A 64 year-old Caucasian gentleman presented with an unusual complaint. He stated that if he touched the inside of his right cheek with his tongue, he felt a tingly sensation in his R eyebrow. This had started one month ago. He also complained of foreign body sensation and discomfort in the right eye for six months. Additionally, he had recently noted a droopy R eyelid for which his local ophthalmologist had placed a stitch in his R upper lid to lift it. He also complained of recent binocular diagonal double vision. Past medical history included hypertension, hyperlipidemia, emphysema, and coronary artery disease requiring 4 stents (2002 and 2011). Social history was significant for 50 pack-years of smoking, and he drank 6 beers per week. His medication list included simvastatin, prasugrel, fluticasonesalmeterol, tiotropium bromide, aspirin, metoprolol, and hydrochlorothiazide. Exam revealed bestcorrected visual acuity of 20/40 and 20/25. BP was 125/70. Pupils were 5.5 mm and 5 mm, with no RAPD. IOP was 19 and 21. Eye movements revealed -1 adduction, -3 supraduction, and -1 abduction in the R eye only. Visual fields were full to confrontation OU. External exam revealed ptosis with an MRD of -2 OD and +2 OS. Facial sensation to cotton tip was WNL bilaterally. Slit lamp revealed a decreased tear film OD and mild corneal scarring OD. There were 2+ nuclear sclerotic cataracts OU. Dilated fundus exam revealed pink, sharp optic discs with normal cups and spontaneous venous pulsation OS. A diagnostic procedure was then performed.
Date
2015
Language
eng
Format
video/mp4
Type
Image/MovingImage
Source
47th Annual Frank Walsh Society Meeting
Relation is Part of
NANOS Annual Meeting Frank B. Walsh Sessions; 2015
