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2004 Series -  June 29, 2004 Lecture 27 of 50  NEXT»

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This 68-year-old woman developed a left esotropia and hypotropia beginning four years ago.  She was operated on twice for a diagnosis of VI nerve palsy.  Neither surgery procedure had a noticeable beneficial effect.  At the time of onset of the strabismus, the patient noticed some weight loss and she reported being nervous. 

1. 

The most likely diagnosis is:

 

a.  thyroid myopathy
b.  late onset esotropia
c. 
VI nerve palsy
d.  Gunderson's syndrome

2. 

A useful additional examination would be: 

  a.  CT or MRI of the orbit with serial coronal views
b.  forced ductions
c.  an endocrine work up

d.  all of the above

3. 

Treatment would include:

  a.  eye muscle surgery emphasizing the freeing of restrictions
b.  steroid therapy
c.  antibiotic therapy
d.  none of the above


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