BINOCULAR AND MONOCULAR DIPLOPIA: DIFFERENTIAL DIAGNOSIS

Diplopia, commonly referred to as double vision, is a clinical manifestation that may arise from a variety of ocular, neuromuscular, and neurological disorders. The condition is classified into monocular and binocular diplopia, each with distinct etiologies and clinical implications. Monocular diplopia occurs when double vision persists in one eye, typically resulting from refractive errors, lens abnormalities, corneal irregularities, or tear film instability. Binocular diplopia arises from misalignment of both eyes, often associated with cranial nerve dysfunction, extraocular muscle disorders, systemic neuromuscular conditions, or central nervous system pathology. Accurate differentiation between monocular and binocular diplopia is critical for identifying potentially life-threatening conditions, guiding diagnostic evaluation, and determining appropriate management strategies. This article reviews the current understanding of the etiological spectrum, clinical presentations, and diagnostic approaches for both monocular and binocular diplopia. Emphasis is placed on structured clinical assessment, including detailed history-taking, ophthalmological examination, neurological evaluation, laboratory studies, and imaging modalities. The importance of distinguishing between benign ocular causes and serious systemic or neurological disorders is highlighted. Furthermore, the review synthesizes evidence from recent peer-reviewed studies and clinical guidelines to provide a comprehensive framework for differential diagnosis. It discusses common causes such as refractive errors, cataracts, cranial nerve III, IV, and VI palsies, myasthenia gravis, thyroid eye disease, and central lesions including stroke and tumors. Pediatric considerations, including congenital strabismus and amblyopia, are also examined. By integrating findings from multiple sources, this review aims to enhance clinicians’ ability to accurately classify and manage diplopia. A structured approach ensures early detection of serious pathology, reduces the risk of misdiagnosis, and guides targeted treatment to improve visual function and patient quality of life.

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