Neurogenic diplopia: paralysis of cranial nerves III, IV, and VI.

Diplopia is a symptom that may be the result of paralytic strabismus. The causes of paralytic strabismus are deficiencies of cranial nerves III, IV, or VI. When encountering neurogenic diplopia, the clinician must determine which ocular motor nerve is involved. The clinician must then decide whether the disturbance is in the nerve nucleus, its fascicles, along the course of the nerve in the subarachnoid space, in the cavernous sinus, or at its termination within the orbit. With proper diagnosis, identification, and localization, appropriate management may be undertaken.