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"Was It Something I Said?": Finding Retinal Pathology Without Actually Examining the Retina

From the State University of New York at Buffalo, Buffalo, New York

Correspondence: Request for reprints should be addressed to: Kyle Arnoldi, C.O., C.O.M.T., Ira G. Ross Eye Institute, 1176 Main Street, Buffalo, NY 14209; e-mail:kylea{at}buffalo.edu

Introduction: Diplopia secondary to maculopathy is a rare disturbance of binocular vision that may present to the orthoptist. The purpose of this study was to identify the distinguishing symptoms and clinical signs of this condition.

Methods: A retrospective medical record review of adults presenting with diplopia that could not be relieved with prism or strabismus surgery.

Results: Six cases were identified. All complained of vertical diplopia, though only one patient had a vertical strabismus. The diplopia improved in dim illumination in all cases. All patients noted monocular visual disturbances, including illusory movement of the image, when fixating with the involved eye. No patient was able to achieve stable binocular single vision with prism.

Conclusion: Symptoms and signs of diplopia secondary to maculopathy include: comitant vertical diplopia that worsens in bright illumination, illusory image movement when monocularly fixating with the involved eye, a tendency to "eat up" prism, and poor fusion potential. Because these patients may present to the orthoptist with no history of retinal disease, it is important to recognize the unique features of this condition.

Key words: diplopia, maculopathy, prism, occlusion