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A 49-year-old man with unilateral, nontender left eyelid swelling
Digital Journal of Ophthalmology 2014
Volume 20, Number 1
January 17, 2014
DOI: 10.5693/djo.03.2013.09.007
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Brandon J. Wong, BA | Keck School of Medicine, University of Southern California, Los Angeles, California
Bryan K. Hong, MD | Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
Daman Samrao, MD | Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
Gene H. Kim, MD | Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
Narsing A. Rao, MD | Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
Examination
On clinical examination, the patient’s best-corrected visual acuity was 20/20 in the right eye and 20/30 in the left eye. Intraocular pressure by applanation was 17 mm Hg in each eye. Ductions were full, and versions were comitant. Pupils were equal, round, and reactive to light. There was no afferent pupillary defect. Ptosis evaluation was performed bilaterally: the right eye had a palpebral fissure of 9 mm, a margin reflex distance 1 of 4 mm, levator function of 15 mm, no lagophthalmos, and a normal eyelid, while the left eye had palpebral fissure of 7 mm, a margin reflex distance 1 of 2 mm, levator function of 14 mm, no lagophthalmos, and painless, nonpitting edema of the left upper eyelid, with no warmth or erythema. There were no palpable orbital masses and no resistance to retropulsion. Hertel exophthalmometry findings were normal, with 19 mm of protrusion bilaterally. Slit-lamp examination and dilated fundus examination were normal bilaterally, with no palpebral conjunctival follicles or lacrimal gland enlargement. Other than the isolated left eyelid swelling, the face was symmetrical, and there was no evidence of other facial swelling. The patient had normal facial motor movement with no signs of weakness or paralysis. In addition, the patient had a relatively normal tongue on examination, with only a minor, centrally located fissure (Figure 2).
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Figure 2
Patient at presentation with relatively normal tongue, with only a mild fissure located centrally (arrow).