Diplopia differential diagnosis: Difference between revisions
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! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Exam Findings''' | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Exam Findings''' | ||
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| colspan="1" rowspan="4" style="background: #DCDCDC; padding: 5px; text-align: center;" |Orbital disorder | | colspan="1" rowspan="4" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Orbit (anatomy)|Orbital]] disorder | ||
| colspan="1" rowspan="1" |Trauma | | colspan="1" rowspan="1" |Trauma | ||
| | | | ||
* Direct injury to the orbit or eye | * Direct injury to the [[orbit]] or [[eye]] | ||
| | | | ||
* Ecchymosis | * [[Ecchymosis]] | ||
* Bone fracture | * [[Bone fracture]] | ||
* Hematoma formation | * [[Hematoma]] formation | ||
* Altered mental status | * [[Altered mental status]] | ||
| | | | ||
|- | |- | ||
|Orbital apex mass<ref name="urlthejns.org">{{cite web |url=https://thejns.org/doi/pdf/10.3171/foc.2001.10.5.2 |title=thejns.org |format= |work= |accessdate=}}</ref> | |[[Orbital cavity|Orbital apex]] mass<ref name="urlthejns.org">{{cite web |url=https://thejns.org/doi/pdf/10.3171/foc.2001.10.5.2 |title=thejns.org |format= |work= |accessdate=}}</ref> | ||
| | | | ||
* Inflitration or mass effect in the orbital apex or cavernous sinus | * Inflitration or mass effect in the [[Orbital cavity|orbital apex]] or [[cavernous sinus]] | ||
* Compression of the oculomotor nerve | * Compression of the [[oculomotor nerve]] | ||
| | | | ||
* Palsies of oculomotor, trochlear and/or abducens nerves | * [[Palsy|Palsies]] of [[oculomotor]], [[trochlear]] and/or [[Abducens nerve|abducens nerves]] | ||
* Periorbital or facial numbness | * Periorbital or facial [[Paresthesia|numbness]] | ||
* Retro-orbital pain | * Retro-orbital [[pain]] | ||
* Proptosis | * [[Proptosis]] | ||
* Signs of venous congestion | * Signs of venous congestion | ||
| | | | ||
* Multi-directional horizantal and vertical diplopia | * Multi-directional horizantal and vertical diplopia | ||
* Down and out pupil | * Down and out pupil | ||
* Pupillary dilation | * [[Pupillary dilation]] | ||
* Deterioration of visual acuity | * Deterioration of [[visual acuity]] | ||
* | * [[Exophthalmos]] | ||
* Prominent choroidal folds | * Prominent [[Choroidal|choroidal folds]] | ||
* Optic atrophy | * [[Optic atrophy]] | ||
* Bone destruction | * [[Bone]] destruction | ||
|- | |- | ||
|Orbital cellulitis<ref name="pmid22346113">{{cite journal |vauthors=Chaudhry IA, Al-Rashed W, Arat YO |title=The hot orbit: orbital cellulitis |journal=Middle East Afr J Ophthalmol |volume=19 |issue=1 |pages=34–42 |date=January 2012 |pmid=22346113 |doi=10.4103/0974-9233.92114 |url=}}</ref><ref name="pmid23960899">{{cite journal |vauthors=Lee S, Yen MT |title=Management of preseptal and orbital cellulitis |journal=Saudi J Ophthalmol |volume=25 |issue=1 |pages=21–9 |date=January 2011 |pmid=23960899 |doi=10.1016/j.sjopt.2010.10.004 |url=}}</ref> | |[[Orbital cellulitis]]<ref name="pmid22346113">{{cite journal |vauthors=Chaudhry IA, Al-Rashed W, Arat YO |title=The hot orbit: orbital cellulitis |journal=Middle East Afr J Ophthalmol |volume=19 |issue=1 |pages=34–42 |date=January 2012 |pmid=22346113 |doi=10.4103/0974-9233.92114 |url=}}</ref><ref name="pmid23960899">{{cite journal |vauthors=Lee S, Yen MT |title=Management of preseptal and orbital cellulitis |journal=Saudi J Ophthalmol |volume=25 |issue=1 |pages=21–9 |date=January 2011 |pmid=23960899 |doi=10.1016/j.sjopt.2010.10.004 |url=}}</ref> | ||
| | | | ||
* Spread of infection from contiguous sinuses (especially ethmoidal | * Spread of [[infection]] from contiguous sinuses (especially [[Ethmoid sinus|ethmoidal sinus]]) | ||
* Culprit organisms include S. aureus and S. pneumoniae | * Culprit organisms include [[Staphylococcus aureus|S. aureus]] and [[S. pneumoniae]] | ||
| | | | ||
* Proptosis | * [[Proptosis]] | ||
* Eyelid edema | * [[Eyelid]] [[edema]] | ||
* Ophthalmoplegia | * [[Ophthalmoplegia]] | ||
* Ocular pain | * [[Ocular]] [[pain]] | ||
* Presence of risk factors: | * Presence of [[risk factors]]: | ||
** Recent upper respiratory illness | ** Recent [[Upper respiratory infection|upper respiratory illness]] | ||
** Sinus infection | ** [[Sinusitis|Sinus infection]] | ||
** Younger age | ** Younger age | ||
** Retained foreign bodies within the orbit | ** Retained foreign bodies within the [[Orbit (anatomy)|orbit]] | ||
** Trauma | ** [[Trauma]] | ||
** Immunosuppression | ** [[Immunosuppression]] | ||
** Systemic infection | ** [[Systemic infection]] | ||
** Dental infections | ** [[Dental caries|Dental infections]] | ||
| | | | ||
* Eyelid swelling | * [[Eyelid]] [[swelling]] | ||
* Conjunctival chemosis | * [[Chemosis|Conjunctival chemosis]] | ||
* Axial proptosis | * Axial [[proptosis]] | ||
* Restriction of eye movements | * Restriction of eye movements | ||
* Retinal venous congestion | * Retinal venous congestion | ||
