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Neurologist. 2005 Mar;11(2):98-110.

Binocular diplopia. A practical approach.

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Department of Neurology and Ophthalmology, Case Western Reserve School of Medicine, Cleveland, Ohio 44106, USA.



Diplopia is a common complaint in both inpatient and outpatient neurologic practice. Its causes are many, and special historical and examination features are important to localization and accurate diagnosis.


This review is divided into 2 sections: the first related to diagnosis and the second to treatment of binocular diplopia. In the diagnostic section, emphasis is placed on identification of historical and examination features that can help to differentiate diplopia caused by dysfunction of cranial nerves versus neuromuscular junction, or orbital extraocular muscle. Techniques available to the neurologist for examining ocular motility and ocular misalignment and focused laboratory testing to evaluate diplopia are discussed in detail. The final section covers the various treatments for binocular diplopia, with recommendations regarding the utility of each treatment for different types of diplopia.


A logical step-by-step approach applied to each patient with diplopia will help prevent misdiagnosis and improve patient care.

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