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Diplopia can also occur when viewing with only one eye; this is called monocular diplopia, or where the patient perceives more than two images, monocular polyopia. While serious causes rarely may be behind monocular diplopia symptoms, this is much less often the case than with binocular diplopia. [15]
Cerebral diplopia or polyopia describes seeing two or more images arranged in ordered rows, columns, or diagonals after fixation on a stimulus. [ 1 ] [ 2 ] The polyopic images occur monocular bilaterally (one eye open on both sides) and binocularly (both eyes open), differentiating it from ocular diplopia or polyopia.
Because the eyes are in different positions on the head, any object away from fixation and off the plane of the horopter has a different visual direction in each eye. Yet when the two monocular images of the object are fused, creating a Cyclopean image, the object has a new visual direction, essentially the average of the two monocular visual ...
If left untreated at a young age foveal suppression occurs and the eccentric area of the deviated eye replaces foveal fixation for both binocular and monocular vision. This occurs with the interest of finding better visual acuity, however all patients found with eccentric fixation have amblyopia, suppression, anisometropia and poorer stereopsis ...
Two lights: If the patient sees two lights, this is indicative of diplopia as the patient has an image from each eye but is unable to fuse the two. One line: If only one line is seen, this means one eye is suppressing. The eye that is suppressing is the eye which the corresponding line is not seen.
With both eyes open, a patient with normal binocular vision will appreciate four lights. If the patient either closes or suppresses an eye they will see either two or three lights. If the patient does not fuse the images of the two eyes, they will see five lights ( diplopia ).
Many cases are asymptomatic, however patients many have decreased vision, glare, monocular diplopia or polyopia, and noticeable iris changes. [2] [5] On exam patients have normal to decreased visual acuity, and a "beaten metal appearance" of the corneal endothelium, corneal edema, increased intraocular pressure, peripheral anterior synechiae, and iris changes.
To measure the horizontal deviation, the Maddox rod is placed in front of the right eye (it is done on both eyes) with the cylinder horizontal, making the red line vertical. The patient is then asked whether the white light is superimposed on the red line, or if it is to the left or right of the red line.