BINOCULAR VERTICAL DIPLOPIA

The assessment of a patient with binocular vertical diplopia begins wi th a thorough history and neuro-ophthalmologic examination, The neuro- ophthalmologic examination includes observation for a compensatory hea d, face, or chin position; ocular ductions and versions in the nine ca rdinal positions of gaze; the three-step test; the double Maddox rod t est; indirect ophthalmoscopy to observe the location of the fovea in r elationship to the optic nerve head to determine cyclodeviation; and t he forced ductions test, Binocular vertical diplopia may be due to sup ranuclear processes, ocular motor nerve dysfunction, neuromuscular jun ction disease, diseases of eye muscle, mechanical processes causing ve rtical eye misalignment, and even retinal disease, In this article, th e differential diagnosis of these processes is outlined.