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A 33 year old man with left upper lid swelling
Digital Journal of Ophthalmology 2004
Volume 10, Number 12
December 18, 2004
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Lucas Maischner | Kings College Hospital
Kashif Qureshi | St George's Hospital
Fiona Robinson | Kings College Hospital
Scott Robiee | St George's Hospital
Shahram Kashani | Kings College Hospital
Neelanjana Dutt | Kings College Hospital
Examination
Examination revealed a collapsed nasal bridge and swollen left upper eyelid (figures 1and 2). Cover testing in primary position demonstrated left hyportropia with increased height in lateral gaze together with chin elevation .


Extra ocular movements revealed limitation of upgaze in the left eye with vertical diplopia. He had 3mm axial proptosis and there was marked conjunctival injection on the lateral aspect of the left eye .

His visual acuities, colour vision, pupillary reflexes, and fundoscopy were normal .
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Figure 1
Frontal view demonstrating the left upper lid swelling

Figure 2
Side view demonstrating collapse of the nasal bridge

Figure 3
Hess chart showing the restriction in elevation of the left eye