What is the role of imaging studies in the workup 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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Order CT scan or MRI (with contrast) of the skull and orbits to rule out intracranial masses or other pathologic processes, such as the following [9] :

  • A blow-out fracture requires imaging of the orbital floor.
  • Enlarged muscles due to thyroid ophthalmopathy.
  • Tumor of orbit
  • Tumor along cranial nerve pathway
  • Increased intracranial pressure can account for bilateral abducens palsy.
  • Aneurysm of intracranial carotid artery
  • Carotid cavernous fistula: Angiography may be required to confirm the presence of a low-flow fistula.
  • Disease of sinuses (eg, infection, tumor) or bony disorders (eg, dysostoses, encephalocele) can account for displacement of the eye.

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