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Binocular diplopia is always caused by...

  1. a weak or paralyzed extraocular muscle

  2. misaligned spectacle lenses

  3. excessive blinking

  4. corneal abrasion

The correct answer is: a weak or paralyzed extraocular muscle

Binocular diplopia is defined as the perception of two images instead of one when looking at an object. It is more common to occur due to a defect in the extraocular muscles, which are responsible for controlling eye movements, rather than factors such as misaligned spectacles, excessive blinking, or a corneal abrasion. These other options may cause temporary or isolated diplopia, but overall, binocular diplopia is often caused by a weakened or paralyzed extraocular muscle.