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AbstractSA.11.04 Diplopia legal problems after head and neck trauma und for car drivers Kolling G.
University eye clinic, Heidelberg Binocular diplopia, loss of fusion and asthenopia caused by traffic accidents are frequent problems in neuroophthalmological practice. Often loss of consciousness, nausea and vomiting are concomitant symptoms. Difficulties arise, if a driver complains of these symptoms without any other sign of cerebral disturbances and without any MRI-lesions.
Case reports are demonstrated to differentiate between really existing signs of brain damage and symptoms only. Objective signs and subjective symptoms should be strongly correlated: f. i. in cases of blurred vision loss of accommodation has to be controlled by retinoscopy or in cases of loss of fusion subjective localisation of double images and objective findings in cover test have to correlate. Frequently asthenopic symptoms without any objective signs are uttered to get money from insurances or from conflicting parties in the court. Sometimes 100% correct decisions are not possible.
Drivers suffering from diplopia of recent onset are not allowed driving cars for at least three months. Having adapted to monocular vision for three to six months they can restart driving motor vehicles of class B, only, not for C and D. In some patients with partially recovered palsies the region of binocular single vision is not large enough to fulfil regular requirements of the FeV of Germany. In these cases individual decisions are necessary to decide whether they are allowed to drive again or not. Slight head turn or tilt, Fresnel prisms and other compensating strategies f. i. moving the head instead of eyes are helpful to regain driving licences. After surgical correction of ocular motor deficits diplopia is still present in peripheral parts of the visual field. Individual cases are presented to give some generally accepted recommendations concerning diplopia and car driving.
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