Gather as much information as possible about the diplopia. Clarify what the patient means by double vision. Is it true diplopia or blurred vision? Is there a precipitating injury? Is it vertical or horizontal diplopia? Are the images completely separated or joined? Is it monocular (diplopia remains when the patient shuts one eye) or binocular (on shutting one eye the vision returns to normal). Is it worse in one direction of gaze e.g. every time the patient looks down or every time they look right? Does tilting their head improve the diplopia? Is it associated with a headache or ptosis?
Past Medical History is important including relevant features such as BP, diabetes, cholesterol, thyroid disease and any recent blood results relating to cardiovascular risk.
On examination is there any restriction of eye movements? Is there a ptosis/abnormal pupils/pupillary response/nystagmus?
Please see the diplopia algorithm which can help you work through the symptoms to reach a differential diagnosis.
Please advise patients to not drive if they have ongoing double vision.
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.
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.
