Diplopia

Description:

Diplopia (Greek diploos "double" + ops, opos "eye") — the vision disorder consisting in doubling of the image of the considered subject as a result of a deviation of a visual axis of one eye. Emergence of doubling is connected with the fact that the image of the considered subject at a deviation of an eyeglobe gets not on the central pole, and on other site of a retina.

At a diplopia solid vision always falls apart. Doubling of the image disappears when closing one eye. Seldom (for example, at an eyeglobe injury with a separation of a root of an iris of the eye and formation as if of two pupils, at a crystalline lens incomplete dislocation) there can be a monocular diplopia - the same subject gives two images in one eye. When closing other eye doubling does not stop.

Diplopia symptoms:

Symptoms of a diplopia is doubling in eyes, dizziness, difficulty in assessment of location of objects. When closing one eye these phenomena disappear.

Character of a diplopia depends on process localization. At damage of direct muscles parallel doubling is noted, at damage of oblique muscles objects when doubling can "be located" one over another. The eye deviation aside, opposite to the affected muscle, can be expressed in different degree. The movement of an eyeglobe towards the affected muscle is absent or is limited. There can be forced position of the head — turn or its inclination towards the affected muscle (in this case doubling disappears).

At infectious diseases, meningitis, intracranial tumoral processes, vascular diseases of a brain, fractures of base of the skull the diplopia is combined with accurately expressed symptoms characteristic of the corresponding state. At patients with diphtheria the diplopia develops in the disease heat, and at botulism can be one of its early symptoms.

Diplopia reasons:

The diplopia can be caused by disturbances in the central departments of the visual analyzer and disturbance of muscular balance as a result of weakening of function of the affected eye muscles that leads to a deviation or restriction of mobility of an eye in this or that party; it is caused by the neurogenic reasons or pathological process directly in an eye-socket.

Most often the diplopia happens during the weakening (paresis) or paralysis of one of oculomotor muscles when the coordinated harmonious movements of eyeglobes are broken. Such disturbance of mobility can come owing to damages of the muscles providing the movement of an eyeglobe (an eye form of a myasthenia – muscular weakness), or at damage of the nerves managing these muscles (third cranial nerves).

The pathological processes proceeding in a cavity of an eye-socket and leading to eyeglobe shift can be the reasons of a diplopia. Doubling of the image is often observed at an orbit injury (at a change of the lower wall of an eye-socket with infringement of a muscle of an eye), at the hematomas and tumoral processes causing restrictions in the movement of an eyeglobe up to its full fixing. All injuries of the head can also cause doubling of the image that is a consequence of damage of a third cranial nerve. At development of aneurisms of an internal carotid artery this nerve can be compressed that leads also to emergence of a diplopia.

At the heart of defeat of the third cranial nerves responsible for doubling of the image, various diseases of the neurologic nature (intracranial tumoral processes, tubercular meningitis, etc.) can lie. The diplopia is a symptom of the damage to a trunk of a brain caused by an infection when it is mentioned the central nervous system (a rubella, parotitis, diphtheria, tetanus) and also alcoholic or medicamentous intoxication. The diplopia can also be a botulism symptom (imitates symptoms of an eye form of a myasthenia), a thyrotoxicosis (at hypostasis of oculomotor muscles their movement is complicated), multiple sclerosis, and also a diabetes mellitus. And defeat of third cranial nerves at diabetes has secondary character and takes place independently, but a recurrence is frequent.
The diplopia can arise after injuries and brain operations, operations for squint, amotio of a retina, a cataract, at psychoneuroses and hysterical attacks.

Treatment of the Diplopia:

Treatment of a diplopia consists in identification and elimination of its reason. Acute management is defined by character and the course of the main disease. Urgent hospitalization is necessary at diphtheria, meningitis, botulism (in infectious department), at fractures of base of the skull (in neurosurgical or traumatologic department). In other cases of the indication to hospitalization are defined by a current of a basic disease and the general condition of the patient.