Author: Mussa Adil Butt / Editor: Sarah Edwards / Codes: OptC2, OptP1, SLO1, SLO2 / Published: 11/10/2022

A 54-year-old man presents to the Emergency Department (ED) on a Saturday afternoon with sudden onset of double vision. He also tells you that his wife said his right eyelid looked ‘droopy. He is a known diabetic and takes medications to control his blood pressure.

On examination, the patient is conscious and has clear speech, but there is right-sided ptosis, and the right eye is in the ‘down and out’ position. On further testing, the right pupil does not react to light. The left eye is normal.

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