4th leads to vertical diplopia. Often patients can reduce double vision by tilting their head to one side.
6th leads to horizontal diplopia. It leads to reduced lateral rectus function and hence reduced abduction. It is worse looking into the distance and towards the side of the palsy.
An isolated nerve palsy is commoner in patients with diabetes, hypertension and hypercholesterolaemia and is thought to be microvascular in nature. Trauma is another potential cause. In many cases the cause remains unknown. They can take up to 6 months to improve and prisms provided by orthoptists can improve symptoms. If they fail to resolve in this time surgery may be considered but the majority improve given time.
Myasthenia gravis can lead to diplopia and symptoms may worsen when tired.
Giant cell arteritis is important not to miss and so see Giant Cell Arteritis – RefHelp (nhslothian.scot) .
Who to refer:
Please see Lothian GP and optometry ophthalmology referral pathway.
Urgency of the condition for details on how soon patients should receive an appointment.
Patients who present with a problem with their only seeing eye should be advised to see an optician/ophthalmologist for review.
How to refer:
We require a referral letter for EVERY patient.
The preferred referral process is via SCI Gateway. If sending/forwarding a referral via SCI gateway please include past medical history, allergies and medications
If you do not have access to fax or SCI Gateway e.g. if you have arranged an appointment out of hours please send a written referral letter with the patient to bring to their appointment.
Only if SCI Gateway is unavailable should a letter be typed or handwritten. Please write legibly and include your examination findings.
If you have arranged an appointment in the acute referral clinic and you are referring from within another hospital in Lothian please use TRAK to type the referral letter.
