Double vision is a common subjective complaint.

May be elicited during the course of an eye examination.

Often the first manifestation of many systemic disorders, especially muscular or neurologic processes.

A description of the symptoms including constancy, intermittency, variability, or stability of the process needed to make appropriate diagnosis.

May be noted with near or at far vision and may involve one eye [monocular] or with both eyes [binocular].

Diplopia may be horizontal, vertical, or oblique.

Binocular diplopia can be corrected by covering either eye.

Monocular diplopia persists in one eye despite covering the other eye.

Physiologic diplopia can be a normal phenomenon when focusing on a finger held close resulting in distant objects being blurry but double.

Binocular diplopia refers to breakdown in the fusional capacity of the binocular system, and the normal neuromuscular coordination does not maintain the connection of the visual objects on the retinas of the eyes.

Occasionally fusion is impaired because of dissimilar image size, which can occur after changes in the optical function of the eye following refractive surgery or after a cataract is replaced by an intraocular lens.

Monocular diplopia may occur from corneal distortion or scarring, openings in the iris, cataract or subluxation of the natural lens or lens implant, vitreous abnormalities, and retinal conditions.

Associated with difficulty with depth perception and disorientation of objects.

Occurs almost exclusively in adults.

The onset, progression, and variability with head posture or gaze direction is helpful in the diagnosis and management.

Evaluation of diplopia includes speed of onset, severity, duration, location, associated symptoms, and aggravating and relieving factors.

Past medical and surgical history and review of systems help in diagnosis.

Facial and head trauma may impair extraocular muscle or cranial nerve function.

Evaluate the ocular system with respect to 2 specific aspects: first, physiologically (in turn also with 2 aspects, ie, sensory function and motor function), and, second, anatomically.

Monocular diplopia is very uncommon and may be caused by severe corneal deformity, astigmatism, multiple pupils or openings in the iris, refractive anomalies, lens implantation and retinal scarring and distortion.

Major differences between the eyes will frequently produce diplopia, especially in extremes of gaze.

Improvement in visual acuity with a pinhole test suggests intraocular or refractive problems.

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