One Eye Up, One Eye Down
neuro ophthalmology
Patient Demographics
Age: 79 years
Gender: Male
History of Presenting Complaint
Sudden onset of vertical diplopia.
Past Medical History
- No significant past medical history reported
- No known primary malignancy identified at presentation
Examination Findings
Visual Acuity
OD: 6/24 (longstanding cataract). OS: 6/9
Pupils
Bilateral miosis, poorly reactive to light, with intact constriction on convergence (light-near dissociation)
Extraocular Movements
Impaired vertical gaze, convergence-retraction nystagmus on attempted upgaze, skew deviation (vertical ocular misalignment) present
Anterior Segment
OD — dense cataract (longstanding, incidental). OS — unremarkable
Posterior Segment
Lids: bilateral ptosis, right greater than left
Which investigations would you choose?
Try to decide before revealing the results. You have 2 attempts.
Urgent neuroimaging (CT/MRI brain)
Staging CT chest, abdomen and pelvis
Orthoptic assessment of ocular alignment and motility
Clinical photography of lids and fixation testing
Immediate cataract surgery
0 of 4 investigations selected
Investigations (Locked)
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