Hello,

Here is my article and thoughts on it below.

Firstly, thanks to Jay for sourcing this article for me from the UoA.

The journal I have picked this month is about paradoxical diplopia. We currently have a patient in Auckland with this. He would very much like his eyes to be straight for his wedding photographs. I could not find many articles on this. This is a pretty old article. They suggest Botulinum toxin and prism wear for the residual angle.   The patient was then able to have her surgery and remain symptom free and is cosmetically good.

We decided to try this approach on our patient below.

He has had 2 previous surgeries. Initially had an esotropia, Immediately was  still ET but 6 months post up, then was XT increasing in size. 2^nd surgery was a 10 years for a consecutive exotropia, still exotropia at post op.

Patient is now 27 years of age had some trouble with fixation switch but can cope with that main issue is cosmesis.

PODT gets diplopia from 2 dioptres base in.

Had Botox to the left lateral rectus injection was noted to be difficult, it made no difference to angle of deviation. We have tried prism adaption with no success.

My feeling is that we should leave him alone. Has anyone had successful outcomes with paradoxical diplopia? When I very first graduated in the UK we had a patient who consented to having surgery knowing she would have diplopia post surgery as the cosmetic appearance was affecting her mental wellbeing. She was very upset with the double vision even though she was cosmetically excellent and refused an occlusive contact lens.