This article presents an overview of the most important points a neurologist must remember when dealing with a patient complaining of diplopia. Patients with monocular diplopia and those with full ocular motility and comitant misalignment should be referred to an ophthalmologist and do not require further testing. Patients with recent onset of binocular diplopia who have associated "brainstem" symptoms should have an urgent brain MRI. All patients with 3rd cranial nerve palsy require urgent brain CTA to rule out compressive aneurysmal lesion. Management of patients over 50 years of age with microvascular risk factors with new onset of 6th nerve palsy is controversial: some image these patients at presentation while others choose a short period of observation as most of these patients would have a microvascular etiology for the 6th nerve palsy which should improve spontaneous in 2-3 months. All others with 6th nerve palsy require brain MRI with contrast. Patients with 4th palsy with hyperdeviation that worsens in downgaze should have an MRI with contrast and all others referred to an ophthalmologist. If there is more than one cranial nerve palsy, urgent neuroimaging should be performed with attention to cavernous sinus and superior orbital fissure. Ocular myasthenia should be suspected in patients with eye misalignment that does not fit a pattern for any cranial nerve palsy. Orbital pathology (most commonly thyroid eye disease) can result in restriction of ocular motility and has specific clinical signs associated with it.

中文翻译：

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复视患者的处理方法

本文概述了神经科医生在处理主诉复视的患者时必须记住的最重要的几点。单眼复视患者和眼球运动完全和伴随错位的患者应转诊给眼科医生，不需要进一步检查。最近出现双眼复视并伴有“脑干”症状的患者应进行紧急脑部 MRI 检查。所有第 3 颅神经麻痹患者均需行紧急脑 CTA 以排除压迫性动脉瘤病变。对 50 岁以上有微血管危险因素且新发第 6 神经麻痹的患者的管理存在争议：一些患者在就诊时对这些患者进行成像，而另一些则选择短期观察，因为这些患者中的大多数都有第 6 神经麻痹的微血管病因，应该会在 2-3 个月内自发改善。所有其他患有第 6 神经麻痹的人都需要进行脑部 MRI 对比。第 4 麻痹的过度偏斜在向下凝视时恶化的患者应进行 MRI 对比检查，所有其他患者均应转诊给眼科医生。如果有多个颅神经麻痹，应进行紧急神经影像学检查，注意海绵窦和眶上裂。对于不符合任何颅神经麻痹模式的眼睛错位的患者，应怀疑眼肌无力。