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Double Vision - approach to by Mind Map: Double Vision - approach to
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Double Vision - approach to


EFNS Conference overview

Free Teaching Course overview

Strabismus (squint)


the degree of misalignment varies with gaze position

suggests a recent paretic or restrictive aetiology ("paralytic")


Tropia (a manifest deviation)

Phoria (a latent deviation)


Slide 1



usually ophthalmological

Differential Diagnosis, refractive error, corneal disease, iris injury, cataract, media opacity, macular disease, primary or secondary visual cortex disorder (usually bilateral monocular diplopia, Conversion syndrome


Nature of the separation of the two images: horizontal / vertical / oblique

Direction of maximal separation

Onset and progression: sudden onset with improvement / constant / progressive / intermittent

Exacerbating and relieving factors: blinking / worsening at end of day

Associated symptoms: perioribital pain / new headache / intermittend ptosis / visual loss / proximal limb weakness

Past medical and family history: childhood strabismus / childhood glasses / eye occlusion, risk factors -- not complete list -


In different gaze positions

Neuro-ophthalmology illustrated, Bousser et al


Cross-cover test

2nd picture

3rd picture

4th picture

Red glass test

Diagnostic use, 3rd nerve palsy, 4th nerve in tact?, Hypertropia, Left Adduction Paresis


Examination 1

Examination 2

4th Nerve Palsy

Neuro Anatomy

Neuro Anatomy

Clinical Picture

Clinical Picture

Clinical investigation

Additional investigations

A possible Differential Diagnosis



Topic overview