Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Etiology and Treatment Outcomes in Patients with Binocular Diplopia: Experience of a Tertiary Center
Binoküler Diplopi Hastalarında Etiyoloji ve Tedavi Sonuçlar: Üçüncü Basamak Bir Merkezin Deneyimi
Pınar BİNGÖL KIZILTUNÇa, Huban ATİLLAa
aDepartment of Ophthalmology, Ankara University Faculty of Medicine, Ankara, TURKEY
Turkiye Klinikleri J Ophthalmol. 2019;28(4):250-5
doi: 10.5336/ophthal.2019-64681
Article Language: EN
Full Text
ABSTRACT
 Objective: Diplopia is a common symptom in ophthalmologic and neurological diseases. In the presence of binocular diplopia, investigation should be made for differential diagnosis. Detection of the underlying etiology provides early diagnosis of accompanying neurological diseases and facilitates the treatment of diplopia. In this study, we aimed to evaluate the causes of binocular diplopia, treatment modalities and treatment outcomes in a tertiary center. Material and Methods: Medical records of patients with binocular diplopia were reviewed. Demographic features and ophthalmological examination findings were noted. Etiological differential diagnoses of diplopia were elucidated according to the results of full ophthalmological examination and neuro-radiological evaluation with cranio-orbital magnetic resonance imaging. Treatment modalities and responses to these treatments were noted. Results: A total of 70 patients were evaluated. Thirty-six patients (51.4%) had cranial nerve palsies. Of 36 patients, 61.1% had 6th nerve palsy, 22.2% 3th nerve palsy and 16.7% 4th nerve palsy. Patients without cranial nerve palsies were also grouped according to the type of deviations. The most common deviations were acute-decompansated esotropia (21.2%) and agerelated esotropia (18.2%). Diplopia recovered in 8 patients (11.4%) after treatment of the underlying etiology. Nineteen (27.1%) patients were not treated due to spontaneous recovery. Prism glasses were prescribed in 22 (31.4%) patients. Twelve patients (17.1%) were operated. Six (8.6%) patients received Botulinum-A toxin injections. Conclusion: In the presence of binocular diplopia, cranial nerve palsies should be investigated. Diplopia can resolve spontaneously. In cases with persistant diplopia, prism glasses, Botulinum toxin- A injection and surgery can be performed.

Keywords: Abducens palsy; binocular diplopia; cranial nerves; oculomotor nerve diseases; strabismus; trochlear nerve diseases
ÖZET
 Objective: Diplopi, oftalmolojik ve nörolojik hastalıklarda sık izlenen bir semptomdur. Binoküler diplopi varlığında ayırıcı tanı için gerekli araştırmalar yapılmalıdır. Altta yatan etiyolojinin tespiti hem eşlik eden nörolojik hastalıkların erken tanısını sağlamakta hem de tedaviyi kolaylaştırmaktadır. Bu çalışmada, üçüncü basamak sağlık merkezine başvuran binoküler diplopili hastalarda, etiyolojinin tespit edilmesini, tedavi yöntemlerinin belirlenmesini ve tedaviye alınan yanıtın değerlendirilmesini amaçladık. Gereç ve Yöntemler: Binoküler diplopili hastaların medikal kayıtları incelendi. Hastaların demografik özellikleri ve oftalmolojik muayene bulguları kaydedildi. Oftalmolojik ve nöro-radyolojik muayene sonuçlarına göre etiyolojik ayırıcı tanılar yapıldı. Tedavi yöntemleri ve sonuçları değerlendirildi. Bulgular: Toplam 70 hasta çalışmaya dahil edildi. Hastaların 36'sında (%51,4) kranial sinir felci vardı. Kranial sinir felci olan hastaların %61,1'inde 6. sinir felci, %22,2'sinde 3. sinir felci, %16.7'sinde ise 4. sinir felci mevcuttu. Kranial sinir felci olmayan hastalar kayma tipine göre sınıflandırıldığında, en sık görülen kayma, akut-dekompanze ezotropya (%21,2) ve yaşa bağlı ezotropya (%18,2) idi. Altta yatan hastalığın tedavisi ile 8 (%11,4) hastada diplopi düzeldi. On dokuz (%27,1) hastada ise spontan düzelme izlendi. Yirmi iki (%31,4) hastaya prizmatik gözlük verilirken, 12 (%17,1) hasta ameliyat edildi. Altı (%8,6) hastaya ise Botulinum-A toksin enjeksiyonu yapıldı. Sonuç: Binoküler diplopi varlığında, kranial sinir felçleri ayırıcı tanıda düşünülmelidir. Diplopi kendiliğinden düzelebilir. Devam eden diplopisi olan hastalarda prizmatik gözlük, Botulinum-A toksin enjeksiyonu ve cerrahi uygulanabilir.

Anahtar Kelimeler: Abdusens felci; binoküler diplopi; kranial sinirler; okülomotor sinir hastalıkları; şaşılık; troklear sinir hastalıkları
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