Case presentation

Dr.K.Anusha
PG RESIDENT
RUBY EYE HOSPITAL
A male patient of age 39 years came with chief complaint of
drooping of Right upper eyelid , pain in RE, Foreign Body
sensation in Right Eye from 10 days

History of present illness

Patient was apparently normal 10 days back , then he had
injury to his head with unknown material followed by
development of swelling & pain of Right Eye

History of past illness

No similar complaint in the past
No history of Hypertension, DM,TB, Asthma or any infective
lesion in any part of body.
● Nutritional history: Average body built.

● Personal history: alcoholic from 15 years, smoker , tobacco

addiction from 20 years

● Family history: Not significant

● Socioeconomic status: middle class family

● Drug or Allergy history: No drug or allergy history

General examination
Patient is conscious, coherent, cooperative, well
oriented to time, place, person
Systemic examination
No pallor, cyanosis, clubbing,icterus,lymphadenopathy
● All other systems- WNL
● Pulse 76/min, BP_110/80, RBS 96mg/dl
Ocular examination
-Visual acuity- RE :6/24p LE :6/9
-IOP- RE:18 LE : 18
Anterior segment Right Eye Left Eye

Orbit Ptosis of upper eyelid Normal

Eyelids & Adnexa drooping of upper eyelid Normal

Conjuntiva Normal Normal

Cornea Clear Clear

Anterior chamber Quiet,Normal depth Quite, Normal depth

Pupil Dilated ,nonreactive Not visible

Iris Normal Colour, pattern Not visible

Lens Normal Not visible

EOM Limitation of Full,painless

adduction ,elevation,depression
, Normal abduction
Fundus RE LE
Ocular media Clear Clear
Optic disc :
● Size,shape Normal Normal
● Colour Hyperemic Hyperemic
● Margins Normal Clear
Nerve head fibres Normal Normal
Cup 0.3 cupping 0.3 cupping

A:V ratio 2:3 2:3

Vessels Normal Normal

Macula Normal Normal

General fundus WNL Normal

Investigations
● BP
● RBS
● CT scan of brain & Orbit
● Cerebral angiography
Provisional diagnosis
Third nerve palsy involving pupil

Differential diagnosis
● Myasthenia gravis
● Thyroid associated orbitopathy
● Chronic progressive external ophthalmoplegia
● Idiopathic orbital inflammatory disease
Third cranial nerve
● Occulomotor nerve
● Entirely motor
● Supplies all EXTRAOCULAR muscles except
SO & LR
● LPS
● Intraocular muscles - sphincter pupillae &
ciliary muscle
Symptoms
● Drooping of eyelid
● Binocular double vision
● Pain

signs
● Ptosis, abduction of globe
● Intorsion on attempting down gaze
● Limitation of adduction, elevation,depression
● Dilated pupil vth defective accommodation.
Thank you