Author:
Dr. Michael Peng, MD, Indiana University School of Medicine, Glick Eye Institute
A 30-year-old man with a past ocular history of myopia presents with a 3-day history of diplopia. The doubled images are side-by-side and resolve when he covers one eye. Corrected visual acuity is 20/20 in each eye. His motility pattern is seen here:
Ok thanks
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Comprehensive history to look for the most reliable etilogy and to characterize the diplopia. Specially look for notion of trauma, heat intolerance, symptoms of raised intracranial pressure (nausea and vomiting, constipation, headaches). The diplopia is a binocular one, hence resolvong when closing one eye. the direction,the intensity , the evolution of the diplopia should be precised.
Past history should notice if previous history of diplopia or any neurological deficit (multiple sclerosis hypothesis).
Physical examination.
Should include refraction measurement looking to astigmatism and anisometropia specially , oculomtor exams to rule out oculomotor palsy. It is important to look for sign of grave ophtalmopathy especially if notion of intermittent diplopia or diplopia at the end of the day. Completing physical examination by slit lamp exam, IOP measurement and fundoscopy should be done.
Paraclinical exams shoud envolve red lens test, Lancaster test to confirm an oculomotor muscle palsy or limitation. Brain imaging may be urgent if oculomotor nerd palsy suspected.
Thank you for this case. I’ve learned a lot, as always.
I’d suggest you please put in parentheses the whole term for any abbreviation that you use, so that the colleagues from other countries can fully understand.
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What is the management of this case?
It’s in the last slide. He was referred for chemotherapy.
It’s in the last slide. He was referred for chemotherapy and other therapy
How would you manage such case?
It in the last slide. They referred him for Chemotherapy.
Very informative. Thank you for sharing.
This case is impressive, would you tell if in your Center perform Lumbar Punction for every patient with VI nC paresis or in every young patient who has this problem or maybe you have the suspicion based on some other subtle sign to indicate the lumbar punction?
Thank you very much, this is very educative with Acute onset Esotropia
Thank you very much, this is very educative.
Thanks
Very informative and interesting case
Very interesting observation, thank you for the correction
This was a very interesting case.. so what are some of the treatment options you offer to patients with diplopia whilst you wait for resolution (6th cranial nerve palsy in this case).
So refreshing!
Keep this coming
Thank you, it’s indeed interesting and educative
Interesting case
Thanks for sharing, really interesting case
Nice case
Excellent case study.
Thank you for sharing .
Its intersting case thanks alot
Thank you for the toughtfull explination .
Thanks for the update.
Thanks this was informative
Excellent learning
Thank you
Welcome 🤗
Thank you, very informative!
Thank you, very informative
Interesting as usual
Thanks, good question, informative.
Interesting case
I know
RE ishemic 6th nerve palsy
Great learning!!
Thanks for sharing an interesting case to revise and update our knowledge.
Prognosis?
Very interesting quiz
Thank you for interesting case.
Thankyou very much
Very interesting case!
This case is very interesting. Hope you tell me more this case. Thanks Doctor!