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A 51-year-old woman with binocular diplopia and unilateral ptosis
Digital Journal of Ophthalmology 2019
Volume 25, Number 3
August 18, 2019
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Landon J. Rohowetz, BS | University of Missouri – Kansas City School of Medicine, Kansas City, Missouri
Anjulie K. Quick, MD | Department of Ophthalmology, University of Kansas School of Medicine, Prairie Village, Kansas
Best-corrected near visual acuity with +2.50 reading glasses was 20/30 in the right eye and 20/30 in the left eye. In room light, the right pupil measured 6 mm and was 1+ reactive; the left pupil, 4 mm and 3+ reactive. Confrontation visual field testing was unremarkable. There was no relative afferent pupillary defect. Motility in the right eye was −4 to adduction and supraduction and −3 to infraduction (Figure 1). Left eye motility was full. The right eye was exo- and hypotropic, and there was complete ptosis, with no observable corneal light reflex. (Given the inpatient setting and the acuteness of the patient’s condition, prism correction was not measured at this time but was deferred until outpatient follow-up.) The left eye was without ptosis. No exophthalmos nor enophthalmos was apparent. The rest of the examination, including fundus and the remainder of the cranial nerve examination, was unremarkable.

Figure 1.

Ocular motility testing demonstrating impaired adduction, supraduction, and infraduction of the right eye. Left eye motility was full.