Author: Ankit Sinha / Editor: Yasmin Sultan / Codes: EnC6, NeuP7, OptP1, SLO1, SLO2Published: 28/09/2022

A 31-year-old woman presents to the Emergency Department (ED) complaining of gradual onset double vision for the past week. When asked to elaborate she shouts – “I see 2 cigarettes when I’m smoking! I keep dropping them!”. She also describes general discomfort around the eye and puffy eyes due to lack of sleep. No other symptoms.

She has no medical or surgical history, takes the oral contraceptive pill and has no allergies.

On examination, you find bilateral oedematous eyelids, conjunctival injection and that she is fidgeting with her hands. She has normal visual acuity but is unable to close her eyes.

Observations: RR 15, SpO2 100% RA, HR 98, BP 145/76, T 37.4.

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