* Papilledema | * [[Papilledema]] | ||
|- | |- | ||
|Thyroid-associated ophthalmopathy (Grave's disease)<ref name="pmid28405484">{{cite journal |vauthors=Şahlı E, Gündüz K |title=Thyroid-associated Ophthalmopathy |journal=Turk J Ophthalmol |volume=47 |issue=2 |pages=94–105 |date=April 2017 |pmid=28405484 |doi=10.4274/tjo.80688 |url=}}</ref><ref name="pmid26351570">{{cite journal |vauthors=Barrio-Barrio J, Sabater AL, Bonet-Farriol E, Velázquez-Villoria Á, Galofré JC |title=Graves' Ophthalmopathy: VISA versus EUGOGO Classification, Assessment, and Management |journal=J Ophthalmol |volume=2015 |issue= |pages=249125 |date=2015 |pmid=26351570 |doi=10.1155/2015/249125 |url=}}</ref> | |Thyroid-associated ophthalmopathy ([[Grave's disease]])<ref name="pmid28405484">{{cite journal |vauthors=Şahlı E, Gündüz K |title=Thyroid-associated Ophthalmopathy |journal=Turk J Ophthalmol |volume=47 |issue=2 |pages=94–105 |date=April 2017 |pmid=28405484 |doi=10.4274/tjo.80688 |url=}}</ref><ref name="pmid26351570">{{cite journal |vauthors=Barrio-Barrio J, Sabater AL, Bonet-Farriol E, Velázquez-Villoria Á, Galofré JC |title=Graves' Ophthalmopathy: VISA versus EUGOGO Classification, Assessment, and Management |journal=J Ophthalmol |volume=2015 |issue= |pages=249125 |date=2015 |pmid=26351570 |doi=10.1155/2015/249125 |url=}}</ref> | ||
| | | | ||
* Autoimmune | * [[Autoimmune]] | ||
| | | | ||
* Proptosis | * [[Proptosis]] | ||
* Restriction of elevation and abduction of the eyes | * Restriction of elevation and [[abduction]] of the eyes | ||
* Tachycardia | * [[Tachycardia]] | ||
* Intolerance to heat | * Intolerance to heat | ||
* Weight loss | * [[Weight loss]] | ||
* Insomnia | * [[Insomnia]] | ||
* Fatigue | * [[Fatigue]] | ||
* Diarrhea | * [[Diarrhea]] | ||
| | | | ||
* Dysthyroid orbitopathy (involvement of medial and inferior rectii muscles) | * Dysthyroid orbitopathy (involvement of [[Medial rectus muscle|medial]] and [[Inferior rectus muscle|inferior rectii]] muscles) | ||
* Von Grafe's sign (lid lag on downward gaze) | * [[Von Graefe sign|Von Grafe's]] sign (lid lag on downward gaze) | ||
* Joffroy sign (Absent creases on forehead on upward gaze) | * Joffroy sign (Absent creases on forehead on upward gaze) | ||
* Stellwag sign (Infrequent and incomplete blinking) | * [[Stellwag's sign|Stellwag sign]] (Infrequent and incomplete blinking) | ||
* Boston sign (jerky irregular movements on downward gaze) | * [[Boston's sign|Boston sign]] (jerky irregular movements on downward gaze) | ||
* Vigouroux sign (eyelid fullness) | * Vigouroux sign (eyelid fullness) | ||
* Dalrymple’s sign | * [[Dalrymple sign|Dalrymple’s sign]] | ||
* Optic disc edema | * [[Optic disc]] [[edema]] | ||
* Choroidal folds | * [[Choroidal|Choroidal folds]] | ||
* Optic disc paleness | * [[Optic disc]] paleness | ||
|- | |- | ||
| rowspan="3" style="background: #DCDCDC; padding: 5px; text-align: center;" |Extraocular muscle disorder | | rowspan="3" style="background: #DCDCDC; padding: 5px; text-align: center;" |Extraocular muscle disorder | ||
Revision as of 20:00, 19 February 2019
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Diplopia Microchapters |
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Diplopia differential diagnosis On the Web |
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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: Syed Hassan A. Kazmi BSc, MD [2]
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 |
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| Orbital apex mass[1] |
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| Orbital cellulitis[2][3] |
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| Thyroid-associated ophthalmopathy (Grave's disease)[4][5] |
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| Extraocular muscle disorder | Extraocular muscle injury or hematoma[6][7] |
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| Mitochondrial myopathies[8] |
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| Muscular dystrophy[9] |
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| Neuromuscular junction dysfunction | Myasthenia gravis[10][11] |
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| Botulism[12] |
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| Palsies of the third, fourth or sixth cranial nerves | Oculomotor nerve palsy |
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| Trochlear nerve palsy |
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| Abducens nerve palsy |
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| Central nervous system injury (pathways and cranial nerve nuclei) | Basilar artery thrombosis[13][14] |
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| Vertebral dissection[15][16] |
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| Aneurysm |
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| Wernicke's encephalopathy[17][18] |
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References
- ↑ "thejns.org".
