Macular diplopia, also known as dragged-fovea diplopia syndrome, is a rare form of binocular diplopia resulting from foveal displacement caused by macular pathology. Epiretinal membrane (ERM) is the most common underlying cause, producing retinal misregistration that disrupts central fusion while preserving peripheral correspondence. Recognition of this entity is critical to avoid misdiagnosis as strabismic or neurologic diplopia. This type of diplopia highlights the sensory nature of macular diplopia, which arises from foveal displacement and central-peripheral fusion conflict. ERM-induced traction alters retinal correspondence, causing diplopia despite normal ocular alignment. Although surgical membrane peeling can correct macular anatomy, diplopia may persist due to limited cortical adaptation. Conservative management using prismatic correction or partial occlusion remains an effective first-line approach. In conclusion, epiretinal membrane-associated macular diplopia is an uncommon but clinically significant cause of binocular double vision. Accurate diagnosis through multimodal imaging and orthoptic evaluation enables tailored management and can prevent unnecessary surgical or neurological interventions.
Gutovitz et al. (Fri,) studied this question.