What is a common initial management step for symptomatic diplopia due to decompensated strabismus in adults?

What is a common initial management step for symptomatic diplopia due to decompensated strabismus in adults?

• A. Prism correction to align images and reduce diplopia; surgery is considered if prism therapy fails or if the deviation is large or noncomitant.
• B. Immediate surgical realignment.
• C. Eye patching until symptoms resolve.
• D. No treatment until further signs appear.

Answer: (A)

Prismatic correction is a common initial step because it directly offsets the misalignment the eyes are experiencing, allowing the images to fall on corresponding retinal points and enabling fusion to reduce diplopia without immediate surgery. Glasses with prisms (or temporary Fresnel prisms) can be tailored to the amount of deviation and adjusted as needed, making this a versatile noninvasive option for small to moderate, relatively stable deviations. If prism therapy fails to control the double vision, or if the deviation is large or highly gaze-dependent (noncomitant), surgical realignment becomes a consideration. Patching or waiting for new signs isn’t an effective long‑term strategy for symptomatic diplopia, since the goal is to restore binocular single vision, and surgery isn’t the first step when a noninvasive option can help.

Prismatic correction is a common initial step because it directly offsets the misalignment the eyes are experiencing, allowing the images to fall on corresponding retinal points and enabling fusion to reduce diplopia without immediate surgery. Glasses with prisms (or temporary Fresnel prisms) can be tailored to the amount of deviation and adjusted as needed, making this a versatile noninvasive option for small to moderate, relatively stable deviations. If prism therapy fails to control the double vision, or if the deviation is large or highly gaze-dependent (noncomitant), surgical realignment becomes a consideration. Patching or waiting for new signs isn’t an effective long‑term strategy for symptomatic diplopia, since the goal is to restore binocular single vision, and surgery isn’t the first step when a noninvasive option can help.