Palsies of oculomotor, trochlear and/or abducens nerves Periorbital or facial numbness Retro-orbital pain Proptosis Signs of venous congestion
	Orbital cellulitis
	Thyroid-associated ophthalmopathy (Grave's disease)	Autoimmune	Proptosis Restriction of elevation and abduction of the eyes Tachycardia Intolerance to heat Weight loss Insomnia Fatigue Diarrhea
Extraocular muscle disorder	Thyroid-associated ophthalmopathy due to ocular surgery, congenital myopathies, mitochondrial myopathies, muscular dystrophy
	extraocular muscle injury or hematoma
Neuromuscular junction dysfunction	Myasthenia gravis	Auto-antibodies against nicotinic acetylcholine receptors	Fluctuating muscular weakness Ptosis Diplopia and weakness worsens with activity and improves with rest
	Botulism	Inhibition of acetylcholine release due to toxin at cholinergic synapse and pre-synaptic myoneural junction	Dysathria Dysphagia Autonomic dysreflexia Pupillary dysfunction
Palsies of the third, fourth or sixth cranial nerves	Microvascular ischemia – diabetic neuropathy, hemorrhage, tumor, vascular malformation, aneurysm, meningitis, multiple sclerosis
Central nervous system injury (pathways and cranial nerve nuclei)	Basilar artery thrombosis	Occlusive thrombosis of the basilar artery Brainstem ischemia	Dysarthria Vertigo Cranial nerve palsies Presence of risk factors for ischemic stroke
	Vertebral dissection	Vertebrobasilar insufficiency	Acute onset Neck pain Vertigo Presence of risk factors for vertebral dissection
	Aneurysm	Enlarging aneurysm causes direct compression of the cranial nerves	Oculomotor nerve palsy Pupillary involvement
	Wernicke's encephalopathy	Thiamine deficiency leads to metabolic failure and tissue injury	Nystagmus Ataxia Altered mental status Ophthalmoplegia Malnutrition