Category: Neurology
Keywords: diplopia, imaging, radiology, CT, ophthalmology (PubMed Search)
Posted: 11/28/2018 by Danya Khoujah, MBBS
(Updated: 12/5/2025)
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Diplopia can be a challenging complaint to address in the ED. Although not all patients will require imaging, use the simplified table below to help guide the imaging study needed:
| Clinical Situation | Suspected Diagnosis | Imaging Study | |
| Diplopia + cerebellar signs and symptoms | Brainstem pathology | MRI brain | |
| 6th CN palsy + papilledema | Increased intracranial pressure (e.g. idiopathic intracranial hypertension or cerebral venous thrombosis) | CT/CTV brain | |
| 3rd CN palsy (especially involving the pupil) | Compressive lesion (aneurysm of posterior communicating or internal carotid artery) | CT/CTA brain | |
| Diplopia + thyroid disease + decreased visual acuity | Optic nerve compression | CT orbits | |
| Intranuclear ophthalmoplegia | Multiple sclerosis | MRI brain | |
| Diplopia + facial or head trauma | Fracture causing CN disruption | CT head (dry) | |
| Diplopia + multiple CN involvement (3,4,6) + numbness over V1 and V2 of trigeminal nerve (CN5) +/- proptosis | Unilateral, decreased visual acuity | Orbital apex pathology | CT orbits with contrast |
| Uni- or bi-lateral, normal visual acuity | Cavernous sinus thrombosis | CT/CTV brain | |
C.N.: cranial nerve
Margolin E, Lam C. Approach to a Patient with Diplopia in the Emergency Department. J Emerg Med. 2018 Jun;54(6):799-806
