A 70-year-old man complains of new onset double vision. Which of the following associated symptoms or signs would be worrying ab
out an underlying neurological problem, as opposed to pathology only in the eye?a) Abnormality in extraocular movements on examination b) Symptoms of flashing lights
c) An associated conjunctivitis
d) Diplopia persisting in the right eye when the left eye is closed
e) Worsening vision bilaterally on examination
Abnormality in extraocular movements on examination
Explanation:
a) Abnormality in extraocular movements on examination
Paralysis or weakness of extraocular muscles suggests a possible brainstem or cerebellar lesion.
Diplopia persisting in the right eye when the left eye is closed is incorrect. Diplopia in one eye while the other eye is closed suggests a problem in the cornea or lens. An associated conjunctivitis is incorrect. Conjunctivitis is an independent problem and generally a minor one. Worsening vision bilaterally on examination is incorrect. Worsening bilateral vision is common among elderly patients.
