From the Guidelines
For a patient with diplopia due to B-cell lymphoma, a solid, opaque eye patch is recommended as the most effective option. This type of patch completely blocks vision in the affected eye, eliminating the double vision by allowing only the unaffected eye to see. The patch should be comfortable, with an elastic band that secures it firmly without causing pressure or irritation. Frosted or translucent patches are not recommended as they may still allow some light perception, which can interfere with resolving the diplopia. The patch should be worn over the affected eye, but if both eyes are affected, patching the non-dominant eye typically provides better functional vision. Patching is a temporary symptomatic measure while treating the underlying lymphoma, which is the definitive solution. The diplopia occurs because the lymphoma may be infiltrating or creating pressure on the cranial nerves controlling eye movement or affecting the extraocular muscles directly, causing misalignment of the visual axes and resulting in double vision, as discussed in the adult strabismus preferred practice pattern 1.
Key Considerations
- The patch should be solid and opaque to effectively block vision in the affected eye.
- Comfort and proper fit are crucial to prevent pressure or irritation.
- The patch is a temporary solution while the underlying lymphoma is treated.
- The choice of eye to patch (if both are affected) should prioritize the non-dominant eye for better functional vision.
Management and Treatment
The management of diplopia in patients with B-cell lymphoma involves addressing the symptoms while treating the underlying condition. Patching the affected eye with a solid, opaque patch is a recommended approach for temporary relief from diplopia, as it eliminates the conflicting images seen by each eye, thereby reducing the perception of double vision. Other methods, such as prism correction or fogging, may also be considered but are generally less effective for immediate symptom relief compared to patching. The definitive treatment, however, focuses on managing the B-cell lymphoma, which may involve various therapies aimed at reducing the tumor's size and alleviating its pressure on the cranial nerves or extraocular muscles.
Evidence Support
The recommendation for using a solid, opaque eye patch is supported by the principles outlined in the adult strabismus preferred practice pattern 1, which emphasizes the importance of managing diplopia through methods that can provide immediate relief, such as patching, while also considering the underlying cause and the potential for recovery or improvement with treatment of the primary condition.
From the Research
Types of Eye Patches for Diplopia
- There are several types of eye patches that can be used to treat diplopia, including:
- Occlusive patches: These patches cover one eye completely, eliminating double vision 2
- Prism patches: These patches have a prism lens that helps to align the images from each eye, reducing double vision 2
- Orthoptic patches: These patches are used to treat strabismus and other eye alignment problems that can cause diplopia 2
Recommendations for B-Cell Lymphoma Patients
- For patients with diplopia due to B-cell lymphoma, the type of eye patch recommended may depend on the specific cause of the diplopia and the patient's overall health status 3, 4
- In some cases, an occlusive patch may be recommended to eliminate double vision and improve the patient's quality of life 2
- However, it is essential to note that diplopia can be a symptom of a more serious underlying condition, such as a brain tumor or orbital involvement, and should be thoroughly investigated by a healthcare professional 5, 6
Important Considerations
- Diplopia can be a debilitating symptom that affects a patient's daily life and independence 5, 2
- A comprehensive diagnostic evaluation, including imaging studies and laboratory tests, is necessary to determine the underlying cause of diplopia in patients with B-cell lymphoma 3, 4
- Timely recognition and accurate diagnosis are crucial for initiating appropriate treatment and improving patient outcomes 4, 6