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Image challenge
New-onset partial ptosis and double vision
  1. Jason M Kwok1,
  2. Jonathan A Micieli1,2
  1. 1 Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
  2. 2 Kensington Vision and Research Centre, Toronto, Ontario, Canada
  1. Correspondence to Dr Jonathan A Micieli, Kensington Eye Institute, Toronto, ON M5T 3A9, Canada; jonathanmicieli{at}gmail.com

https://doi.org/10.1136/emermed-2020-209540

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    Clinical introduction

    A 70-year-old woman presented to the emergency room with a 1-day history of right periorbital pain, ptosis and binocular horizontal diplopia when looking to the left. Visual acuity was 20/20 in both eyes and external examination revealed partial right ptosis. Assessment of ocular motility revealed a mild limitation of elevation, depression and adduction in the right eye only (figure 1). Pupils were of equal sizes and reactive to light (figure 1). Cranial nerve function and neurological examination were otherwise normal. CT angiography (CTA) of the brain was performed, demonstrating an intracranial aneurysm.

    Figure 1

    Ocular motility photographs demonstrating mild limitation of elevation, depression …

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    Footnotes

    • Contributors Conception and design: JMK and JAM; data acquisition: JMK and JAM; manuscript preparation: JMK; critical revision: JAM; final approval: JMK and JAM.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; internally peer reviewed.