DiplopiaDiplopia

MichaMichaëël l Lxxx Lxxx

DCEM2DCEM2

Toulouse Toulouse PurpanPurpan medicalmedical schoolschool

04/01/201204/01/2012

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OverviewOverview

•• DefinitionDefinition

•• AnatomyAnatomy

•• DiagnosisDiagnosis

•• EtiologiesEtiologies

•• TreatmentTreatment

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DefinitionDefinition

•• DiplopiaDiplopia= Double vision= Double vision: : simultaneoussimultaneousperception of perception of twotwo images of a single images of a single objectobject atat the the samesame time time –– MonocularMonocular diplopiadiplopia

–– BinocularBinocular diplopiadiplopia: : disorderdisorder of the of the oculomotoroculomotorparallelismparallelism

•• ConsequenceConsequence of the of the lacklack of of parallelismparallelism: : abnormalabnormal retinalretinal correspondencecorrespondence

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DefinitionDefinition (2)(2)

httpmedicalcoo-asistent.blogspot.com20101112-diplopia.html httpen.wikipedia.orgwikiDiplopia

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AnatomyAnatomy

•• OculomotorOculomotor muscles (6):muscles (6):

–– RectusRectus muscles: muscles: laterallateral, , medialmedial, superior, , superior,

inferiorinferior

–– Oblique muscles: superior, Oblique muscles: superior, inferiorinferior

•• OculomotorOculomotor nerves (3):nerves (3):

–– III: III: oculomotoroculomotor (MR, SR, IR, IO)(MR, SR, IR, IO)

–– IV: IV: trochleartrochlear (SO)(SO)

–– VI: VI: abducensabducens (LR)(LR)

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AnatomyAnatomy (2)(2)

httpwww.eyescure.comDefault.aspxID=54&Name=Anatomy_of_the_Eyeball

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AnatomyAnatomy (3)(3)

httpradiopaedia.orgimages642

httpradiopaedia.orgimages945

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DiagnosisDiagnosis

•• PC= PC= PresentingPresenting Complaint (Complaint (symptomssymptoms): ):

–– Duplication of an Duplication of an objectobject ((alwaysalways in the in the samesame

direction, direction, whenwhen bothboth eyeseyes are open, are open,

disappearingdisappearing withwith R or L R or L eyeeye occlusion)occlusion)

–– HeadacheHeadache, , funnyfunny turnsturns, , nauseanausea, , vomitingvomiting……

•• O.E= On O.E= On ExaminationExamination::

–– CompensatoryCompensatory torticollistorticollis

–– MisalignmentMisalignment of the of the eyeballeyeball: : strabismusstrabismus

(convergent, divergent(convergent, divergent……))

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DiagnosisDiagnosis (2)(2)

•• OculomotorOculomotor examinationexamination::

–– ParalysisParalysis of nerve III: ptosis, divergent of nerve III: ptosis, divergent

strabismusstrabismus, , paralysisparalysis of the of the eyeballeyeball, , mydriasismydriasis, ,

lossloss of of accomodationaccomodation

–– ParalysisParalysis of nerve IVof nerve IV

–– ParalysisParalysis of nerve VI: convergent of nerve VI: convergent strabismusstrabismus

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DiagnosisDiagnosis (3)(3)

httpwww.siteduzero.comforum-.html

httpwww.pourquoipasgyf.frcategorysimonpage2

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EtiologiesEtiologies

•• Trauma: fracture of the Trauma: fracture of the orbitorbit

•• Tumour: skull base with intracranial Tumour: skull base with intracranial hypertensionhypertension

•• Vascular: stroke, fistula, intracranial aneurysm Vascular: stroke, fistula, intracranial aneurysm

•• DiplopiaDiplopia withwith exophtalmosexophtalmos: Basedow: Basedow

•• PainfulPainful diplopiadiplopia: : diabetesdiabetes, Horton, , Horton, intracranial intracranial aneurysm aneurysm

•• Multiple Multiple sclerosissclerosis ((paralysisparalysis of nerve VI)of nerve VI)

•• MyastheniaMyasthenia

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Etiologies (2)Etiologies (2)

httpwww.ajronline.orgcontent1812583F23.large.jpg

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TreatmentTreatment

•• EarlyEarly stage:stage:–– Occlusion Occlusion of the paralysed eye (to eliminate of the paralysed eye (to eliminate diplopia) diplopia)

–– Prism on glasses (to restore parallelism of Prism on glasses (to restore parallelism of light rays)light rays)

–– Injection of Injection of botulinumbotulinum toxintoxin

•• LateLate stage (stage (dependingdepending on the on the etiologyetiology):):–– EyeEye exercisesexercises

–– WaitWait for nerve for nerve regenerationregeneration (6(6--12 12 monthsmonths))

–– SurgerySurgery (to restore (to restore eyeeye parallelismparallelism))

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TakeTake home messagehome message

•• DiplopiaDiplopia cancan bebe due to a due to a veryvery seriousserious

disorderdisorder!!

•• It It cancan leadlead to to amblyopiaamblyopia ((reducedreduced vision)vision)

•• InvestigateInvestigate immediatelyimmediately::

–– IntracranialIntracranial aneurysmaneurysm ((paralysisparalysis of nerve III of nerve III

withwith headacheheadache))

–– TumourTumour

–– Multiple Multiple sclerosissclerosis ((paralysisparalysis of nerve VI)of nerve VI)

–– MyastheniaMyasthenia

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BibliographyBibliography

•• http://www.eyerobics.com.au/diplopia.htmlhttp://www.eyerobics.com.au/diplopia.html

•• http://http://merckmanuals.commerckmanuals.com/professional/eye /professional/eye disorders/symptoms of disorders/symptoms of ophtalmologicophtalmologicdisorders/disorders/diplopia.htmldiplopia.html

•• http://www.intelihealth.com/IH/ihtIH/WSIHW00http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/9843.html0/9339/9843.html

•• http://en.wikipedia.org/wiki/Diplopiahttp://en.wikipedia.org/wiki/Diplopia

•• http://www.healthscout.com/ency/68/671/main.http://www.healthscout.com/ency/68/671/main.htmlhtml

•• http://www.fascicules.fr/data/consulter/ophtalmhttp://www.fascicules.fr/data/consulter/ophtalmoo--polycopiepolycopie--2323--diplopiediplopie--COUF.pdfCOUF.pdf