Tandt Delphine, Le Lez Marie-Laure, Level Claude, Stach Émilie, Cottier Jean-Philippe, Pisella Pierre-Jean, Khanna Raoul Kanav
Service d'ophtalmologie, centre hospitalier régional universitaire de Tours, Tours, France.
Service de gérontologie, centre hospitalier d'Agen, Agen, France.
J Fr Ophtalmol. 2023 May;46(5):449-460. doi: 10.1016/j.jfo.2022.12.025. Epub 2023 Apr 5.
To describe the etiologies of binocular diplopia for patients presenting to the ophthalmologic emergency department of the Regional University Center Hospital (CHRU) of Tours.
This is a retrospective study of the medical records of patients who presented with binocular diplopia in the ophthalmic emergency department of the CHRU of Tours between January 1st and December 31st, 2019. Binocular diplopia was classified as paralytic or non-paralytic according to the ocular motility examination.
One hundred twelve patients were included. The median age was 61 years. Internal referral from other hospital services represented 44.6% of the patients. On ophthalmological examination, 73.2% had paralytic diplopia, 13.4% non-paralytic diplopia and 13.4% normal examination. Neuroimaging was performed in 88.3% of cases, with 75.7% of patients receiving it on the same day. Oculomotor nerve palsy was the most frequent cause of diplopia in 58.9%, the majority represented by abducens nerve palsy (60.6%). The most frequent etiology of binocular diplopia was ischemic, with microvascular damage in 26.8% of cases and stroke in 10.7% of cases.
Among patients assessed in an ophthalmological emergency department setting, one in ten patients had stroke. It is essential to inform patients of the urgent nature of ophthalmological evaluation in the case of acute binocular diplopia. Urgent neurovascular management is also mandatory and should be based on the clinical description provided by the ophthalmologist. Neuroimaging should be performed as soon as possible, based on the ophthalmologic and neurological findings.
描述图尔地区大学中心医院（CHRU）眼科急诊科双眼复视患者的病因。
这是一项对2019年1月1日至12月31日期间在图尔CHRU眼科急诊科出现双眼复视的患者病历进行的回顾性研究。根据眼球运动检查，将双眼复视分为麻痹性或非麻痹性。
纳入112例患者。中位年龄为61岁。来自其他医院科室的内部转诊患者占44.6%。眼科检查显示，73.2%为麻痹性复视，13.4%为非麻痹性复视，13.4%检查正常。88.3%的病例进行了神经影像学检查，75.7%的患者在同一天接受检查。动眼神经麻痹是复视最常见的原因，占58.9%，其中大多数由展神经麻痹（60.6%）代表。双眼复视最常见的病因是缺血性，微血管损伤占26.8%，中风占10.7%。
在眼科急诊科评估的患者中，十分之一的患者患有中风。对于急性双眼复视患者，告知其眼科评估的紧迫性至关重要。紧急神经血管管理也是必要的，应基于眼科医生提供的临床描述。应根据眼科和神经科检查结果尽快进行神经影像学检查。
