Diplopia in adult patients following cataract extraction and refractive surgery

Purpose of review The purpose of this article is to report the incidence and cause of diplopia following cataract surgery and laser in-situ keratomileusis (LASIK). Recent findings Ocular misalignment following cataract extraction with retrobulbar anesthesia has an incidence of approximately 7%. Diplopia ranges in this group of patients from 0.23 to 0.98%. The incidence of ocular misalignment decreases with topical anesthesia for cataract extraction to 5%, and diplopia occurs with an incidence of 0.21–0%. Although there are small case series, the incidence of diplopia following LASIK has not been reported. The causes of diplopia following cataract extraction and LASIK include decompensation of pre-existing strabismus, new-onset accommodative esotropia, concurrent onset of systemic disease, disruption of central fusion, and monocular diplopia. The leading cause for diplopia following retrobulbar anesthesia for cataract extraction is extraocular muscle paresis/restriction and is unique to this type of procedure. In cases of topical anesthesia for cataract extraction and for LASIK procedures, the leading cause of diplopia is decompensation of pre-existing strabismus. Summary Detailed history and evaluation for pre-existing strabismus can dramatically decrease the incidence of unexpected diplopia following refractive procedures.