Clinical Note

Diplopia and Ptosis

Patients with ophthalmoplegia (lesions of cranial nerve III) usually present with an initial complaint of seeing double (diplopia). This visual abnormality results from the loss of conjugate eye movements and the inability to maintain the image of the visual target on foveae of both eyes simultaneously. Remember that the visual cortex always receives a double image, one from each eye, but these images are normally fused by cortical processing into a single three-dimensional image. With loss of conjugate eye movements, the two images are no longer in normal register on the retinotopic map of the visual cortex, and these higher centers cannot fuse the two images. With time, the cortex will try to make adjustments by

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