My story today is about a 65-year-old patient who, for a week, has perceived 2 images instead of one, after a concussion.
Double vision or diplopia is the perception of two images of the same object. It is a symptom to take seriously; some causes of diplopia are not serious, but others need urgent medical attention.
It can be binocular (disappears when covering one eye) or monocular (persistent when covering one eye). In binocular diplopia, the problem is in the extraocular muscles and some cranial nerve. On the other hand, when the diplopia is monocular, it is a disease of the eyeball.
The extraocular muscles are responsible for moving the eyeball towards the object of attention in the visual field, so that the images perceived by each eye merge into one in the brain. By exploring the movement of the extraocular muscles, it is detected which muscle is altered and using different tests, the amount of deviation can be measured.
It should also be considered that if the movement deficit is partial, it is called paresis, while if the deficit is total, we are talking about paralysis. The causes are varied, and can manifest at any age. There are congenital paralysis, which may be secondary to neurological or anatomical abnormalities, trauma to the birth canal, or neonatal asphyxia. Among the acquired causes, the vascular ones (due to diabetes mellitus, arterial hypertension or arteriosclerosis), infectious, inflammatory, tumoral and traumatic stand out.
After questioning, careful examination of the eye and eye movements, as well as the result of different tests, my patient showed a problem of the oculomotor system, specifically a Paresis of the IV cranial nerve of the left eye.
In fourth cranial nerve palsy, the superior oblique muscle is affected; patients see double images, one above and slightly to the side of the other.
For the treatment it is necessary to individualize each case according to the cause, time of evolution and the degree of strabismus. When it comes to a paresis, the treatment is conservative, it can include oral Vitamin B, occlude one eye or botulinum toxin; On the other hand, in the case of a small paralysis, prisms are used and when it is greater, the treatment is surgery. In the case of my patient, he only needed conservative treatment.
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