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A 64-year-old woman with dilated right pupil, nausea, and headache
Digital Journal of Ophthalmology 2013
Volume 19, Number 1
January 27, 2013
DOI: 10.5693/djo.03.2012.11.001
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Ali Haider, BMedSc, MBBS | The Canberra Hospital, Canberra, Australia
Prashanth J. Rao, MBBS, MS | The Canberra Hospital, Canberra, Australia
Examination
On physical examination, she exhibited a cushingoid habitus and centripetal obesity. Vital signs were normal. Best-corrected visual acuity was 6/6 in both eyes. Neuro-ophthalmic assessment revealed a right partial ptosis with a fixed and dilated right pupil measuring 7 mm on the right (no direct or consensual response to light) and a reactive pupil measuring 3 mm on the left. Fundus examination was normal. Ocular motility showed limited adduction, elevation, and depression of the right eye but full ductions of the left eye (Figure 1). There was subjective diplopia on left and up- gazes. Visual fields were intact on confrontation. The remainder of the cranial nerve examination was unremarkable. Formal perimetry confirmed intact visual fields.
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Figure 1
Photographs showing right oculomotor nerve palsy, with sparing of abducens nerve function (abduction) in right gaze, ptosis and mydriasis of the right eye in primary position, and restricted adduction in left gaze.