Diplopia - Double Vision - Differential Diagnosis Algorithm Clinical Pearls: • Diplopia is almost always binocular. • CN VI palsy is a red flag for intracranial masses. • Look for ptosis with CN Ill palsy. • Examine both eyes to determine which is affected. • Neurologic symptoms suggest a mass as the cause. • Myasthenia Gravis is fatiguable. • Migraine is a diagnosis of exclusion. Monocular • Refractive Error • Cataract/Lens Dislocation • Functional • Corneal Distortion/Scarring • Vitreous Abnormalities Neuromuscular Junction • Myasthenia Gravis Extraocular Muscle - Restriction/Entrapment • Orbital Inflammation • Orbital Tumor • Orbital Floor Fracture Strictly Horizontal (Cranial Nerve VI problem) - Cannot Abduct • Ischemia • Diabetes Mellitus • Aneurysm • Tumor • Trauma Cranial Nerve Ill - Eye depressed, abducted, ptosis, large/unreactive pupil • Ischemia • Diabetes Mellitus • Aneurysm • Trauma Cranial Nerve IV - Eye cannot depress when looking medially • Ischemia • Diabetes Mellitus • Aneurysm • Trauma • Subdural Hemorrhage Grave's Ophthalmopathy • Hyperthyroidism #Diplopia #DoubleVision #Differential #Diagnosis #Algorithm #Causes #Ophthalmology
