Author: Mohammad Saleki / Editor: Sarah Edwards / Codes: NeuC8, NeuP7, OptP1, SLO1, SLO2 / Published: 17/08/2023
A 55-year-old female presents to the emergency department (ED) with a complaint of double vision. She reports that she first noticed the diplopia 2 days ago and it has progressively worsened since then. The patient denies any recent head trauma, falls, or accidents. She denies any pain, redness, or discharge from her eyes. She reports no history of diabetes, hypertension, or thyroid disease. She also denies any recent changes in her medication regimen.
On review of systems the patient reports a history of migraines but denies any recent headaches. She denies any changes in her vision, hearing, speech, or balance. She denies any chest pain, shortness of breath, abdominal pain, nausea, vomiting, or diarrhoea. She reports no recent fever, chills, or night sweats.
The patient’s vital signs are within normal limits. On ophthalmologic examination, her visual acuity is 6/6 in both eyes. She has no nystagmus or strabismus. The extraocular movements are limited in all directions of gaze, particularly the left lateral gaze. The pupils are equal, round, and reactive to light. The anterior and posterior segments are within normal limits.