Article

Conduite à tenir devant une diplopie binoculaire - strabisme
Diplopia is a frequent neuro-ophthalmologic symptom with diverse etiologies. This
article describes elementary diagnostic tests and frequent causes of diplopia.
Monocular diplopia persists when the other eye is closed and usually disappears
when the patient looks through a pinhole. It is usually caused by errors in the
optical media of the eye and has to be differentiated from spectacle-induced side
effect and non-organic disorders. A sign of non-organic etiology is absence of
change in image position when the head is tilted. Binocular diplopia disappears
regardless of which eye is closed. Binocular diplopia occurs when the images of
both eyes cannot be fused. The most frequent direct cause of diplopia is acquired
strabismus. Knowledge of several specific types of strabismus enables efficient
patient management. Congenital and decompensating strabismus like accommodative
esotropia, pathophoria, strabismus surso- and deorsoadductorius, retraction
syndrome, Brown's syndrome and esotropia in high myopia only need ophthalmologic
treatment. Orbital injury, orbital tumor, ocular myositis, Graves orbitopathy and
vascular disease usually require multidisciplinary management. Neurogenic
paresis, superior oblique myokymia, ocular neuromyotonia, myasthenia, chronic
progressive external ophthalmoplegia (CPEO), internuclear ophthalmoplegia (INO)
and skew deviation require specific neurologic examination. Treatment of diplopia
includes treatment of the fundamental disorder, monocular occlusion, prisms and
strabismus surgery.
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Langue : ANGLAIS