Diplopia

Differential Diagnosis

• Monocular
  • Ophthalmology problems
• Binocular
  • Muscle
    • Thyroid orbitopathy
    • Myasthenia gravis
  • Nerves
    • CN III, IV, VI
  • Brain
    • Brainstem mass or infarct
    • etc

Physical Examination

• Inspection
  • Head tilt (away from CN IV lesion) or head turn (toward CN VI lesion)
  • Eyelid retraction (orbitopathy) or ptosis (MG and CN III palsy)
  • Pupils for anisocoria and pupillary light reflex
• Alignment & motility
  • Look for deviation, confirm with cover-uncover
  • Extraocular movements
• Special tests
  • CN exam
  • Pupil size and ligh reaction (CN III)
  • Head tilt test (CN IV)
  • Fundoscopy for papilledema (CN VI)