To present guidelines for the diagnosis and management of fixation switch diplopia.
Adults with a history of strabismus since childhood may experience acquired diplopia if a change in their refractive error or use of spectacles encourages fixation with their nondominant eye. This is referred to as "fixation switch diplopia." If correctly diagnosed, this seldom-recognized cause of acquired diplopia in adults can almost always be successfully treated with the proper optical management.
A retrospective review was carried out for all patients with the diagnosis of fixation switch diplopia who were seen in my private practice.
A review of patient records identified 16 patients with fixation switch diplopia. In four patients, the switch in fixation was spontaneous owing to the development of myopia in the previously preferred eye in patients with mild contralateral amblyopia. Six patients developed diplopia owing to their "monovision" (one eye optically corrected for distance and the other eye presbyopic). In six patients, fixation switch diplopia occurred because a noncycloplegic subjective refraction was performed in the presence of amblyopia, resulting in an unbalanced refractive correction. In all 16 patients, symptoms were eliminated when proper optical correction was instituted to encourage fixation with the dominant eye.
Fixation switch diplopia is a cause of acquired diplopia in adults with a history of strabismus since childhood. It can usually be successfully treated with proper optical management.
Kushner BJ. Fixation Switch Diplopia. Arch Ophthalmol. 1995;113(7):896–899. doi:10.1001/archopht.1995.01100070070027
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