29th December 2023

Binocular diplopia

Acute management is aimed at relieving any debilitating symptoms due to the diplopia. The aim is to regain single binocular vision by unilateral occlusion of the poorer eye. In younger patients, there is a risk of developing amblyopia, and so the occlusion is alternated between each eye. Other options include using prisms to realign the visual axis in vertical or horizontal diplopia. When the binocular diplopia is long-standing or an underlying cause cannot be identified or managed, then surgery can be considered. Some cases are managed with botulinum injections into the antagonistic muscle to the paretic one, i.e. MR to LR in a 6ᵗʰ nerve palsy.