RT Book, Section
A1 Lueder, Gregg T.
SR Print(0)
ID 56150265
T1 Chapter 11. Diplopia
T2 Pediatric Practice: Ophthalmology
YR 2011
FD 2011
PB The McGraw-Hill Companies
PP New York, NY
SN 9780071633802
LK accesspediatrics.mhmedical.com/content.aspx?aid=56150265
RD 2024/04/20
AB Table  Graphic  Jump  Location|Download  (.pdf)|PrintThe  Problem“I  see  two  of  things.”Common  CausesPhysiological  diplopiaBreakdown  of  phoriaCranial  nerve  palsyThird  nerve  palsyFourth  nerve  palsySixth  nerve  palsyOther  CausesDecompensated  childhood  strabismusDuane  syndromeMyasthenia  gravis  (discussed  in  ptosis  chapter)KEY  FINDINGSHistoryPhysiological  diplopiaUsually  noticed  about  ages  5  to  6  yearsMost  common  in  bright,  observant  childrenNot  bothered  by  symptomsBreakdown  of  phoriaOften  no  known  history  of  strabismusDevelop  strabismus  and  diplopia  during  severe  illnessResolves  after  recovery  of  illnessCranial  nerve  palsiesThird  nerve  palsyHorizontal  and  vertical  diplopiaPtosisUnequal  pupils  (anisocoria)Fourth  nerve  palsyUsually  gradually  worsening  vertical  diplopiaHead  tiltSixth  nerve  palsyHorizontal  diplopiaRecent  viral  illnessIdiopathic  intracranial  hypertensionHeadacheBrief  episodes  of  vision  loss  (transient  visual  obscurations)Recent  medication  changeCorticosteroids,  isotretinoic  acid,  othersExaminationPhysiological  diplopiaNormal  ophthalmic  examinationNormal  physical  examinationBreakdown  of  phoriaVariable  esotropia  or  exotropiaNo  limitation  of  extraocular  movementsCranial  nerve  palsiesFourth  nerve  palsyUsually  head  tiltEyes  straight  when  head  tilted  to  unaffected  sideVertical  misalignment  when  tilted  to  affected  sideSixth  nerve  palsyEsotropiaInability  to  move  affected  eye  outwardIdiopathic  intracranial  hypertensionObesityPapilledemaThird  nerve  palsyEye  out  and  downPtosis  on  affected  sideAnisocoria  (affected  pupil  larger  in  acquired  third  nerve  palsy)Possible  other  neurological  signs