![]() ![]() Occasionally, magnetic resonance imaging (MRI) or other appropriate imaging will be performed to diagnose a condition affecting the brainstem, like a stroke.Specific treatment varies depending on the underlying cause, but supportive measures can be taken to reduce associated symptoms. Depending on the suspected cause, blood tests may be performed to diagnose the condition, such as testing for myasthenic antibodies in the case myasthenia gravis is suspected. If only one muscle is affected, the diplopia will be worse when the individual looks in the direction of the affected eye muscle. Additionally, the clinician may ask the individual to move their eyes in different directions, which can show whether a particular eye muscle or cranial nerve is affected. During the physical examination, a clinician will often test the individual’s sight while covering one eye at a time to differentiate between binocular and monocular diplopia. Diagnosis often begins with a medical examination, including a physical examination and review of symptoms and medical history. How is binocular diplopia diagnosed and treated?ĭiagnosis of binocular diplopia focuses on determining the underlying cause. Refractive error, which occurs when the shape of the eye keeps light from hitting the retina properly, is another source of monocular diplopia. Dry eye is a common cause of monocular diplopia, as reduced tear production can damage the front of the eye. Monocular double vision usually indicates a problem with a structure in one eye. In contrast, an individual with binocular diplopia sees double when both eyes are uncovered, and their double vision resolves when they cover either eye. Monocular diplopia, which is when double vision affects only one eye, is pronounced when the unaffected eye is covered, and it appears to resolve when the affected eye is covered. Monocular and binocular diplopia can be differentiated from one another by covering one eye at a time. Join millions of students and clinicians who learn by Osmosis! Start Your Free Trial How can you tell the difference between monocular and binocular diplopia? Severe central nervous system infections, such as meningitis, may also lead to swelling or inflammation around the brain stem and subsequently block the nerves from sending messages to the eyes. Tumors may grow in areas of the brainstem affecting the eyes. A stroke occurs when a blood vessel is blocked, preventing oxygen from getting through to part of the brain, including areas that affect the eyes. For example, multiple sclerosis is a neurological disorder that often causes diplopia by damaging the myelin sheaths, or protective barriers, on the nerves that facilitate vision.įinally, brainstem disorders, which are rare and often caused by a stroke, tumor, demyelination, or infection, can also lead to binocular diplopia. Such damage may be a result of conditions including diabetes, infection, inflammation, or a cerebral aneurysm, which happens when blood flow causes a weak spot in a brain artery to protrude.ĭouble vision may also be a result of problems in the nervous system due to a neurological disorder. Damage to cranial nerves III, IV, and VI may cause double vision. In the case of botulism, a bacterial toxin causes muscle weakness, particularly in the face.Ĭranial nerves, which go directly from the brain to the area they innervate, are also involved in vision. Ocular myasthenia gravis affects only the eyes, while generalized myasthenia gravis causes body-wide symptoms in addition to binocular diplopia. There are two types of myasthenia: ocular and generalized. Myasthenia gravis is a neuromuscular disease in which the body’s immune system blocks communication between nerves and muscles, causing muscle weakness and fatigue. ![]() Neuromuscular diseases, such as myasthenia gravis and botulism, affect neurons at the neuromuscular junction and can lead to binocular diplopia. When a trauma breaks bones around the eye, a muscle can get caught in the bone fragment, potentially reducing eye mobility and leading to double vision. Injuries can also interfere with the eye muscles. Similarly, ocular myositis is an inflammatory condition that affects the extraocular muscles. Graves' ophthalmopathy, or thyroid eye disease, is an autoimmune disorder that causes inflammation and swelling around the extraocular muscles, consequently restricting the eyes’ range of movement. Graves’ ophthalmopathy, orbital myositis, and muscular entrapment can all create problems with the eye muscles. There are many potential causes of binocular diplopia, including problems with the eye muscles, neuromuscular diseases, damage to the cranial nerves, and neurological or brainstem disorders. ![]()
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