Abstract
The dilemma of diplopia after cataract surgery can be extremely frustrating and disappointing for both patient and surgeon. Thoughtful analysis can usually define both the cause and appropriate treatment, especially if tackled in a systematic manner. A decision tree is presented to help the ophthalmologist through this unwelcome predicament, hopefully resulting in a grateful patient. Recent reports of vertical misalignment presumably caused by the local anesthesia merit particular attention, since the frequency of such reports has increased dramatically.