Shippman Sara, Heiser Larisa, Cohen Kenneth R, Hall Lisabeth
From the New York Eye and Ear Infirmary, New York Medical College, New York, New York.
Am Orthopt J. 2008;58:92-8. doi: 10.3368/aoj.58.1.92.
Evaluation of adults with a symptom of acquired double vision is a challenging diagnostic problem. This retrospective report reviews a series of adult patients who presented with a symptom of "double vision" but did not have diplopia related to a recently acquired or decompensated strabismus. The symptom of double vision was related mainly to blurred vision and often was not true binocular diplopia.
This is a retrospective study of medical records.
261 patients, age 40 years or older referred for a recent onset symptom of double vision were reviewed. Sixty-seven patients were included in the study. These patients presented with no findings that indicate a recent onset of incomitance or breakdown of a long-standing strabismus. The patients were divided into five groups with common etiologies and their findings were analysized. Group 1 (17 patients) had symptoms of double vision due to monocular blur without diplopia. Group 2 (21 patients) had symptoms of double vision related to monocular blur that caused a dissociation of a small phoria. Group 3 (10 patients) had symptoms of double vision related to superimposition of images due to a distorted image. Group 4 (13 patients) had symptoms of double vision related to convergence insufficiency. Group 5 (6 patients) had symptoms of double vision related to an induced tropia secondary to anisometropia correction. Options for treatment include improving vision and having the patient understand the nature of the problem.
"Double vision" does not mean the same thing to the patient and the examiner. The examiner must distinguish true diplopia from other symptoms and be able to demonstrate this to the patient. Treatment is directed to the specific type of problem, but improvement of vision resolves the large majority of these complaints. Examination and treatment techniques are discussed.
对出现后天性复视症状的成年人进行评估是一个具有挑战性的诊断问题。本回顾性报告回顾了一系列出现“复视”症状但并非与近期获得性或失代偿性斜视相关的复视的成年患者。复视症状主要与视力模糊有关，且通常并非真正的双眼复视。
这是一项对病历的回顾性研究。
对261例40岁及以上因近期出现复视症状而转诊的患者进行了评估。67例患者被纳入研究。这些患者未发现表明近期出现斜视异常或长期存在的斜视失代偿的迹象。将患者分为五组，根据常见病因进行分析。第1组（17例患者）因单眼模糊而非复视而出现复视症状。第2组（21例患者）的复视症状与单眼模糊有关，该模糊导致微小隐斜分离。第3组（10例患者）的复视症状与图像扭曲导致的图像叠加有关。第4组（13例患者）的复视症状与集合不足有关。第5组（6例患者）的复视症状与屈光参差矫正后继发性诱导性斜视有关。治疗方案包括改善视力并让患者了解问题的本质。
“复视”对患者和检查者而言并非同一概念。检查者必须将真正的复视与其他症状区分开来，并能够向患者证明这一点。治疗针对特定类型的问题，但改善视力可解决大多数此类主诉。文中讨论了检查和治疗技术。
