IS THE DIPLOPIA MONOCULAR OR BINOCULAR?
For monocular diplopia, think about cataracts or astigmatism. 3. Is diplopia vertical or horizontal? For vertical double vision, consider common etiologies such as fourth nerve paresis and skew deviation. For horizontal diplopia, the differential diagnosis includes such entities as sixth nerve paresis, divergence palsy and convergence insufficiency. Asking whether the horizontal diplopia is worse at near or distance can further narrow the possibilities. If horizontal diplopia is worse in the distance, this usually points toward a sixth nerve palsy or divergence paresis. If the horizontal diplopia is worse at near, often the culprit is convergence insufficiency. The ExaminationA good refraction needs to be performed to be sure that vision is maximized. The presence of cataracts and/or macular degeneration can threaten fusion in susceptible patients. Patients with tenuous fusion may lose their control as their vision worsens in one eye.In seniors, despite a vigorous complaint of diplopia
