diplopia (double vision) - referral criteria from primary care

Last reviewed 01/2018

Acute onset diplopia

  • painful diplopia
    • immediate referral to ophthalmologist

  • painless diplopia
    • in general, urgent referral for specialist review (within one week) (1)
    • if associated with neurological symptoms suggestive of possible TIA/stroke - then consider immediate referral (2)
      • if patient has persistent symptoms or signs when seen, is anticoagulated or has had more than 1 event in 24 hours, consider admission to emergency department (2)
    • if associated with neurological symptoms suggestive of brain tumour - then urgent referral (3)

Chronic diplopia (old strabismus)

  • consider non-urgent referral if troublesome (1)

Chronic diplopia without simple refractive explanation

  • requires referral for specialist review (2)

Notes (3):

  • rapid onset of diplopia associated with CNS symptoms that arouses suspicion of a brain tumour requires urgent referra
    • such symptoms may include
      • unilateral sensorineural deafness;
      • progressive neurological deficit;
      • recent-onset seizures; mental or cognitive changes;
      • cranial nerve palsy;
      • headaches with vomiting, drowsiness or related to posture

  • persistent diplopia with no simple refractive explanation should also be referred
    • particularly if accompanied by headaches of recent onset that persist for at least a month, even in the absence of signs of raised intracranial pressure or neurological deficit

Reference:

Related pages:

diplopia