Diplopia and eye movement disorders.

Correspondence to: Professor Christopher Kennard, Department of Visual Neuroscience, Division of Neuroscience and Psychological Medicine, Imperial College London, Charing Cross Campus, St Dunstan’s Road, London W6 8RP, UK; c.kennard@imperial. ac.uk _________________________ D iplopia—seeing double—is a symptom with many potential causes, both neurological and ophthalmological. Accurate diagnosis and appropriate plans of management can be achieved with careful history taking and clinical examination. In this article we review the practical points for clinicians dealing with diplopia. The general approach is demonstrated in fig 1. A diagnosis of functional diplopia should not be entertained based simply on the absence of gross ocular misalignment, because sometimes very subtle misalignment of the ocular axes, which are difficult to elucidate at the bedside, may require more sensitive tests. On the other hand, one should not be surprised to see gross ocular misalignment without diplopia as brain plasticity usually takes over if diplopia is longstanding and the image from one eye is suppressed.