DIAGNOSIS CHECKLIST
for Double vision

Why: to determine if acute or chronic.

Why: Unilateral double vision (i.e. double vision that persists when one eye is covered) is rare, but it can be encountered in dislocated lens (as associated with Marfan's syndrome), as well as in congenital double pupil, cataracts, astigmatism, corneal opacities and hysteria.

Why: Intermittent double vision may suggest myasthenia gravis or Eaton-Lambert syndrome.

Why: Double vision is an early sign of eye muscle weakness and this question will help determine which eye muscles are weak e.g. if images are side by side the lateral or medial recti are responsible. If the images lie one above the other then superior or inferior oblique or superior or inferior recti may be involved.

Why: helps determine which pair of eye muscles are responsible. e.g. separation is greatest in the direction in which the weak muscle has its purest action.

Why: e.g. if the outermost image disappears the covered eye is the one that is responsible for the double vision.

Why: may cause double vision by several different mechanisms e.g. damage to nerves to the eye muscles themselves or by orbital damage with eyeball displacement.

Why: may cause temporary double vision.

Why: e.g. diabetes may cause cranial nerve palsies; thyroid disorders.

Why: e.g. Wernicke's encephalopathy due to Vitamin B1 deficiency may cause 6th nerve palsy and consequent double vision.

Why: may suggest orbital abscess, cavernous sinus thrombosis or rarely diphtheria.

Why: may suggest brain stem tumor, cavernous sinus thrombosis associated with sinusitis, intracranial aneurysm or temporal arteritis.

Why: e.g. nausea, vomiting, bilateral blurring of vision or blindness, double vision, dizziness and difficulty speaking.

Why: e.g. impaired vision, limb weakness, limb numbness or tingling, tremor of hands, dizziness.