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A 72-year-old man with double vision
Digital Journal of Ophthalmology 2007
Volume 13, Number 7
February 17, 2007
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Sreekumari Pushpoth | Wolverhampton and Midlands Eye Infirmary
Stephanie Smith | East Lancashire Hospitals NHS Trust
J.P. Roper | East Lancashire Hospitals NHS Trust
On examination, visual acuity was 6/9 in both eyes without correction. There was no proptosis, with a Hertel’s exophthalmometry reading of 18 mm in either eye. There was 25 prism diopter exotropia present at 1/3 meter and 6 meters. There was no movement on elevation or depression (duction or version). The eye movement was slow on horizontal gaze, but normal. Convergence was absent. Dolls eye movement was normal. Vertical saccades were absent, horizontal saccades slow. There was no response to optokinetic nystagmus drum. Anterior segment evaluation was unremarkable with equal size of pupils, briskly reacting to direct and consensual reflex. Fundus evaluation was normal. General examination showed lack of expression with axial rigidity and shuffled gait. There was no resting tremor.
Figure 1
Attempted upgaze

Figure 2
Attempted down gaze

Figure 3
Right gaze

Figure 4
Left gaze