Causes and outcomes for patients presenting with diplopia to an eye casualty department.
OBJECTIVE
To evaluate the causes and outcomes for patients presenting with diplopia to an eye casualty department.


METHODS
Patients presenting with diplopia as a principal symptom, who were referred to the Orthoptic Department from Moorfields Eye Casualty over a 12-month period, were retrospectively investigated.


RESULTS
One hundred and seventy-one patients were identified with complete records in 165 cases. There were 99 men and 66 women with an age range of 5-88 years. Monocular diplopia accounted for 19 cases (11.5%), whereas 146 patients (88.5%) had binocular diplopia. Cranial nerve palsies were the most common cause of binocular diplopia accounting for 98 (67%) of cases. Isolated sixth nerve palsy was the largest diagnostic group (n=45). Microvascular disease (hypertension or diabetes mellitus, or both) was present in 59% of patients with cranial nerve palsies, and of this group, 87% resolved spontaneously by 5 months rising to 95% by 12 months.


CONCLUSIONS
Patients with clinically isolated single cranial nerve palsies associated with diabetes or hypertension are likely to recover spontaneously within 5 months and initially require observation only. However, patients with unexplained binocular diplopia and those who progress or fail to recover should be investigated to establish the underlying aetiology and managed as appropriate.
Comer
R M
RM
Department of Paediatric, Moorfields Eye Hospital, London, UK. comerrichard@hotmail.com
Dawson
E
E
Plant
G
G
Acheson
J F
JF
Lee
J P
JP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003389:Cranial Nerve Diseases / Q000150:complications / Q000503:physiopathology; D048909:Diabetes Complications / Q000209:etiology / Q000503:physiopathology; D004172:Diplopia / Q000209:etiology* / Q000503:physiopathology; D004630:Emergencies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015348:Vision, Binocular / Q000502:physiology