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A 77 year old man with diplopia
Digital Journal of Ophthalmology 2004
Volume 10, Number 11
November 19, 2004
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Pieter Gouws | Bristol Eye Hospital
Anthony G Quinn | West of England Eye Hospital



Examination
Visual acuity - OD: 20/30 OS: 20/20

Pupillary examination - Normal OU

Ocular Motility -
Primary position: 40 prism diopter (PD) right hypotropia and 8 PD right exotropia.
Right gaze: 35 PD right hypotropia.
Left gaze: 30 PD right hypotropia.
Up and right gaze: 35 PD right hypotropia.
Down and right gaze: 35 PD right hypotropia.
Up and left gaze: 30 PD right hypotropia.
Down and left gaze: 30 PD right hypotropia.

Forced duction testing revealed a marked restriction of elevation of the right eye.

Tonometry: Normal OU

Slit lamp examination of the anterior segment: Normal OU

Fundus examination: Normal OU without torsion.
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Figure 1
 Hess chart 7 months after cataract extraction demonstrating marked vertical muscle imbalance.

Figure 2
 Motility examination


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