The Painful Eye That Won't Move
neuro ophthalmology
Patient Demographics
Age: 84 years
Gender: Female
History of Presenting Complaint
Progressive double vision (both vertical and horizontal) and deep left orbital pain over several weeks.
Past Medical History
- Hypertension
- No previous neurological or ophthalmological conditions
Examination Findings
Visual Acuity
Visual acuity testing was limited by ptosis and diplopia but was estimated at approximately 6/9 bilaterally. Formal documentation was incomplete at initial presentation.
Pupils
Left pupil involvement suspected (CN III palsy with possible pupillary involvement)
Extraocular Movements
Severe restriction: Left eye shows marked limitation in elevation, depression, and adduction (CN III palsy). Impaired abduction suggests CN VI involvement. Right eye movements normal.
Anterior Segment
Left eye: Moderate ptosis. Both eyes: Otherwise unremarkable
Posterior Segment
No papilloedema or retinal abnormalities noted
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CT brain with contrast
OCT macula
MRI brain
Humphrey visual field
Digital subtraction angiography (DSA)
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