Acute Diplopia of Non-neurological/restrictive Etiology: a Retrospective Comparative Study.

Abstract PurposeTo describe and compare the clinical features and management of different types of acute diplopia of non-neurological/restrictive etiology.MethodsRetrospective comparative study carried out reviewing medical records of forty-eight patients referred to one tertiary referral center between January 2016 and June 2020.Thirty-two were classified as Acute Acquired Comitant Esotropia (AACE), 3 cases as type I (group A), 12 cases as type II (group B) and 17 cases as type III (group C). Four cases were classified as Decompensated MonoFixation Syndrome (DMFS) (group D), 6 cases as High Myopia-Comitant Esotropia (HMCE) (group E) and 6 cases as Sagging Eye Syndrome (SES) (group F). Patients with diplopia of neurological or restrictive etiology were excluded.All patients underwent a complete orthoptic and ophthalmologic assessment with a postoperative follow-up of 11.4 ± 4.1 months (ranging from 5 to 20 months).ResultsType 3 AACE (Group C) was the most frequent cause of diplopia among the groups (35.4%). High Myopia-Comitant Esotropia (Group E) and Sagging Eye Syndrome (Group F) were significantly older at onset and baseline examination (both P= .001). Constant acute onset was significantly more represented in Group C (P= .026) while all patients in Group F showed an intermittent onset. Near angle of deviation was significantly lower in Group E and Group F compared to Group C (P= .030). A significantly higher near divergence fusion amplitude was detected in Group C (P= .017). Compensation (angle of deviation increasing) at Prism Adaptation Test (PAT) was observed in 75% of total study population, without significant differences among group. Fifty-four % of the total sample underwent surgery as first or secondary treatment choice with good functional results regardless of pathogenesis.ConclusionDemographic characteristics and clinical features (refraction, type of diplopia at onset, angle deviation, fusion amplitudes, response to prismatic correction) can differentiate different types of acute or subacute onset diplopia of not neurological/restrictive etiology.