A retrospective five-year study of clinical profile of patients with acute binocular diplopia at a tertiary eye care center in Kerala

Abstract

To analyse the demography, clinical features and outcome of patients presented with acute binocular diplopia at a tertiary eye care centre of Kerala. A retrospective review of medical records of patients presented with acute (<four weeks) binocular diplopia over the past five years was done. Detailed ophthalmic evaluation was done and risk factors were noted. Patients were followed up until cure or up to six months, whichever was earlier. Patients with restrictive strabismus or lack of follow up were excluded from the study. 161 eyes of 88 (54.65%) males and 73 (43.34%) females with a mean age of 55.71 years (range 6 to 93 years) were included. Isolated cranial nerve palsies were the most common cause for acute diplopia (n=142, 88.2%) and included pupil sparing 3 nerve palsy (n=38), pupil involving 3rd nerve palsy (n=8), 4 nerve palsy (n=17) and 6th nerve palsy (n=79). Microvascular ischemia (n=119), traumatic (n=10), combined cranial nerve palsy (n=6), Idiopathic (n=13), Ocular myasthenia (n=5), Inter nuclear ophthalmoplegia (INO) (n=3), Parkinsonism (n= 1), Progressive Supra Nuclear Palsy (n=1) and decompensated comitant strabismus (n=3) were the other causes. Diabetes mellitus (n=102, 63.3%) was the most common vasculopathic factor followed by hypertension. Most patients (n=144, 89.4%) were relieved of their symptoms within six months. Acute binocular diplopia, though an alarming and distressing condition, had very good prognosis in our patients. Meticulous clinical examination and investigations can establish the diagnosis in most of the cases.