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54 year old man with diplopia
Digital Journal of Ophthalmology 1997
Volume 3, Number 20
June 11, 1997
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Adam Jay Scheiner MD | Scheie Eye Institute, University of Pennsylvania Medical School, Philadelphia, PA
Grant Liu MD | Scheie Eye Institute, University of Pennsylvania Medical School, Philadelphia, PA
Examination
Vision: 20/15 OU
Pupils: Reactive OU, No relative afferent pupillary defect
Color vision: HRR 19/20 OD 20/20 OS
External:
   OD  OS
 Fissure height  7  5
 MRD  4  1
 Levator function  18  18
 Scleral show  0  1 inferior
 Lid crease height  12  12

Motility: See Figure 1
Slit lamp examination: Within normal limits OU
Fundus examination: Within normal limits OU
Neurologic examination:
- Mental Status Exam: Able to remember 3/3 objects. Difficulty with spelling and math as baseline.
- Cranial Nerves: II-XII tested and intact
- Motor: 5/5 strength throughout
- Sensory: intact to temperature throughout
- Cerebellar: slightly slow rapid movements
- Gait: normal toe and heel. some difficulty with toe to heel gait.
- Deep Tendon Reflexes: 3+ throughout. toes downgoing
top
Figure 1a
Figures 1a-1c. The above photographs demonstrate the patients attempts to look to the right, straight, and left respectively. Note the patient's ptosis OS and the limitations in motility OU. This patient also was noted to have nystagmus at extremes of lateral gaze.

Figure 1b

Figure 1c