Prism use in adult diplopia.

PURPOSE OF REVIEW: Prismatic correction to restore binocularity in adult diplopia can be challenging. This review summarizes the results of prismatic correction in adults based on the cause of diplopia.

RECENT FINDINGS: Satisfaction with prismatic correction is achieved in approximately 80% of all adult patients with diplopia when combining the causes. Of patients with vertical diplopia, skew deviation and fourth nerve palsy have the highest satisfaction rates, 100 and 92%, respectively. Patients with thyroid eye disease and orbital blowout fractures associated with diplopia had the lowest satisfaction rates, 55 and 8%, respectively. With regard to horizontal deviations, patients with decompensated childhood strabismus with a combination of horizontal and vertical deviations and patients with convergence insufficiency had the lowest satisfaction rates, 71 and 50%, respectively.

SUMMARY: Careful selection of patients for prismatic correction, management of patient's expectations, and continued follow-up to monitor the symptoms are critical to the successful use of prisms.