PubMed · 6013962
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E Schmidt-Hofman. 1966. [Simple procedure to plot double image findings].. https://pubmed.ncbi.nlm.nih.gov/6013962/
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The assessment of a patient with binocular vertical diplopia begins with a thorough history and neuro-ophthalmologic examination. The neuro-ophthalmologic examination includes observation for a compensatory head, face, or chin position; ocular ductions and versions in the nine cardinal positions of gaze; the three-step test; the double Maddox rod test; indirect ophthalmoscopy to observe the location of the fovea in relationship to the optic nerve head to determine cyclodeviation; and the forced ductions test. Binocular vertical diplopia may be due to supranuclear processes, ocular motor nerve dysfunction, neuromuscular junction disease, diseases of eye muscle, mechanical processes causing vertical eye misalignment, and even retinal disease. In this article, the differential diagnosis of these processes is outlined.
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BACKGROUND: Causes of transient vertical diplopia include myasthenia, dysthyroid orbitopathy, multiple sclerosis, decompensation of a pre-existing state. PURPOSE: To describe an unusual cause of transient diplopia, silent sinus syndrome. METHODS: Clinical, radiological and pathology findings from a 55-year-old man with acquired transient vertical diplopia are reported. RESULTS: Eight months after onset of symptoms, vertical diplopia was constant. Hypoglobus and enophthalmos were present. On CT scan, orbital floor was thinned and lowered by 8 mm. Maxillary sinus was filled with material compatible with the histological diagnosis of mucocele. Sinus surgery and orbital floor reconstruction resulted in resolution of diplopia. CONCLUSION: Sinus disorders can produce diplopia and/or visual loss, when invading the orbit. Usually, an acute orbitopathy is obvious. Our case shows that chronic sinus disorders can produce "silent" oculomotor disturbances and, at least in the beginning, transient diplopia.