COMMENTARY

Seeing Double: Finding the Cause of Diplopia

Brianne N. Hobbs, OD

Disclosures

January 31, 2014

In This Article

Study Summary

This prospective, observational case series described the results of neuroimaging to discover the cause of acute isolated ocular motor nerve palsy in 109 patients older than 50 years. Ten neuro-ophthalmology centers participated in the study, increasing the demographic and geographic diversity compared with previous, single-center studies. All patients had a recent onset of diplopia and were examined within 30 days of the development of symptoms.

Results of neuroimaging showed that:

62 patients had cranial nerve VI palsies;

25 patients had cranial nerve IV palsies; and

22 patients had cranial nerve III palsies.

Using a combination of clinical examination and MRI, it was determined that 18 (16.5%) of the 109 patients had etiologies other than microvascular complications. Among those 18 patients, the most common serious etiologies were neoplasm (8 patients), followed by giant cell arteritis (3 patients) and pituitary apoplexy (2 patients). Of interest, the patients with giant cell arteritis had no systemic symptoms other than diplopia, and all 3 patients had cranial nerve VI palsies. Patients who had at least 1 microvascular risk factor, such as diabetes, hypertension, or previous stroke, were more likely to have a palsy that was microvascular in nature; however, 61.1% of patients with more serious etiologies also had microvascular risk factors, so this was not a reliable predictor of etiology. Nor were age and sex predictive of the etiology of the palsy, because these characteristics were equally distributed between the 2 groups.

 

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