The diplopia is the ophthalmologic pathology connected with sight doubling. The objects which are coming into the view of the person look double as a result of a deviation of an axis of one of eyes. A number of the reasons of ophthalmologic, neurologic or infectious character can cause similar disturbances.
Development of a diplopia can provoke shift in an eyeglobe eye-socket. Quite often bring eye injuries to it, for example, the infringement of eye muscles caused by an eye-socket wall change. The abnormal provision of an eyeglobe is caused also by hematomas of eye fabrics.
Other possible reason of a diplopia - damage of a third cranial nerve. Aneurism of a carotid artery, intracranial tumors or meningitis of a tubercular etiology can provoke it.
Also infectious processes which affected a brain trunk at a rubella, parotitis, diphtheria or tetanus are the reasons of a diplopia. Also severe alcoholic or medicinal intoxication can cause a diplopia.
Doubling of the image or diplopia is quite often observed against the background of botulism, a thyrotoxicosis, multiple sclerosis or hysterical attacks. The diplopia reason as one of types of postoperative complications, manipulations can serve in the eyes at surgical treatment of amotio of a retina, squint or cataract.
The main complaint of patients with a diplopia – doubling of the image. In most cases doubling of objects of surrounding reality happens at sight two eyes. The diplopia binocular is so demonstrated. Doubling of sight can be partial and be displayed only in a certain zone of a field of vision or full. Manifestation of a diplopia also individually depending on remoteness of the considered objects. In certain cases doubling happens only at a look on close located or, on the contrary, is exclusive on remote objects.
Two images of one subject arising at a diplopia have the different brightness and contrast. One of them is usually a little displaced down, and also across and located under a certain corner to the second image.
Because of the progressing diplopia the patient loses labor skills. To it can be heavy to perform homework, to manage transport, and sometimes and just to move. To return image sharpness to the person with a binocular diplopia it is necessary to close one of eyes. The patient with other type of a disease, a diplopia monocular, such measure does not help.
Diplopia binocular - the most common form of the doubled sight. At a binocular diplopia the visual picture of both eyes is not projected in the corresponding retina points. The visual axis moves, and the patient with a binocular diplopia sees the doubled image of objects. The binocular diplopia can be the motor, touch or mixed, constant or temporary, neuroparalytic, orbital, caused injuries, strabogenny at squint, etc.
Monocular diplopia – more rare pathology of the doubled sight. Disturbances of the image in this case arise even at sight one eye. The image projection at the same time to two different points of a retina of one eye leads to a monocular diplopia. The monocular diplopia is caused most often by an incomplete dislocation or a partial phacoscotasmus. The reason of a monocular diplopia can appear also an iridodialysis (a separation of an iris of the eye from a ciliate body as a result of an eye injury) or a polycoria (inborn pathology of a structure of an iris with several openings).
Primary diagnosis of a diplopia is established on the basis of complaints of the patient concerning doubling of images. Further diagnosis of a disease continues by means of test control over sight of the person whose look is directed to the moving light source.
By means of mapping of coordinates of the received images the doctor manages to diagnose what of eye muscles is struck. More modern method of definition of the injured extraocular muscle of an eye – a koordimetriya by means of an oftalmokoordimetr OK.
Diagnosis of a diplopia assumes also obligatory assessment of a condition of situation and mobility a century with the help the Cover test. Inspection of a conjunctiva of eyeglobes is in addition performed, visual acuity, a refraction and color sensation is checked.
Treatment of a diplopia of secondary type of a neurologic, infectious or ophthalmologic etiology assumes therapy of the main disease.
Treatment of a diplopia as a basic disease is under authority of the neuropathologist or neurosurgeon. The surgeon-ophthalmologist who is carrying out a resection or plastics of eye muscles takes part in treatment of a diplopia of the traumatic nature. At the same time to perform eye muscle operation it is allowed, as a rule, only 6 months later after an injury.
Optical correction of a diplopia is carried out by means of a prismatic spectacles. They are capable to improve the clearness of sight of the patient significantly. Optimum correction in treatment of a diplopia makes 6 prismatic dioptries on each eye.
Glasses wearing with bigger prismatic compensation is in rare instances allowed. Frenelevy prisms can be valid to 20 ave. of dioptries, however already at compensation 15 ave. of dioptries they influence visual acuity and create effect of an iris of the eye around visible objects.
Functional treatment of a diplopia consists in performance of special exercises across Kashchenko for recovery of abilities of solid vision and expansion of a field of vision, and also exercise on merge of objects by means of red glass, etc.
In Great Britain there is a law according to which the surgeon can refuse to do to the patient operation if he smokes or has excess weight. The person has to refuse addictions, and then, perhaps, he will not need an operative measure.
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