Diplopia means seeing two images of the same, one object. It is a symptom with numerous causes that can involve many different structures. The cause can lay in the eyeball itself: the cornea, the lens and the retina or behind the eyeball: in the orbit or intracranial. Diplopia is only a symptom that can indicate a life threatening ilness like an aneurysm, a dissection or a brain tumor. That is why when presented with it we have to do a thorough examination and look for a red flag that could indicate danger. This way we can make a timely intervention, saving the patients sight or life. This article describes the most crucial signs of a dangerous underlying condition that we cannot afford to miss, a practical guide to the historical assesment, as well as to the physical examination of a patient with double vision to help localize the cause.
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