Wall-Eyed and Going Nowhere
neuro ophthalmology
Patient Demographics
Age: 59 years
Gender: Male
History of Presenting Complaint
Referred for ophthalmic assessment following a recent stroke, with reported double vision and abnormal eye movements.
Past Medical History
- Known hypertension and hyperlipidaemia
- Former smoker
- No known history of atrial fibrillation or previous stroke
Examination Findings
Visual Acuity
OD: 6/6. OS: 6/6
Pupils
Equal and reactive, no RAPD
Extraocular Movements
Horizontal gaze: impaired adduction of the adducting eye on attempted gaze in both directions, with the abducting eye moving relatively normally. Vertical gaze: impaired both upgaze and downgaze bilaterally.
Anterior Segment
Primary position: bilateral exotropia ("wall-eyed" appearance)
Posterior Segment
Unremarkable bilaterally
Which investigations would you choose?
Try to decide before revealing the results. You have 2 attempts.
MRI brain with attention to the brainstem
Orthoptic assessment of ocular motility and alignment
Vascular risk factor screening (BP, lipids, HbA1c)
Cardiac rhythm monitoring and carotid imaging
Genetic testing for hereditary optic neuropathy
0 of 4 investigations selected
Investigations (Locked)
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