The authors present a retrospective case review with the aim of comparing the frequency of different causes for new onset binocular diplopia in 2 age groups, above and below 65 years old. Adult patients with new onset diplopia within a 21-year period at a single centre were identified. Those with monocular diplopia, absence of manifest or latent strabismus, historic diplopia or physiological diplopia were excluded. The following data was extracted from medical records: demographics, symptom details, ophthalmic findings, imaging and other biomarker results. The cause of the diplopia was categorised into either neurogenic, restrictive or decompensated childhood strabismus with detailed subcategories. A total of 210 patients were included in the analysis with 64% falling within the older group (>65 years old). Neurogenic causes were the most prevalent causes across both age groups. The significant differences between age groups were demyelinating disease, brain tumours and trauma being more common in the younger group (≤65 years old) and microvascular and sagging eye syndrome being more common in the older group. The younger group had significantly more positive findings on imaging with the older group significantly more likely to be referred for other biomarker tests. Complete resolution spontaneously was significantly more common in the older group. The authors acknowledged the following limitations of the study: retrospective methods, 31% of cases were lost to follow-up, missing test results and small numbers in sub-categories weakening the reliability of statistics. Further research is required to optimise the investigation strategies for the suspected causes of new-onset diplopia.
How does presentation, progression and outcome of new onset diplopia vary between older and younger adults?
Reviewed by Lauren Hepworth
Diplopia in the younger adult (≤65 years old) compared with older adult (>65 years old) population – presentative, progression and outcome.
CONTRIBUTOR
Lauren R Hepworth
University of Liverpool; Honorary Stroke Specialist Clinical Orthoptist, Northern Care Alliance NHS Foundation Trust; St Helen’s and Knowsley NHS Foundation Trust, UK.
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