A Woman With Progressive Double Vision and Proptosis

C. Robert Bernardino, MD


February 15, 2013

Clinical Presentation

A 60-year-old white woman complains of progressive double vision in the left eye that began 8 months ago. She also notes tearing and discharge from the eye and complains of increased bulging of the eye during the same course of time. She denies any pain.

She has no significant medical history and is taking no medications.

Ocular examination revealed visual acuity of 20/20 in the right eye and 20/30 in the left eye. Pupils were equally reactive to light and had no afferent pupillary defect. Motility was full in the right eye but was limited on upgaze and downgaze in the left eye. Intraocular pressures were 18 mm Hg in the right eye and 16 mm Hg in the left eye. Hertel exophthalmometry (base 95) revealed 12 mm for the right eye and 15 mm for the left eye (Figure 1).

Figure 1. External photograph demonstrates proptosis of the left eye with minimal inflammation. Upper eyelid fullness is also present.

External examination revealed dermatochalasis in both upper eyelids with increased fullness of the left upper eyelid. Slit lamp examination showed trace conjunctival injection in the left eye.

Diagnostic Question

What is the differential diagnosis?

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