Diplopia Diagnostics: Exploring Underlying Causes and Clinical Features in Neurological Practice

Abstract

Diplopia is a common complaint with two subtypes: monocular and binocular in the emergency department (ED) and outpatient clinic. Monocular diplopia is typically associated with ocular abnormalities and refractive errors, whereas binocular diplopia may indicate the presence of an underlying life-threatening cause. To emphasize the importance of identifying underlying neurologic disease in individuals experiencing diplopia. Over a 3-year period, patients admitted to the ED and neurology outpatient clinic with diplopia were retrospectively analyzed. ‘Secondary diplopia’ was defined when an organic cause was found. ‘Isolated diplopia’ was identified as the absence of additional signs and symptoms other than diplopia. All patients were examined for risk factors and investigated for an etiology. Out of the 222 (male: 138) patients, 213 (96%) had binocular diplopia. Secondary diplopia was observed in 113 (53%) patients and 82 (38.4%) had isolated diplopia. One hundred twenty-five (58.6%) patients had at least one sign or symptom associated with diplopia. The incidence of diabetes was significantly higher in secondary diplopia. Ninety-three (43.6%) patients had ocular cranial nerve palsy, most commonly in the 6th cranial nerve. Diplopia with at least one associated sign or symptom and ocular cranial nerve involvement was statistically significant for secondary diplopia. In cases of acute diplopia the presence of at least one additional associated sign or symptom was significantly higher. It is very important to investigate an underlying neurologic etiology that may be life-threatening because secondary diplopia was detected in half of the patients with diplopia in the present study.