Diplopia counts as one of the most common symptoms encountered in all aspects of ophthalmological and neurological practice. In order to correctly localize the origin of the symptom of diplopia, the physician should possess background knowledge of the motor function of the eyes as well as the pathways exiting the brain which govern the eye movements. Since diplopia has a multitude of origins (from deep brain structural abnormalities to lenticular opacities) it is important to assume a hierarchical methodology in order to arrive at the correct diagnosis. Therefore the lecture will hierarchically delineate causes of diplopia such as: (1) CNS origin (cortex, sub-cortex, brainstem), (2) PNS origin (cranial nerves along their complex courses), neuromuscular junction and muscle origins. The correct identification of the localization of the problem, i.e. Binocular vs. monocular, neurogenic vs. myogenic, neurogenic vs optical, will be explained. The correct identification of the localization will lead to the correct treatment of the problem. Treatment of diplopia will be briefly discussed.
Misha Pless was a neuro-ophthalmologist working on Neuro-ophthalmology, Multiple Sclerosis and General Neurology at Massachusetts General Hospital. In addition, Dr. Pless was an Associate Professor at Harvard Medical School. He was formally an Associate Professor of Neurology and Ophthalmology at the University of Pittsburgh. He was a Woodruff Scholar at Emory University School of Medicine, where he received his MD. Dr. Pless completed a medical internship at the Massachusetts General Hospital and a neurology residency at the Harvard-Longwood Neurology Training Program of Boston. He subsequently joined Dr. Simmons Lessell in specialty training in neuro-ophthalmology at the Massachusetts Eye and Ear Infirmary, Boston. Before joining the University of Pittsburgh, he served as full-time faculty at the Brigham and Women's Hospital and Harvard Medical School in Boston. Dr. Pless is certified by the National Board of Medical Examiners and is a board-certified member of the American Board of Psychiatry and Neurology. He currently serves as neuro-ophthalmologist and neurologist specializing in multiple sclerosis and neuro-ophthalmic disorders at the Hospital of the Canton of Lucerne, Switzerland