Clinical and etiological profile of diplopia in a tertiary neurology clinic

Abstract

Aims: Diplopia is a common neuro-ophthalmological symptom with a wide etiological spectrum involving cranial nerves, the neuromuscular junction, extraocular muscles, and orbital structures. This study aimed to evaluate the clinical characteristics and etiological distribution of patients presenting with diplopia in a tertiary neurology setting.Methods: In this retrospective observational study, 55 patients evaluated for diplopia between January 2023 and August 2025 were analyzed. Demographic data, medical history, neurological and ophthalmological examination findings, laboratory results, neuroimaging, and electrophysiological studies were reviewed.Results: The mean age of the patients was 59±14.2 years, and 52.7% were female. Myasthenia gravis (MG) was the most common etiology (27.27%), followed by microvascular causes (20%) and idiopathic intracranial hypertension (IIH) (16.36%). Other causes included cerebrovascular diseases (14.54%), idiopathic cases (7.27%), multiple sclerosis (7.27%), and single cases of Miller–Fisher syndrome, intracerebral lymphoma, cavernous sinus thrombosis and pontin tumor (1.81% for each). Among the patient population, diabetes mellitus (DM) was diagnosed in 21 individuals and HT in 15. Thyroid function tests and C-reactive protein levels were within normal limits in all patients.Conclusion: The etiology of diplopia varies widely depending on clinical context and patient selection. In this cohort, MG was the leading cause, potentially reflecting referral patterns of a tertiary neurology center, where the diagnostic value and feasibility of single-fiber EMG were prominently demonstrated. The high prevalence of DM highlights diplopia as a potential early indicator of underlying metabolic dysfunction. Early diagnosis and targeted management are essential to improve clinical outcomes.