What are the clinically significant symptoms of diplopia?

Updated: May 21, 2019
  • Author: Jitander Dudee, MD, MA(Cantab), FACS, FRCOphth; Chief Editor: Andrew G Lee, MD  more...
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Three important symptoms should be elicited, as follows:

  • Does covering either eye make the diplopia disappear? This test helps to rule out monocular diplopia, which persists in one eye even if the other eye is covered. Simply asking about resolution of diplopia when covering one eye is insufficient and may be misleading because the patient may inadvertently cover the eye with the monocular diplopia. This may lead to the mistaken impression that the diplopia is binocular (resolves with covering either eye) rather than monocular.
  • Is the deviation the same in all directions of gaze or by tilting and rotating the head into different positions? A comitant deviation shows minimal or no difference in separation of the images in all directions of gaze. When the extent of deviation changes (and indeed possibly disappears in a given direction), then the deviation is incomitant and suggests a problem with innervation, most likely a paretic muscle.
  • Is the second object displaced horizontally (side-by-side images) or vertically (images above each other)? Oblique diplopia (images separated horizontally and vertically) should be considered as a manifestation of vertical diplopia.

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