Eye Patch Application for Right Eye Diplopia
For right eye diplopia, apply occlusion (fogging) to the right eye using Scotch Satin tape or Bangerter foils on the spectacle lens, as these are better tolerated than surgical tape, or consider an occlusive contact lens. 1
Rationale for Occlusion Approach
The goal of patching/fogging in diplopia is to eliminate the binocular conflict by creating a central scotoma in one eye. This approach is particularly effective because:
- Fogging eliminates the foveal conflict that causes double vision by blocking clear vision in the affected eye 1
- This is often the most suitable long-term solution for persistent diplopia 1
- It provides immediate symptomatic relief without requiring surgical intervention
Specific Application Methods (in order of preference)
Primary Options:
- Bangerter foils - Apply to the right spectacle lens (best tolerated) 1
- Scotch Satin tape - Apply to the right spectacle lens (better than regular surgical tape) 1
- Occlusive contact lens - Worn on the right eye 1
Combined Approach:
- In difficult cases: A small amount of prism correction may be added to the Bangerter foil for better diplopia relief 1
Important Clinical Considerations
Common Pitfall: Do not assume prism correction alone will resolve diplopia. While cover testing often shows small-angle strabismus (usually vertical), prismatic or surgical correction is typically not curative because it doesn't resolve the underlying mismatch of images or conflict between foveal and peripheral alignment 1
When to Monitor vs. Treat:
- Monitor only if symptoms are mild, occasional, or patient refuses treatment 1
- Otherwise, proceed with occlusion therapy
Counseling Points
Patients should understand that: