Diplopia

The diplopia is a frequent functional sign translating a double Vision. Term resulting from the Greek diploos: double and ôps: sight.

It can be monocular , i.e. to be observed when only one eye is open. The causes are ophthalmologic (lesion of the Cornée, the iris or the Cristallin.

It can be binocular , being able to be then revealing of a neurological attack and in front of being dealt with fast of manner. It disappears then with occlusion from the healthy eye.

Physiopathology

The occulomotricity (movements of the eyes) is ensured thanks to 6 Muscle S and 3 Nerf S.

Muscles

  • the muscle internal rights ensures the Adduction Eye-ball,
  • the external right ensures the Abduction,
  • the right supérieur' ensures the rise in the eye-ball in abduction,
  • the lower right lowers the eye-ball in abduction,
  • the small oblique raises the eye-ball in adduction,
  • the large oblique lowers the eye-ball in adduction.

Nerves

  • the pathetic nerve (IV) innerve large the oblique,
  • the external ocular motor nerve innerve the external muscle right,
  • the common ocular motor nerve (III) innerve all other muscles, the raising device of the Eyelid, and the iridian muscle (responsible for the contraction or the dilation of the iris - to see Myosis, Mydriase).

Diagnosis

Interrogation

Diplopia results in a double feeling of vision: the image of a point object is duplicated, its projection not corresponding to the same zone of the Rétine. One will seek:

Physical examination

It finds an ocular deviation of rest, a deviation of the head in connection with the nature of diplopia, of the signs in connection with the cause of diplopia. One will practice systematically a measurement of the Vision, a Fond of eye, an examination of the Pupille S (reactivity with the light).

The Test with red glass is used for horizontal diplopias, touching one muscle, The Test of Hess Lancaster, more end, makes it possible to characterize the more complex musculo-nervous attacks.

The other examinations are carried out according to the suspectée cause of diplopia.

Clinical forms

Attack of III

One finds an ocular deviation outwards, the head is deviated on the healthy side. The pupil is in mydriase aréactive, a ptôsis is frequent (falls of the higher eyelid).

Attack of the IV

The eye is deviated in top and outwards (“pathetic” glance, from where the name of the nerve), the head deviated in bottom and on the healthy side. The gene is very intense for the reading, or the descent of the staircases.

Attack of the VI

There are a diplopia horizontal, homonymous, cross axes oclaires. The head is deviated on the side reached.

Causes of binocular diplopias

Traumatic

  • Désinsertion of the pulley of large the oblique
  • Fracture of the floor of the orbit with imprisonment of the muscle lower right
  • Fracture of the skull: fracture rock, fractures Sphénoïde

Vascular

Inflammatory

Tumoral

Carencielles

Muscular

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