Treatment of Diplopia in Parkinson’s Disease

  • Stephen G. ReichEmail author
Part of the Current Clinical Neurology book series (CCNEU)


Diplopia is a common although underappreciated symptom in Parkinson’s disease (PD). It is usually due to a combination of convergence insufficiency and an exophoria. It typically presents with horizontal diplopia, worse at near, which resolves if either eye is closed. It is essential to rule out alternative causes of diplopia unrelated to PD (e.g., myasthenia gravis) as well as recognize and treat other comorbid causes of visual impairment encountered in PD such as dry eye or blepharitis. Convergence insufficiency can be managed with a base in prism, and if ineffective, patients can keep one eye closed, wear an eye patch, or occlude one lens of reading glasses.


Diplopia Convergence insufficiency Ocular motor Parkinson’s disease 

Supplementary material

Video 1

The first part of the video demonstrates the alternate cover test. When the occluder is moved between the eyes, the uncovered eye (which when occluded drifted out) adducts to fixate on a near target confirming the presence of an exophoria. Although not shown there is no ophthalmoparesis. The second part demonstrates impaired convergence (MPG 9130 kb)

Suggested Reading

  1. Almer Z, Klein KS, Marsh L, Gerstenhaber M, Repka MX. Ocular motor and sensory function in Parkinson’s disease. Ophthalmology. 2012;119(1):178–82.CrossRefGoogle Scholar
  2. Archibald NK, Clarke MP, Mosimann UP, Burn DJ. Visual symptoms in Parkinson’s disease and Parkinson’s disease dementia. Mov Disod. 2011;26(13):2387–95.CrossRefGoogle Scholar
  3. Biousse V, Skibell BC, Watts RL, Loupe DN, Drews-Botsch C, Newman NJ. Ophthalmologic features of Parkinson’s disease. Neurology. 2004;62(2):177–80.CrossRefGoogle Scholar
  4. Ekker MS, Janssen S, Seppi K, et al. Ocular and visual disorders in Parkinson’s disease: common but frequently overlooked. Parkinsonism Relat Disord. 2017;40:1–10: S1353-8020(17)30064-0 [pii].CrossRefGoogle Scholar
  5. Friedman DI. Pearls: diplopia. Semin Neurol. 2010;30(1):54–65.CrossRefGoogle Scholar
  6. Hamedani AG, Gold DR. Eyelid dysfunction in neurodegenerative, neurogenetic, and neurometabolic disease. Front Neurol. 2017;8:329.CrossRefGoogle Scholar
  7. Hunt LA, Sadun AA, Bassi CJ. Review of the visual system in Parkinson’s disease. Optom Vis Sci. 1995;72(2):92–9.CrossRefGoogle Scholar
  8. Irving EL, Chriqui E, Law C, et al. Prevalence of convergence insufficiency in Parkinson’s disease. Mov Disord Clin Pract. 2017;4(3):424–9.CrossRefGoogle Scholar
  9. Leigh RJ, Zee DS. The neurology of eye movements. 5th ed. New York: Oxford University Press; 2015. p. 916–26.CrossRefGoogle Scholar
  10. Pinkhardt EH, Jürgens R, Lulé D, et al. Eye movement impairments in Parkinson’s disease: possible role of extradopaminergic mechanisms. BMC Neurol. 2012;12(1):5.CrossRefGoogle Scholar
  11. Racette BA, Gokden MS, Tychsen LS, Perlmutter JS. Convergence insufficiency in idiopathic Parkinson’s disease responsive to levodopa. Strabismus. 1999;7(3):169–74.CrossRefGoogle Scholar
  12. Repka MX, Claro MC, Loupe DN, Reich SG. Ocular motility in Parkinson’s disease. J Pediatr Ophthalmol Strabismus. 1996;33(3):144–7.PubMedGoogle Scholar
  13. Schindlbeck K, Naumann W, Friedrich D, et al. Frequency and characteristics of diplopia in non-demented patients with Parkinsons disease. Mov Disord. 2016;31:S128–9.Google Scholar
  14. White OB, Saint-Cyr JA, Tomlinson RD, Sharpe JA. Ocular motor deficits in Parkinson’s disease: II. control of the saccadic and smooth pursuit systems. Brain. 1983;106(3):571–87.CrossRefGoogle Scholar
  15. Yu C, Lee T, Shariati MA, Santini KP, Liao YJ. Abnormal eye movement behavior during reading in Parkinson’s disease. Parkinsonism Relat Disord. 2016;32:130–2.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.The Frederick Henry Prince Distinguished, Professor in Neurology, Department of NeurologyUniversity of Maryland, BaltimoreBaltimoreUSA

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