On examination visual acuity was 6/12 corrected. She had bilateral ptosis, which was worse on the right side. Hertel exophthalmometry was 17 mm bilaterally, no orbital mass could be palpated, no orbital bruit present and there was no resistance to retropulsion. A right face turn and chin-up head posture was noticed, with a 25 prism diopter right esotropia and an 8 prism diopter right hypertropia. There were limitations of upgaze, abduction, downgaze and adduction bilaterally. On attempted down gaze, incyclotorsion was elicited bilaterally. Sensation was equal bilaterally to light touch and pain on the face and the corneal reflex was brisk and equal on both sides. Cranial nerve and general neurological examination was otherwise unremarkable. The pupils were 4mm in diameter in room light conditions, reacting equally to light and accommodation. There was no relative afferent pupillary defect, or change in pupil diameter on versions. Colour vision was measured with Isihara’s pseudoisochromatic plates; all plates were identified correctly bilaterally. Humphrey neurological visual field examination was unremarkable. The ocular exam was normal; specifically there was no evidence of optic atrophy or a pigmented retinopathy.
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