An 84-year-old female with history of hypertension and hyperlipidemia presented with nontraumatic left eyelid edema, erythema, and ptosis followed by acute painless binocular horizontal diplopia. Best corrected visual acuity was 20/20 OD and 20/30 OS. The OD pupil measured 4 mm in the dark and 2 mm in the light, and the OS pupil measured 3 mm in the dark and 2 mm in the light. No relative afferent pupillary defect was detected. There was a 50 prism diopter esotropia in primary gaze and an abduction deficit of –4 OS (Fig.
An 84-year-old female with history of hypertension and hyperlipidemia presented with nontraumatic left eyelid edema, erythema, and ptosis followed by acute painless binocular horizontal diplopia. Best corrected visual acuity was 20/20 OD and 20/30 OS. The OD pupil measured 4 mm in the dark and 2 mm in the light, and the OS pupil measured 3 mm in the dark and 2 mm in the light. No relative afferent pupillary defect was detected. There was a 50 prism diopter esotropia in primary gaze and an abduction deficit of –4 OS (Fig.