บทความฟื้นวิชา:แนวทางปฏิบัติในการดูแลผู้ป่วยที่มาพบแพทย์ ด้วยอาการเห็นภาพซ้อนเฉียบพลัน
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Abstract
Acute diplopia is a common presenting symptom in ophthalmic practice and often indicates potentially serious underlying conditions. A structured diagnostic approach begins with detailed history taking and physical examination to distinguish between monocular and binocular diplopia. In binocular cases, further assessment of the deviation pattern - horizontal, vertical, or oblique - guides localization and differential diagnosis. Ancillary investigations such as computed tomography (CT) or magnetic resonance imaging (MRI), together with laboratory tests, assist in identifying major causes, including microvascular ischemia, inflammation, and infection. Management depends primarily on the underlying etiology and may require a multidisciplinary approach involving neurology and endocrinology. For persistent diplopia, symptomatic treatment options include prism glasses, botulinum toxin injections, or strabismus surgery. A systematic evaluation not only facilitates timely diagnosis but also improves patient outcomes through targeted management.
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References
De Lott LB, Kerber KA, Lee PP, Brown DL, Burke JF. Diplopia-Related Ambulatory and Emergency Department Visits in the United States, 2003-2012. JAMA Ophthalmol. 2017;135(12):1339–44. PMID: 29075739.
Dulayajinda D, Kosrirukvongs P, Songcharoen S. Causes of diplopia. J Med Assoc Thail Chotmaihet Thangphaet. 1991;74(8):323–8. PMID: 1791381.
Jain S. Diplopia: Diagnosis and management. Clin Med. 2022;22(2):104–6. PMID: 35304368.
Najem K, Asuncion RMD, Margolin E. Diplopia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Sept 30]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK441905/
Low L, Shah W, MacEwen CJ. Double vision. BMJ. 2015;351:h5385. PMID: 26581615.
Chirapapaisan N. Common causes of blurred vision and diplopia in neuro-ophthalmology. Mahidol University; 2019. 346 p.
Mackay DD. Approach to Diplopia. Continuum. 2025;31(2):463–78. PMID: 40179404.
Schiefer U, Hoyt WF, Wilhelm H, Hart W, editors. Clinical Neuro-Ophthalmology: A Practical Guide. Berlin, Heidelberg: Springer Berlin Heidelberg; 2007. 1 p.
Metz HS. Forced duction, active force generation, and saccadic velocity tests. Int Ophthalmol Clin. 1976;16(3):47–73. PMID: 786926.
Kushner BJ. Errors in the three-step test in the diagnosis of vertical strabismus. Ophthalmology. 1989;96(1):127–32. PMID: 2919044.
Parks MM. Isolated cyclovertical muscle palsy. AMA Arch Ophthalmol. 1958;60(6):1027–35. PMID: 13593934.
2022-2023 Basic and clinical science course. section 5, Neuro-ophthalmology. Last major revision 2021-2022. San Francisco: American Academy of Ophthalmology; 2022.
Holmes JM. Evaluation and Management of Divergence Insufficiency-Type Esotropia. J Binocul Vis Ocul Motil. 2022;72(4):230–3. PMID: 36279481
Halmagyi GM, Curthoys IS, Brandt Th, Dieterich M. Ocular Tilt Reaction: Clinical Sign of Vestibular Lesion. Acta Otolaryngol (Stockh). 1991;111(sup481):47–50. PMID: 1927445.
Brodsky MC, Donahue SP, Vaphiades M, Brandt T. Skew Deviation Revisited. Surv Ophthalmol. 2006;51(2):105–28. PMID: 16500212.
Gomez CR, Gomez SM, Selhorst JB. Acute thalamic esotropia. Neurology. 1988;38(11):1759–62. PMID: 3185911.
Miller NR, Subramanian PS, Patel VR, editors. Walsh and Hoyt’s clinical neuro-ophthalmology: the essentials. Fourth edition. Philadelphia, PA: Wolters Kluwer; 2021. 1 p.
Shree R, Mahesh KV, Balaini N, Goel A. Oculomotor Cranial Neuropathies: Diagnosis and Management. Ann Indian Acad Neurol. 2022;25(Suppl 2):S70–82. PMID: 36589037.
Brazis PW. Palsies of the trochlear nerve: diagnosis and localization--recent concepts. Mayo Clin Proc. 1993;68(5):501–9. PMID: 8479214.
Gastaldi M, Scaranzin S, Businaro P, Mobilia E, Benedetti L, Pesce G, et al. Improving laboratory diagnostics in myasthenia gravis. Expert Rev Mol Diagn. 2021;21(6):579–90. PMID: 33970749.
Rath TJ, Policeni B, Juliano AF, Agarwal M, Block AM, Burns J, et al. ACR Appropriateness Criteria® Cranial Neuropathy: 2022 Update. J Am Coll Radiol. 2022;19(11):S266–303. PMID: 36436957.
Margolin E. Approach to patient with diplopia. J Neurol Sci. 2020;417:117055. PMID: 32777577.
Cavallaro M, Coglitore A, Tessitore A, Galletta K, Frosina L, Cuffari A, et al. Three-Dimensional Constructive Interference in Steady State (3D CISS) Imaging and Clinical Applications in Brain Pathology. Biomedicines. 2022;10(11):2997. PMID: 36428564.
Diplopia [Internet]. Clinical Gate. 2015 [cited 2024 Oct 11]. Available from: https://clinicalgate.com/diplopia/
Tamhankar MA, Ying GS, Volpe NJ. Success of prisms in the management of diplopia due to fourth nerve palsy. J Neuro-Ophthalmol Off J North Am Neuro-Ophthalmol Soc. 2011 ;31(3):206–9. PMID: 21378578.
Binenbaum G, Chang MY, Heidary G, Morrison DG, Trivedi RH, Galvin JA, et al. Botulinum Toxin Injection for the Treatment of Strabismus. Ophthalmology. 2021;128(12):1766–76. PMID: 34176652.
Lou L, Sun Y, Huang X, Jin K, Tang X, Xu Z, et al. Automated Measurement of Ocular Movements Using Deep Learning-Based Image Analysis. Curr Eye Res. 2022;47(9):1346–53. PMID: 35899319.
Jin X lu, Liu Y fei, He B bing, Fan Y fei, Zhou L yun. A deep learning-based image analysis model for automated scoring of horizontal ocular movement disorders. Front Neurol. 2025 ;16:1522894. PMID: 40672453.
Liu YA, Ko MW, Moss HE. Telemedicine for neuro-ophthalmology: challenges and opportunities. Curr Opin Neurol. 2021;34(1):61–6. PMID: 33230033.
