Diplopia (double vision) - referral criteria from primary care

Acute onset diplopia

• painful diplopia
  • immediate referral to ophthalmologist
    
    
• painless diplopia
  • in general, urgent referral for specialist review (within one week) (1)
  • if associated with neurological symptoms suggestive of possible TIA/stroke - then consider immediate referral (2)
    • if patient has persistent symptoms or signs when seen, is anticoagulated or has had more than 1 event in 24 hours, consider admission to emergency department (2)
  • if associated with neurological symptoms suggestive of brain tumour - then urgent referral (3)

Chronic diplopia (old strabismus)

• consider non-urgent referral if troublesome (1)

Chronic diplopia without simple refractive explanation

• requires referral for specialist review (2)

Notes (3):

• rapid onset of diplopia associated with CNS symptoms that arouses suspicion of a brain tumour requires urgent referra
  • such symptoms may include
    • unilateral sensorineural deafness;
    • progressive neurological deficit;
    • recent-onset seizures; mental or cognitive changes;
    • cranial nerve palsy;
    • headaches with vomiting, drowsiness or related to posture
      
      
• persistent diplopia with no simple refractive explanation should also be referred
  • particularly if accompanied by headaches of recent onset that persist for at least a month, even in the absence of signs of raised intracranial pressure or neurological deficit

Reference:

• Department of Health - Government of Western Australia. Diplopia referral guidance - accessed 2/7/2014
• Royal United Hospital Bath NHS Foundation Trust. Fast Track TIA clinic referral form - accessed 2/7/2014
• GPonline - Management of diplopia (15 April 2011) - accessed 2/7/2014