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2004 Series -  September 28, 2004 Lecture 14 of 50  NEXT»

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This 81-year-old woman had bilateral cataract extraction with placement of an intraocular lens and then treatment of a secondary membrane in the left eye.  Both procedures on the left eye were done with local anesthesia.  Immediately after the second procedure on the left eye the patient noted double vision.  She presented as shown two months after the last procedure with a left hypotropia, limited elevation of the left eye, and increased depression in the left eye.  There is also a small left exotropia but normal horizontal versions in the left eye.  The patient has 20/25 vision in each eye in the distance. 

1.  The double vision reported by the patient would most likely be described as the second image being:  

a. sharper than the object of regard
b. to the left and above the object of regard
c. to the right and above the object of regard

none of the above

2.  The most likely cause for the vertical diplopia is:  

a. blepharochalaisis
b. euthyroid thyroid ophthalmopathy
c. right superior oblique palsy fixing with the paretic eye

toxic effect from injection of local anesthetic

3.  Treatment for this condition:
a. should not be undertaken at this age
b. should be carried out with prism
c. can be achieved with a recession of the left inferior rectus

is best done with weakening of the right inferior oblique

For answers to the above, click here:

Lecture 14 of 50 «Previous Lecture   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50    Next»