Binocular horizontal diplopia, worse for distance than near, most pronounced in the direction of the paretic lateral rectus muscle.
(See Figures 10.8.1 and 10.8.2.)
Critical
Deficient lateral movement of an eye with negative forced duction testing (see Appendix 6, FORCED DUCTION TEST AND ACTIVE FORCE GENERATION TEST).
Other
No proptosis.
Adults
More Common
Vasculopathic (e.g., diabetes, hypertension, other atherosclerotic risk factors), trauma, idiopathic.
Less Common
Increased intracranial pressure, cavernous sinus mass (e.g., meningioma, aneurysm, metastasis), MS, sarcoidosis, vasculitis, after myelography or LP, stroke (usually with other neurologic deficits), meningeal inflammation/infection (e.g., Lyme disease, neurosyphilis), and GCA.
Children
Benign and usually self-limited after viral infection or vaccination, trauma, increased intracranial pressure (e.g., obstructive hydrocephalus), pontine glioma, and Gradenigo syndrome (petrositis causing sixth and often seventh cranial nerve involvement, with or without eighth and fifth cranial nerve involvement on the same side; associated with complicated otitis media).
Adults
Children