Prism use in adult diplopia

Abstract

Prismatic correction to restore binocularity in adult diplopia can be challenging. This review summarizes the results of prismatic correction in adults based on the cause of diplopia. Satisfaction with prismatic correction is achieved in approximately 80% of all adult patients with diplopia when combining the causes. Of patients with vertical diplopia, skew deviation and fourth nerve palsy have the highest satisfaction rates, 100 and 92%, respectively. Patients with thyroid eye disease and orbital blowout fractures associated with diplopia had the lowest satisfaction rates, 55 and 8%, respectively. With regard to horizontal deviations, patients with decompensated childhood strabismus with a combination of horizontal and vertical deviations and patients with convergence insufficiency had the lowest satisfaction rates, 71 and 50%, respectively. Careful selection of patients for prismatic correction, management of patient's expectations, and continued follow-up to monitor the symptoms are critical to the successful use of prisms.