- ↑ Chaudhry IA, Al-Rashed W, Arat YO (January 2012). "The hot orbit: orbital cellulitis". Middle East Afr J Ophthalmol. 19 (1): 34–42. doi:10.4103/0974-9233.92114. PMID 22346113.
- ↑ Lee S, Yen MT (January 2011). "Management of preseptal and orbital cellulitis". Saudi J Ophthalmol. 25 (1): 21–9. doi:10.1016/j.sjopt.2010.10.004. PMID 23960899.
- ↑ Şahlı E, Gündüz K (April 2017). "Thyroid-associated Ophthalmopathy". Turk J Ophthalmol. 47 (2): 94–105. doi:10.4274/tjo.80688. PMID 28405484.
- ↑ Barrio-Barrio J, Sabater AL, Bonet-Farriol E, Velázquez-Villoria Á, Galofré JC (2015). "Graves' Ophthalmopathy: VISA versus EUGOGO Classification, Assessment, and Management". J Ophthalmol. 2015: 249125. doi:10.1155/2015/249125. PMID 26351570.
- ↑ Thacker NM, Velez FG, Demer JL, Wang MB, Rosenbaum AL (2005). "Extraocular muscle damage associated with endoscopic sinus surgery: an ophthalmology perspective". Am J Rhinol. 19 (4): 400–5. PMID 16171176.
- ↑ Chen J, Kang Y, Deng D, Shen T, Yan J (September 2015). "Isolated Total Rupture of Extraocular Muscles". Medicine (Baltimore). 94 (39): e1351. doi:10.1097/MD.0000000000001351. PMID 26426604.
- ↑ Schrier SA, Falk MJ (September 2011). "Mitochondrial disorders and the eye". Curr Opin Ophthalmol. 22 (5): 325–31. doi:10.1097/ICU.0b013e328349419d. PMID 21730846.
- ↑ "Oculopharyngeal Muscular Dystrophy - NORD (National Organization for Rare Disorders)".
- ↑ "Update on the Diagnosis of Ocular Myasthenia Gravis - American Academy of Ophthalmology".
- ↑ Nair AG, Patil-Chhablani P, Venkatramani DV, Gandhi RA (October 2014). "Ocular myasthenia gravis: a review". Indian J Ophthalmol. 62 (10): 985–91. doi:10.4103/0301-4738.145987. PMC 4278125. PMID 25449931.
- ↑ Khakshoor H, Moghaddam AA, Vejdani AH, Armstrong BK, Moshirfar M (May 2012). "Diplopia as the primary presentation of foodborne botulism". Oman J Ophthalmol. 5 (2): 109–11. doi:10.4103/0974-620X.99375. PMC 3441016. PMID 22993467.
- ↑ Demel SL, Broderick JP (July 2015). "Basilar Occlusion Syndromes: An Update". Neurohospitalist. 5 (3): 142–50. doi:10.1177/1941874415583847. PMID 26288672.
- ↑ von Campe G, Regli F, Bogousslavsky J (December 2003). "Heralding manifestations of basilar artery occlusion with lethal or severe stroke". J. Neurol. Neurosurg. Psychiatry. 74 (12): 1621–6. PMID 14638878.
- ↑ Park KW, Park JS, Hwang SC, Im SB, Shin WH, Kim BT (September 2008). "Vertebral artery dissection: natural history, clinical features and therapeutic considerations". J Korean Neurosurg Soc. 44 (3): 109–15. doi:10.3340/jkns.2008.44.3.109. PMID 19096659.
- ↑ Gottesman RF, Sharma P, Robinson KA, Arnan M, Tsui M, Ladha K, Newman-Toker DE (September 2012). "Clinical characteristics of symptomatic vertebral artery dissection: a systematic review". Neurologist. 18 (5): 245–54. doi:10.1097/NRL.0b013e31826754e1. PMID 22931728.
- ↑ Serlin T, Moisseiev E (2017). "Fundus Findings in Wernicke Encephalopathy". Case Rep Ophthalmol. 8 (2): 406–409. doi:10.1159/000478924. PMID 28924437.
- ↑ "Nystagmus from Wernicke's Encephalopathy | NEJM".