A 20-year-old woman with abnormal eye movements

Abstract

A 20-year-old woman was referred to the neuro-ophthalmology clinic at Beth Israel Deaconess Medical Center for evaluation of diplopia. Three months prior to presentation, she awoke with oblique binocular diplopia, which resolved spontaneously over a period of several weeks but recurred 1 month prior to presentation, accompanied by an inability to make facial expressions on her left side and difficulty with eye movements. She denied diplopia in primary gaze but complained of horizontal diplopia in right- and leftward gaze, worse in left gaze. She denied eye pain and any change in visual acuity. Associated symptoms included dry eye on the left, for which she was applying artificial tears four times daily and lubricating ointment at bedtime. She was previously healthy and took no medications. Family history was unremarkable. She had no history of head or eye trauma.