Manual

Approach to diplopia

Neuro-Ophthalmology

Approach to diplopia

Monocular vs binocular.

  1. 1Does it resolve covering either eye? Yes → binocular (misalignment). No → monocular (refractive, cornea, lens, retina).
  2. 2Horizontal or vertical? Worse at distance or near? Which gaze direction?
  3. 3Variable/fatigable with ptosis → myasthenia (ice pack test, AChR/MuSK antibodies).
  4. 4Proptosis, lid retraction → thyroid eye disease (IR and MR most commonly restricted).
  5. 5Parks-Bielschowsky 3-step for vertical deviations — see Testing.

Educational summary — follow local protocols and current guidelines.