36 y/o man with longstanding strabismus, concerned that left eye "goes off" and he has trouble in social situations.
No prior eye surgery or patching. Specs for myopia.
Va cc 20/20 ou
Rotations: Trace limitation to elevation in adduction OD
R gaze: LHT 8 Primary: LHT 12 L gaze: LHT 15
Double Maddox Rod: No torsion ou
Worth 4 dot: Suppresses left eye distance and near
Displays a left head tilt ~5-10 degrees
Q 3.1 What is your working diagnosis? Are there additional tests that may help confirm your diagnosis?
Q3.2 What is your surgical plan?
42 y/o woman with 2 day history of left-sided numbness (face, arm, torso, leg) and bilateral dysacusis, presents with "right eye turning in."
MRI shows 1.2 cm ring-enhancing lesion of the right pons consistent with tumefactive demyelination.
Remote history of subfoveal CNV OD secondary to ocular histoplasmosis, had submacular surgery with no recurrence.
Va cc: 20/400 OD (central scotoma stable), 20/20 OS
Rotations: Severe limitation to abduction OD
R gaze: ET 45 Primary: ET 25 L gaze: ET 4
Ocular exam: Stable 2+ NS, foveal RPE atrophy; optic nerves pink and flat ou with no RAPD
|Upper photo: Left gaze; Lower photo: Attempted right gaze|
Representative photo from http://bingskee.hubpages.com
Q 4.1 Assuming her alignment is stable in 4-6 mos, what is your surgical plan?