It is important to differentiate
binocular double vision from monocular vision. Binocular double vision
disappears when one eye is covered and is usually caused by an imbalance
of the extraocular muscles. There may be associated systemic diseases such
as hypertension, diabetes mellitus or intracranial lesions.
Some may present with blurred vision
Determine if the double vision is binocular
by getting the patient to cover one eye and observe if the double vision
Determine if the double vision is vertical
or horizontal, an imbalance of horizontal muscles causes horizontal double
vision whereas an imbalance of vertical muscles causes vertical double
Examine the ocular movement for any
underaction of the extraocular muscles.
Look for associated signs especially
the presence of ptosis and dilated pupil (third nerve palsy)
If the double vision was binocular refers
the patient within 24 hours. The patient will be evaluated by the orthoptic
department and may be prescribed prism to fuse the images.
If the double vision was monocular,
advise the patient to consult an optician as the problem may be refractive.
If the double vision can not be abolished with glasses refers the patient
to the clinic.
A patient with a right abducent
nerve palsy. Note the failure of the right eye to
abduct on right gaze. In the elderly
patient it is important to exclude hypertension
or diabetes mellitus as vascular
causes of the palsy. In younger patient, trauma or
intracranial malignancy should be