Can osteoarthritis (OA) cause double vision, also known as diplopia?

Double Vision in Osteoarthritis: Causes and Management

Osteoarthritis itself does not directly cause double vision (diplopia). However, certain inflammatory conditions associated with osteoarthritis may rarely affect the extraocular muscles or their function, potentially leading to diplopia.

Potential Mechanisms for Diplopia in Patients with Osteoarthritis

• Diplopia in patients with osteoarthritis is most likely due to an associated inflammatory condition affecting the extraocular muscles or their function, rather than osteoarthritis itself 1
• Brown's syndrome, a stenosing tenosynovitis of the superior oblique tendon, has been reported as a rare extraocular manifestation of rheumatoid arthritis that can cause vertical diplopia 1
• Inflammatory conditions affecting the orbit or extraocular muscles can lead to strabismus (misalignment of the eyes), resulting in binocular diplopia 2

Diagnostic Approach for Diplopia

• Distinguish between monocular and binocular diplopia by having the patient cover each eye separately:

  • In binocular diplopia, one of the two images disappears when either eye is covered 3
  • In monocular diplopia, double vision persists when the affected eye is viewing alone 3

• For binocular diplopia, a complete sensorimotor evaluation with special attention to:

  • Measuring torsion and determining position of gaze with greatest deviation 2
  • Assessing whether torsion is a barrier to fusion 2
  • Quantifying magnitude and direction of torsional diplopia 2

• Consider neuroimaging (MRI with contrast) if there are additional central nervous system signs or symptoms 2

Management Options for Diplopia

• For mild or occasional symptoms, observation may be appropriate 2

• Non-surgical options:

  • Prism glasses for small vertical deviations, although lateral incomitance may limit success 2
  • Fogging the vision in one eye using Scotch Satin tape or Bangerter foils on spectacle lenses 2
  • Occlusive contact lenses in some cases 2

• Surgical options:

  • Consider if prism correction or non-surgical approaches are insufficient 2
  • Various procedures may be used depending on the specific cause of diplopia 2
  • Note that in cases of binocular retinal diplopia, surgery may not be curative 2

Important Considerations

• Diplopia warrants thorough evaluation as it may indicate serious underlying pathology 2
• If diplopia is associated with scalp tenderness, temporal region pain, or jaw claudication in elderly patients, consider giant cell arteritis, which requires prompt diagnosis and treatment to prevent permanent visual loss 2
• The majority of acute sixth nerve palsies in adults are vasculopathic, associated with risk factors such as diabetes and hypertension 2
• Most vasculopathic palsies resolve after 6 months, but if no recovery is apparent by 6 months, approximately 40% of patients demonstrate serious underlying pathology warranting further evaluation 2

Referral Recommendations

• A complaint of diplopia normally prompts referral to an ophthalmologist, orthoptist, or neuro-ophthalmologist familiar with the diagnosis and management of this condition 2
• Neurological evaluation may be indicated based on associated symptoms or if there is concern for a neurological cause 2