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Diplopia and Strabismus

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Albert and Jakobiec's Principles and Practice of Ophthalmology

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Abstract

Several requirements are necessary for single visual images. Individuals with normal retinal correspondence and aligned eyes have single vision. Anomalous retinal correspondence occurs to restore crude binocularity when the eyes are not able to work together via sensory and motor fusion. Central fusion results when an image falls on corresponding retinal points within the fovea. Peripheral fusion occurs in response to images falling on corresponding retinal areas within the extrafoveal retinal periphery. Sensory fusion refers to binocular single vision. Motor fusion is the ability to align the eyes so that sensory fusion is maintained. Suppression is strictly limited to binocular vision, an adaptation to avoid diplopia and confusion. Binocular diplopia is a normal, physiologically correct response and happens when identical objects are imaged on disparate retinal areas. Monocular diplopia may occur from anomalies of the ocular media, in the presence of optical aberrations, due to cortical dysfunction, or due to sensory anomalies. Physiologic diplopia is a normal response to binocular vision and serves as evidence of normal cooperation of the two eyes. Paradoxical diplopia takes place in the presence of persistent anomalous retinal correspondence after strabismus surgery. It usually resolves within days to weeks. Binocular triplopia exists when the fovea of one eye localizes one visual object simultaneously in two visual directions while viewing the object with both eyes at the same time. Confusion develops when two different objects are imaged on corresponding retinal areas and perceived concurrently by the brain. Strabismus, with or without diplopia, can negatively impact the psychosocial health and quality of life of an individual. Treatment for double vision may be surgical or nonsurgical, and the treatment method applied depends on multiple factors such as the characteristics of the diplopia, presence or absence of extraocular muscle paralysis, and patient preference. Nonsurgical treatment options include occlusion and prisms. If systemic disease such as myasthenia is present, this should be addressed. Surgical treatment options include botulinum toxin injections and eye muscle surgery, which may involve transposition procedures, adjustable sutures, and oblique muscle surgery. Careful preoperative evaluation is crucial, and both forced duction testing and mapping of the deviation using Lancaster red-green or Hess screen evaluation may be helpful.

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Authors and Affiliations

  1. The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Angela N. Buffenn

  2. Roski Eye Institute, University of Southern California, Los Angeles, CA, USA

    Angela N. Buffenn

  3. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Angela N. Buffenn

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  1. Angela N. Buffenn
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Correspondence to Angela N. Buffenn .

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Editors and Affiliations

  1. Casey Eye Institute, Oregon Health & Science, Portland, OR, USA

    Daniel M. Albert

  2. Department of Ophthalmology, Massachusetts Eye and Ear, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Joan W. Miller

  3. Department of Ophthalmology, University of Illinois College of Medicine, University of Illinois at Chicago, Chicago, IL, USA

    Dimitri T. Azar

  4. Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA

    Lucy H. Young

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  1. No affiliation provided

    Michael Chiang

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Buffenn, A.N. (2022). Diplopia and Strabismus. In: Albert, D.M., Miller, J.W., Azar, D.T., Young, L.H. (eds) Albert and Jakobiec's Principles and Practice of Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-030-42634-7_291

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