Differential Diagnosis of Diplopia following Cataract Extraction

Abstract

Small vertical deviations following cataract surgery have been reported to occur from a variety of mechanisms. Most include perioperative complications such as injection of anesthetic agents^1–14 or antibiotics,¹⁵ or from intraoperative tissue manipulation.^16–19 Other causes include decompensation of preexisting strabismus and undiagnosed systemic disorders.^{2, 7, 17}

Twenty-three patients were referred to the Saint Louis University Eye Institute for evaluation of binocular diplopia noted after cataract surgery. A prospective study was conducted to investigate the types of deviations present, and the causes. Several explanations for the vertical diplopia in our patients were determined and the mechanisms were divided into three groups. Almost seventy percent of the patients had diplopia caused by factors other than the surgical intervention.

A careful history should be taken in all patients undergoing cataract extraction to rule out previous or current strabismus, and all patients should be warned of the possibility of postoperative diplopia. The importance of a thorough orthoptic examination in the differential diagnosis of postoperative diplopia is emphasized.

• diplopia
• binocular diplopia
• vertical diplopia
• cataract surgery complications
• hypertropia
• hypotropia
• retrobulbar anesthesia