A 44-Year-Old Man With Blurred Vision

Rod Foroozan, MD


August 08, 2016

Clinical Presentation

A 44-year-old man notes trouble focusing. He says that it began about 2 months prior to an initial eye examination. At first the symptoms were intermittent, but they gradually worsened.

He has no prior medical problems and he does not drink alcohol or smoke tobacco. There is no family history of visual loss. He is currently taking no prescription medications.

Visual acuity is 20/20 and J1 for each eye at near. Color vision with Ishihara pseudoisochromatic plates is 10/10 for each eye. Pupils are briskly reactive to light with no anisocoria and no relative afferent pupillary defect. Slit lamp examination of the anterior segment and funduscopy are normal.

He is orthotropic with alternate cover testing in all positions of gaze. He has full ductions in right gaze, left gaze, and downgaze. He has a symmetric limitation in upgaze and becomes symptomatic with blurred vision. With saccades in upgaze, both globes retract slightly. The limitation in upgaze is unchanged with a doll's head maneuver. There is no ptosis and no fatigability in upgaze.


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