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JAMA Ophthalmology Clinical Challenge |

Ptosis, Miosis, and Intermittent Esotropia Following Pituitary Adenoma Resection QUIZ

Philip P. Storey, MD, MPH1; Esther Lee Kim, MD1; Vivek Patel, MD1
[+] Author Affiliations
1USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles
JAMA Ophthalmol. 2016;134(8):941-942. doi:10.1001/jamaophthalmol.2016.0787.
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An Asian woman in her 50s presented with ptosis, intermittent esotropia, and adduction deficit. She was presumed to have oculomotor nerve III damage and cranial nerve VI palsy. What would you do next?

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Figure.

A, Right eye esotropia after voluntary leftward gaze. B, Right upper eyelid retraction after downward gaze. C, Magnetic resonance imaging of the brain showing a very small amount of residual tumor (arrowhead) in the right cavernous sinus, creating a slight convexity of the lateral wall.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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Extraocular Movements

After the patient was asked to voluntarily adduct the right eye, the patient noted persistent esotropia, lasting approximately 45 seconds, before spontaneous relaxation of the right medial rectus muscle.

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