Abstract
When diplopia occurs after refractive surgery, a systematized approach to diagnosis and treatment is useful. First, determine if the problem is monocular or binocular. Monocular diplopia usually is caused by anterior segment complications and should be referred to an anterior segment surgeon. If the problem is binocular, determine if there is iatrogenic monovision. If monovision was created by the refractive surgery, determine if the double vision is due to fixation switch diplopia. If so, the monovision state needs to be reversed. If fixation switch is not the cause of the symptoms, try “optical rescue.” If monovision is not present, check old refraction and motility records, and correct any residual refractive error. Strabismus may need to be treated with surgery, orthoptic exercises, or prisms.
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