Examine this patient's fundus.



· History of diplopia (monocular diplopia).

· Floaters.

· History of diabetes, hypertension.


· Small white opacities which are present in front of the retinal vessels.

· The patient may complain of diplopia (monocular diplopia).

Proceed as follows:

Tell the examiner that you would like to:

· Test for monocular diplopia.

· Check urine for sugar.

· Check the blood pressure.


This patient has vitreous opacities (lesions) with monocular diplopia (functional status),

and has underlying diabetes mellitus (aetiology).


What are the causes of vitreous opacities?

· Blood: diabetes, retinal vein occlusion, trauma, subarachnoid haemorrhage,

sickle cell retinopathy.

· Cholesterolosis bulbi, where free-floating, highly refractile crystals are seen in

liquified vitreous and in patients with severe intraocular disease.

· Asteroid hyalitis (Benson's disease), where whitish yellow solid bodies,

con-taining calcium palmitate and stearate, are suspended in normal vitreous.

Prognosis for vision is good.

· Synchysis scintillans: gold or yellowish-white particles made up of cholesterol

are located in the vitreous; they settle to the bottom of the eye due to gravity.

Associated with previous trauma or surgery to the eye.

· Other, e.g. retinoblastoma, primary amyloidosis.

What are the other causes of monocular diplopia?

· Opacities in the lens.

· Corneal opacities.

· Retinal detachment.